An Underrecognized Epidemic: Toxic Positivity in Medicine

An Underrecognized Epidemic: Toxic Positivity in Medicine

Joshua Russell, MD, MSc, FCUCM, FACEP A colleague, Dr. Mitchell we’ll call him, told me about a PA that he was supervising recently who made a great catch in a patient with a swollen, blue finger: Achenbach syndrome. When the PA presented the presumptive diagnosis, Dr. Mitchell, unfamiliar with the condition, had to Google it before seeing the patient. Our PA was right, though. The patient walked out of clinic, happy to have a benign …

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Stepping Outside Yourself

Stepping Outside Yourself

Joshua Russell, MD, MSc, FACEP Until recently, I’ve had the rare luxury of working in busy urgent care centers where I was virtually always working side-by-side with another provider. However, with changes in my career and UC staffing models in the wake of the pandemic, I find myself working in single coverage situations the majority of the time nowadays. While I do miss the camaraderie of multi-coverage practice, I miss the unfettered access to a …

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The Last Hour Problem

The Last Hour Problem

It’s 8 pm and I’m 9 hours into a 10-hour shift when four new patients walk in. Even though I’m feeling drained, I smile warmly as each passes my workstation. I “eyeball” them each as they walk by; my grin persists because they all seem stable and my “TUR” for this shift in the emergency department is now only 45 minutes away. TUR (or “time until relief”) is a metric I continuously track with ruthless …

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The Unvaccinated Aren’t the Enemy

The Unvaccinated Aren’t the Enemy

Taylor wore her embroidered sorority sweatshirt and a mask below her nose when she came to see me. She was 19 and had just finished her freshman year at the local university. Her story was cliché, as well: cough, runny nose, and sore throat “that wouldn’t go away.” She’d been sick for 8 days and she’d come in to get antibiotics. This isn’t a story about antibiotic stewardship, though. “Have you been tested or vaccinated …

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ICYMI: A Rational System for Charting Has Finally Arrived

ICYMI: A Rational System for Charting Has Finally Arrived

Remember the fall of last year—when the nation and world pined for an expedient end to 2020, as if such an arbitrary change as turning a page on the calendar could somehow reverse our collective fortune? Unsurprisingly when January 2021 arrived, all our woes were not magically and immediately remedied. In fact, the start of this year was among the most grim in U.S. history: nearly a quarter of a million new cases were being …

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A Crisis of Trust

The conversation was going nowhere. After 15 minutes of explaining my concerns about the possibility of COVID-19, the lack of indication for antibiotics, the unreliability of rapid testing, I was no closer to satisfying my patient, Mrs. Fletcher, than when I first introduced myself. Joan Fletcher was a 40-something working mother of three who came to urgent care on a mission, as many patients do. The reason for her visit: an antibiotic prescription and a …

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Why Don’t You Take A Break?

Why Don’t You Take A Break?

I took up smoking for about 6 months in college, but not for the reasons you’d guess. This was during my freshman year shortly after I got a job waiting tables. It was a hard job. There was always work to be done—refill a drink, check how the food was cooked, and, most importantly, bring the check post-haste when the customers wanted to leave. The shifts always seemed like a blur. I’d run around non-stop …

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Don’t Forget about the Road Behind

Don’t Forget about the Road Behind

If you’re reading this, you’ve survived 2020. Congratulations!—although it probably doesn’t feel like there’s much success to revel in at the moment. Indeed, this has been a year of hardship for everyone in some form and certainly, for many, it still may feel like there’s no end in sight. And it doesn’t seem like much cause for celebration to have dodged a bullet when you’re still staring down the barrel of a loaded gun. However, …

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Opportunity is Knocking. Do you hear it?

Opportunity is Knocking. Do you hear it?

It is not the strongest species that survive, nor the most intelligent, but the most responsive to change. – Charles Darwin Imagine, if you will for a moment, that you’re a dinosaur. Specifically, a late cretaceous era one —any species you like. I tend to envision myself a triceratops. It’s about 66 million years ago (give or take an epoch or two) and animals like you have dominated the world for over 100 million years—not …

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Stories Speak Louder Than Statistics

After the vivid video of the wrongful death of George Floyd went viral in late May, millions of people of all races in America and abroad took to the streets to demonstrate in the name of solidarity and justice. This was all motivated by one man’s story and, more broadly, was a potent remind of the power of story to capture our attention and provoke action. George Floyd was the most recent widely publicized victim …

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