I’m going to take a break – probably for the rest of the week. Grandma WhiteCoat is having unexpected surgery and needs our family support. I have several ideas that I just have to expand upon, so I may toss up a short post, but don’t expect much. If you want to do a guest post – now would be a good time. Just send your post to

While I’m gone, I would appreciate some feedback about a few things, though.

Is the new blog interface better or worse than the previous one? I like a minimalist approach and would like to know what you all think. Anything you would add or delete?

Also, just looking for what people like/don’t like in content on the blog. I admit things have gotten a little political lately, but only because of the events dominating the news now. Don’t think that describing whether my lawn has dandelions yet would be very interesting for anyone.

What should we have more or less of? News commentary? Patient stories? Medical studies/commentary? Case presentations? Contests? Is the Healthcare Update a good or bad thing? Rather see individual posts for the links in the Update or all grouped together in a weekly post as we have it now? Are there other things relating to emergency medicine that you think I should be including that I’m not? Product reviews? Are the star ratings a good or bad thing? Do they dissuade people from making comments?

It would help me make this blog better if you could give me an idea of what I’m doing right and what I could improve upon.

One last thing –
One of the things that keeps me motivated to write is the discussion that is generated. The topics presented are controversial and I don’t expect everyone to agree with me or to agree with anyone else who comments. I want this blog to be a forum where we can air our views.
Over the past several weeks, I have noticed that people have become upset and have made personal attacks toward others. We have to stay civil. I have no problem with others attacking someone’s ideas. Just don’t make the attacks personal. “That idea is ridiculous, here’s why …” is fine because it leads to further discussion about the views. “You’re a [insert pejorative term here]” or “That’s why I hate [insert class/ethnic background/political party/profession here]” aren’t OK because all they do is start flame wars. You are an intelligent and insightful bunch. Please keep things civil.

Happy Easter to everyone if I’m not back by then. Enjoy time with your family.

P.S. I took the picture above at a pier in San Francisco. Afterwards, I sat down and talked to the fisherman for a while. Interesting guy.


  1. Good luck to Grandma WC.

    Were you visiting S.F? I’m in Central Valley of CA at the “other” wine country (NOT Napa valley!)

  2. I love to hear war stories (which is why I love ER Stories). I’m a medical student so case presentations would be of interest to me as well.

    I like the current format of the healthcare/policy/politics coverage. An update post is nice to browse through and pick out what interests me.

  3. I like the content of your posts, there’s a good mix of everything. It’s good to hear the honest opinions of someone working in the field, whether everyone agrees with them or not. Keep it up!

    • WC, if you want an echo chamber as many of the commenters seem to, all you have to do is ask. I’ll gladly not give my $.02.

      • actually I don’t mind you, Matt. I finally figured it out. You’re just defending our constitutional right to have our transgressions addressed in a court of law…like the defense lawyer who defends a serial killer not because he likes the guy but that is his constitutional right.
        Having said that, I sympathize with docs who have to defend themselves against wild and outlandish lawsuits.
        Medicine may be a science but the human body does not follow rigid rules like a bridge does.
        Maybe there should be two kinds of insurance..malpractice for the egregious (sp?) cases of incompetence and reckless disregard and a policy called sh*t happens…which it does with the most careful and competent physicians.

      • I wouldn’t compare victims of malpractice with serial killers, but ok.

        I don’t know that it matters what type of insurance you have – the costs to the victim are still the same.

      • I was just trying to walk a mile in your shoes Matt. The serial killer comment was just that everybody has a constitutional right to due process. I would call patients victims only if they suffered adverse consequences due to true malpractice. I don’t know how you adequately compensate patients who have an adverse outcome that is not in anyway anybody’s fault and not drag everybody and their brother through legal muck. My home insurance doesn’t cover certain things..they say that’s an “act of god”. No such luck with the docs.

      • Docs only think they’re God. An “act of god” means weather related events. A physician’s actions haven’t reached that level of sacredness, despite their best legislative efforts, just yet.

        As to not having to go through the process of dispute resolution – how would you propose we resolve disputes? Remember, you have to let both sides have access to all evidence, and to put their evidence before someone who is hearing the case. Presumably neutral.

        The other reason your serial killer/malpractice victim comparison doesn’t work is that you’re mixing criminal/civil law. The serial killer is guaranteed a defense by the Constitution. The victim isn’t guaranteed an attorney to pursue their claim.

      • I thought she explained very well wwhat she thought. ‘S*it happens’ policies would cover the bad, devastating outcome scenario that currently is not covered. This is where some bad thing happens to you and it’s not the doctor’s fault. In my malpractice case, I felt really bad for the widow. It really sucked that her husband died in his 40s. It doesn’t change the fact that I did everything right(and in my case, I never saw a deposition saying otherwise). That I didn’t do anything wrong doesn’t change that her family lost its wage earner and loved one. I wouldn’t mind her getting some money. I just didn’t appreciate it being at the expense of my name since I didn’t do anything wrong.

  4. Good luck with your grandmother, hope she is well.

    I must admit, I’m more of a sideline gazer. I really enjoy the war stories, as they amuse me and further cement my choice of not becoming a physician. But I also enjoy your commentary on the latest health care reform and other issues associated with being a provider. I’m a doctoral student focused on public health research and policy and as a consequence, I’m insulated from the very providers that health care policy impacts and that we research. It’s ironic and sad.

  5. More patient stories that cause my jaw to drop. HealthCare update is fine the way it is. Also, you need to have another lawsuit to write about. Finally, if the guy in the photo is so interesting, tell us about your conversation with him.

    Best wishes to you, your family and your grandmother.

    • He was an old merchant marine and had to live in a nursing home because of a drinking problem. I don’t remember the whole conversation because the picture was taken 5-6 years ago, but I just remember sitting on the bench after we spoke wondering what he was thinking as he looked out over the Bay.

  6. I like the new look. The old one was pretty generic.

    And frankly I’m pretty tired of political rhetoric. I check your blog frequently, but if it’s another political rant, I skip reading it.

  7. New follower here.

    I’m with Steve Parker — more war stories, not only of memorable patients and their families, but also your encounters with other health care personnel, administrators, and the general public.

    Health Care updates work well as formatted. Individual entries would be overkill.

    Less on health care politics. There are multiple other sources for this info. Blog reading got to be very boring recently with everyone writing about the reforms — it became a case of redundancy, repeated.

    Best wishes for Grandma WC. She and your family are in my thoughts.

  8. Good luck to Grandma Whitecoat.

    Love the blog the way it is, more patient stories and case presentations would be good though.

    As someone that is not an American I really enjoy reading your Health Care Updates to get an insight into a different culture. For the same reason I find the political stuff interesting too.

  9. Personally don’t like the healthcare updates. The first rule of debate is you’ll rarely change anyone’s opinions…which to me translates to why bother debating in the first place?

    I love patient stories and case presentations, even though I’m an elec. engineer. It’s great to get a taste of what I would have been doing if I didn’t do this.

    Get rid of the stars. They don’t prevent people from commenting stupid stuff and just hurt people who make unpopular, but not stupid comments.

  10. My best wishes go to Grandma WhiteCoat!

    I like the case studies and ‘war stories’ the best. I realize that the blog has gotten more political lately, but why would you avoid talking about something that would have a huge effect on everyone in this country, professionals and patients alike?

  11. I like the case studies and anecdotes of real events. I do like to read about how current and proposed health care policies will affect your specialty. The really big picture and the national debate, not so much.

    I like to hear about how on the rare instances I’m an ER visitor I can improve my experience and be a better patient/family member.

    I also appreciate the rational debate that occurs. Any thing personal, I skim over.

    Also, I love that you respond to your readers’ comments. Your continued involvement in your posts makes them much more engaging.

    Loved the multi-part story about the lawsuit.

    • I agree with the author’s conclusion(read this a while ago). However ED abuse represents low-lying fruit as well as highlighting the lack of primary care. Many of the patients I see are ones who could not see their PCP’s – hence representative of the lack of access that is a big part of the health care problem.

      The real cost of health care is end of life care. This is a very divisive issue – as limiting the cost means that rationing must be initiated.

  12. I hope your mom and all of you are doing well. Good thoughts and prayers are being sent your way WC your Mom and all of you. 🙂


    You need a soundtrack for ocean waves
    and sea gulls! 😉

    I like the new look to the blog. You have a nice balance with what you write and I think you have a great blog.

    I usually forget to vote with stars. When I do remember it’s fun ..but I usually forget. I guess because I am so used to seeing them ..they just blend in. I think the stars would stand out better if they were covered with a bit of turquoise glitter. I’m just sayin. 😉

    Happy Easter to you and your family! 🙂

  13. I like the new format. Minimalist is good.

    Although the health care debate can be interesting, I tend to get bored with the polarized arguments. Has anyone changed their opinion after reading another post or comment? I doubt it, but there may be some open-minded soul out there.

    I’m a big fan of your patient stories and case presentations. Those are the type of posts that keep me reading. Of course, nothing tops your lawsuit series.

  14. One more thing: ERP, if you are reading, I’m afraid to go back to your blog. My computer took a big hit after going there last night (almost happened before, but I somehow escaped it). I didn’t click on any ads, but I was hit with the “Vista Internet Security unregistered version” pop-ups that claim to have found adware, spyware, scaryware. I had to put the computer into firewall lockdown & let McAfee do its thing.

    • I likewise no longer go to ERP’s site since I liked most of his stuff. But I got a bad virus once, and warnings about viruses everytime.

  15. I like it all. And the easier to navigate the better.

    It does kinda suck when you feel the need to spew back, in some cases, I cannot see that as avoidable, but I do try not to get out of hand if I must go there.

    The problem IMO, with Matt is that he does not appear to hear what we say and would rather chest puff and beat the experiences of doctors, nurses or others into the ground because he’s convinced he is right, no margins for the rest of us who live it.

    The truth will come out in the end on this health care issue. And my truth is that we will have rationed care, decreased quality and access. It is already apparent to me. I might have to pay for this “BMW” plan for the rest of my productive life, but in the end, I’ll be driving a Yugo.

    • I’m not sure why you reached that conclusion. I hear what you say very well and am not discounting your position. I just don’t agree that making it harder on injured patients is the solution to the problems you claim. That is the fundamental difference in our positions.

      I actually wish you had more freedom as a professional. And it saddens me that the insurance and tobacco industry funded tort reform movement has created such distance between professions that have so much in common.

  16. Patient encounters and case studies are my favorites. I like the “what’s your diagnosis?” posts. They remind me of a similar series in JAVMA. Your patients are of a different species so I don’t presume to contribute but it is fascinating.

  17. Grandma WhiteCoat (my mom) is doing better. Unfortunately ended up needing a temporary colostomy, so she’s having a little difficulty adjusting to that, but at least she’s recovering.
    Thanks for all the good wishes.
    I decided to yank the star ratings. Votes against were many and votes for were none. The “nays” have it.
    Believe it or not, I’m working on the trial series #2. Involved in another lawsuit now. Just can’t publish it until the case is over … which will likely be another few years based upon the average time it takes lawsuits to go through to trial … if it gets that far. This one will likely be different because everyone that reviewed it has said it is frivolous. Then I’ll write about the legal and professional actions I take against the patient, the plaintiff attorney, and the expert witness.

  18. I’m very glad to hear she is recovering WC.

    I’m sorry about the lawsuit and maybe they will drop it before it goes that far.

    Perhaps you should consider doing a book ..a fiction based on reality book that will be an eye opener to the general public. You kept us riveted with your lawsuit series/characters and your personal feelings and so now ..just expound on it.

    I missed commenting on the pic and I do like it. i especially like B&W photography, arty and captures moods better.

  19. I’m glad she’s doing ok. Elderly women are as tough as pine knots.

    Sorry about another lawsuit and all the emotional turmoil that entails. It sounds like you’ve been through a lot lately.

  20. I absolutely like the new background and layout. I also think you should write more ER stories you encounter at your work. I get a good laugh out of them! What else is the point of working at an ER?

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