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Easing CME requirements
CORRESPONDENCE Opinions expressed in the Correspondence Section are those of the authors, and not necessarily of the Journal editors, ACEP, or UA/EM.
Easing CME Requirements To the Editor: I wish to add my hearty endorsement to the views expressed by John McDade, MD, in his editorial in the August issue of Annals (9:443, 1980). The spectrum of conditions the emergency center physician is expected to master, or at least diagnose, is far too extensive for ACEP to establish complete programs for all emergency center physicians. ACEP can advise what types of CME theoretically should be valuable, but only the individual physician knows the areas of knowledge he should strengthen to make him a more effective emergency physician. Let us operate under the principle that we are honest professionals striving to improve our skills. Heads of departments or services individually can help their colleagues choose programs most likely to improve their efficiency. We must break the ~straightjacket" of the bureaucratic approach of making everyone conform to a single model.
Gordon W. Hasse, MD Madison, Ohio (Editor's note: The 1980 Council passed a resolution supporting the current CME requirement and urged that the method of granting credit be eased. The Board of Directors subsequently assigned a task force to review the requirement and methods of granting all CME credit. Due to time constraints, the Board also extended the grace period and requested the task force to report back to the Board in December.)
A Note on Emergency Medicine To the Editor: For years I have been chiding my fellow emergency physicians nationwide about the use of the term "the attendings" in reference to other staff physicians. We, sir, are "attendings" in the emergency department, certainly of equal status to all other staff members. I would not go so far as to repeat the toast of my ancestors - - '~Here's tae us, whae's like us? - - Gey few, an' they're a' deid" or, translated, ~Here's to us, who's like us? - - Very few, and they're all dead." I would, however, reiterate on our behalf one Royal Air Force comment: "To have been first is a sign of antiquity; to have become first is a sign of merit." Some years ago, a non-emergency physician made a somewhat derogatory remark about our branch of the profession as "in-house physicians." I could not resist rising to my feet, before the goodly crowd assembled, to say: '~I am sure that we do not mind being called in-house physicians as long as the gentleman
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Ann Emerg Med
does not object to being called an out-house physician." I do not think my remark, and the roar of laughter following, especially endeared me to the gentleman. The pioneers in emergency medicine fought long, hard, and well for the 23rd "piece of turf." Now that we have it, let us see that we defend it by demonstrated ability, impeccable ethics, a high standard of care, and perfect public relations.
Cyril T M. Cameron, MD Troy, New York
Silver Dollar Syndrome To the Editor: A 29-year-old right-handed female physician developed pain and tenderness in the right volar wrist 24 hr after arriving at a medical convention in a wellknown desert resort community. The pain was most marked on attempted lifting or pushing of heavy objects and on volar flexion of the wrist and/or fingers, especially the third finger. There was tenderness over the flexor retinaculum, but full range of motion despite pain, and no evident "swelling, redness, heat, or neurologic symptoms or findings. The discomfort did not respond to heat and aspirin, but improved rapidly with a short course of Ibuprofen (kindly supplied by the exhibitor) as well as abstinence from the use of mechanical gambling devices with which the sufferer had won $50 on the evening of arrival. I propose that this previously undescribed type of exertional tenosynovitis be known as ~Silver Dollar Syndrome," and suggest that future conventioneers take prophylactic measures to avoid similar unnecessary discomfort or temporary disability.
Louise B. Andrew, MD Associate Director, Emergency Medicine Baltimore City Hospitals Baltimore, Maryland
Unusual Intra-Abdominal Bleeding To the Editor: Recently a 22-year-old woman came to the Emergency Department of the University of Arizona Health Sciences Center with an acute abdomen. The surprise findings at laparotomy deserved report. This healthy young college student had been in "good health until the day of admission. That morning she jogged her usual four miles. Shortly thereafter, at breakfast, she noted abdominal discomfort and pain in the left shoulder. There was neither history of trauma nor gastrointestinal or urinary tract symptoms. She was gravida two, para two and had normal menses. Her menstrual period had begun four days prior to this event and was
9:12 (December) 1980
Easing CME Requirements To the Editor: I wish to add my hearty endorsement to the views expressed by John McDade, MD, in his editorial in the August issue of Annals (9:443, 1980). The spectrum of conditions the emergency center physician is expected to master, or at least diagnose, is far too extensive for ACEP to establish complete programs for all emergency center physicians. ACEP can advise what types of CME theoretically should be valuable, but only the individual physician knows the areas of knowledge he should strengthen to make him a more effective emergency physician. Let us operate under the principle that we are honest professionals striving to improve our skills. Heads of departments or services individually can help their colleagues choose programs most likely to improve their efficiency. We must break the ~straightjacket" of the bureaucratic approach of making everyone conform to a single model.
Gordon W. Hasse, MD Madison, Ohio (Editor's note: The 1980 Council passed a resolution supporting the current CME requirement and urged that the method of granting credit be eased. The Board of Directors subsequently assigned a task force to review the requirement and methods of granting all CME credit. Due to time constraints, the Board also extended the grace period and requested the task force to report back to the Board in December.)
A Note on Emergency Medicine To the Editor: For years I have been chiding my fellow emergency physicians nationwide about the use of the term "the attendings" in reference to other staff physicians. We, sir, are "attendings" in the emergency department, certainly of equal status to all other staff members. I would not go so far as to repeat the toast of my ancestors - - '~Here's tae us, whae's like us? - - Gey few, an' they're a' deid" or, translated, ~Here's to us, who's like us? - - Very few, and they're all dead." I would, however, reiterate on our behalf one Royal Air Force comment: "To have been first is a sign of antiquity; to have become first is a sign of merit." Some years ago, a non-emergency physician made a somewhat derogatory remark about our branch of the profession as "in-house physicians." I could not resist rising to my feet, before the goodly crowd assembled, to say: '~I am sure that we do not mind being called in-house physicians as long as the gentleman
74/647
Ann Emerg Med
does not object to being called an out-house physician." I do not think my remark, and the roar of laughter following, especially endeared me to the gentleman. The pioneers in emergency medicine fought long, hard, and well for the 23rd "piece of turf." Now that we have it, let us see that we defend it by demonstrated ability, impeccable ethics, a high standard of care, and perfect public relations.
Cyril T M. Cameron, MD Troy, New York
Silver Dollar Syndrome To the Editor: A 29-year-old right-handed female physician developed pain and tenderness in the right volar wrist 24 hr after arriving at a medical convention in a wellknown desert resort community. The pain was most marked on attempted lifting or pushing of heavy objects and on volar flexion of the wrist and/or fingers, especially the third finger. There was tenderness over the flexor retinaculum, but full range of motion despite pain, and no evident "swelling, redness, heat, or neurologic symptoms or findings. The discomfort did not respond to heat and aspirin, but improved rapidly with a short course of Ibuprofen (kindly supplied by the exhibitor) as well as abstinence from the use of mechanical gambling devices with which the sufferer had won $50 on the evening of arrival. I propose that this previously undescribed type of exertional tenosynovitis be known as ~Silver Dollar Syndrome," and suggest that future conventioneers take prophylactic measures to avoid similar unnecessary discomfort or temporary disability.
Louise B. Andrew, MD Associate Director, Emergency Medicine Baltimore City Hospitals Baltimore, Maryland
Unusual Intra-Abdominal Bleeding To the Editor: Recently a 22-year-old woman came to the Emergency Department of the University of Arizona Health Sciences Center with an acute abdomen. The surprise findings at laparotomy deserved report. This healthy young college student had been in "good health until the day of admission. That morning she jogged her usual four miles. Shortly thereafter, at breakfast, she noted abdominal discomfort and pain in the left shoulder. There was neither history of trauma nor gastrointestinal or urinary tract symptoms. She was gravida two, para two and had normal menses. Her menstrual period had begun four days prior to this event and was
9:12 (December) 1980