Ask Me Anything – Kevin Klauer, DO, EJD, FACEP

We’re excited to announce our next AMA: Kevin Klauer will be with us TODAY: Tuesday, September 2nd, from 2-4pm CST.

Some background on Dr. Klauer from his bio page on emp.com:

  • Chief Medical Officer of Emergency Medicine Physicians, one of the leading providers of emergency medical services in the nation
  • Has received the ACEP National Faculty Teaching Award and the EMRA Robert J. Dougherty Teaching Fellowship Award
  • He is the ACEP Council Vice Speaker and serves as Medical Editor-in-Chief for ACEP Now
  • Co-author of two risk management books: Emergency Medicine Bouncebacks: Medical and Legal and Risk Management and the Emergency Department: Executive Leadership for Protecting Patients and Hospitals

Hope you can join us!

Ask Me Anything with Kevin Klauer (09/02/2014)
1:44
Adaira Landry:

Welcome everybody to this Ask Me Anything with Kevin Klauer, DO EJD (@Emergidoc)! We’ll get started in just a few minutes – feel free to start typing in questions anytime. 🙂

Tuesday September 2, 2014 1:44 Adaira Landry
1:55
Kevin Klauer:

Hello everybody! Ready to go and excited to answer any questions you may have for me!

Tuesday September 2, 2014 1:55 Kevin Klauer
1:57
[Comment From Alex KoyfmanAlex Koyfman: ]

Can you talk a bit about how you were able to diversify your career in EM? Why did you choose this path?

Tuesday September 2, 2014 1:57 Alex Koyfman
Kevin Klauer:

Alex, Great question. I’ll now expound on this question for the next two hours!

  Kevin Klauer
2:00
Kevin Klauer:

OK. Here we go. I began my career with many interests, particularly in EM, as I was a paramedic and firefighter. I enjoyed teaching as well. So, the areas of interest I had were easy to pursue. Never pursue something that doesn’t make you happy or at least gets you to something that fulfills you and makes you happy.

In an interview, I never ask, “Where to you see yourself in 10 years?” Who cares. I would rather know where you were and how you got to where you are. This tells me what decisions you have made and the path that you are on.

Tuesday September 2, 2014 2:00 Kevin Klauer
2:06
[Comment From Alex KoyfmanAlex Koyfman: ]

What are 3 myths in EM that you hope would go away?

Tuesday September 2, 2014 2:06 Alex Koyfman
Kevin Klauer:

Wait just a minute!!! A new source of insomnia for me is the acute reduction of blood pressure in ischemic stroke to facilitate administering tPA. tPA is controversial, maybe beneficial, certainly harmful to some. However, lowering MAP decreases CPP and thus puts acute cerebral watershed areas at risk. Hypertension in ischemic stroke is cerebroprotective. There is no cause and effect between acute hypertension and ischemic stroke. BAM!!!!

  Kevin Klauer
2:07
[Comment From Alex KoyfmanAlex Koyfman: ]

What are the things about the field of EM that have changed over the course of your practice?

Tuesday September 2, 2014 2:07 Alex Koyfman
Kevin Klauer:

OK. Alex Back to you my friend.

1. Explosion of technology good and bad
2. Regulatory aspects of care delivery have become insanely complex.
3. My hair is a lot longer!

  Kevin Klauer
2:13
[Comment From JohnGreenwoodMDJohnGreenwoodMD: ]

Thanks for putting this together Adaira, Alex. Dr. Klauer, in your opinion as an expert in risk management what are some of the risk mgt pitfalls EM docs find themselves making when taking care of critically ill patients or ICU boarders?

Tuesday September 2, 2014 2:13 JohnGreenwoodMD
Kevin Klauer:

John, really hard to narrow this down. Let’s hit some risk management (RM) basics. Three primary areas of litigation or cause of action against EPs are: Failure to Dx, Delay of definitive care and Errors in procedures.

So, in critically ill patients, we need to stabilize efficiently and safely, while being mindful of when the ED has served its purpose.

1. Talk to patients and families about their clinical condition. Let them know the risks of procedures and the potential bad outcome they may experience from their disease. I’m amazed that we don’t tell septic patients (and obtain informed consent) about the risk of pressors. We may need them to improve your blood pressure (not so sure about outcomes, another myth is surfacing), but when we do, you will likely lose a digit or extremity due to peripheral vasoconstriction. Yet, we are surprised that they sue when they experience these outcomes.
2. Consult when needed.
3. Do not exceed your capabilties

  Kevin Klauer
Adaira Landry:

Thanks John, but really Baker Hamilton is the brain behind running this. I’m just filling in today:)

  Adaira Landry
2:16
[Comment From CoryCory: ]

Hello Kevin! I am applying for faculty jobs right now and preparing for interviews. How do you like to answer the question “what are your biggest weaknesses/strengths?”

Tuesday September 2, 2014 2:16 Cory
Kevin Klauer:

Cory,

Knock it out of the park my brother!!
Every interview question is an opportunity to tell them something vital about you. Sure, answer the question directly, but make certain you illustrate why you are “the one.” Highlight the strengths, then a weakenss, but show it as a strength by how you have or are growing in that area. You have the power of choice. If your weakness is poor impulse control and you frequently run naked through the ED, leave that one out!

  Kevin Klauer
2:17
[Comment From Alex KoyfmanAlex Koyfman: ]

What are your go-to sources / ways of keeping up-to-date in clinical EM?

Tuesday September 2, 2014 2:17 Alex Koyfman
Kevin Klauer:

Emergency Medical Abstracts are a favorite. I try to perform regular pubmed searches and it is key to search places beyond your comfort level. It is always fun and gratifying to share information that others haven’t identified yet.

  Kevin Klauer
2:20
[Comment From GuestGuest: ]

How do you recommend signing someone out Against Medical Advice? Is it worth it to spend 30 minutes printing the consent form? Or can I just document the conversation that I had with the patient?

Tuesday September 2, 2014 2:20 Guest
Kevin Klauer:

“Guest,” another great question. Refusal forms aren’t worth the paper they are printed on if the informed discussion for the informed refusal is absent. Talking to the patient and getting the informed refusal is more important than a signature on a form. So, if I had to choose, I’d much rather you discuss in the EMR that the pt had the capacity for medical decision making (C,A and Ox4) and understands the risks and benefits of all treatment options and of their refusal (specifically what the risks are). Standard refusal forms have a signature and what they are refusing, but in no way indicates that they understand what could happen due to their refusal. ALWAYS INCLUDE THAT THEY CAN COME BACK ANYTIME

  Kevin Klauer
2:23
[Comment From GuestGuest: ]

f/u question…how can we encourage physicians to be more vocal about errors they made versus feeling only ashamed. With less shame there might be more room for sharing experiences/teaching others.

Tuesday September 2, 2014 2:23 Guest
Kevin Klauer:

This must start during medical school and residency. Crazy that we expect people to disclose freely, but are taught in a punitive environment.
Step 1. Understand that most errors are multifactorial
Step 2. Most errors are blamed on the last provider to touch the patient, very rarely is that the case.
Step 3. If we freely disclose and do not blame, the world becomes a safer place.

Looking forward to the day when we are rewarded and incentivized for reporting our events that didn’t go according to plan

  Kevin Klauer
2:23
[Comment From JohnGreenwoodMDJohnGreenwoodMD: ]

Great points, thanks. Getting to your previous points – I just typed “Epic Men’s Hairstyle” into Google and your photo came up first. Well done.

Tuesday September 2, 2014 2:23 JohnGreenwoodMD
Kevin Klauer:

Wow.. I will have to google that one. New term for me
I have been enriched by you 🙂

  Kevin Klauer
2:25
[Comment From Alex KoyfmanAlex Koyfman: ]

Can you recommend a few resources for leadership development pertinent to EM?

Tuesday September 2, 2014 2:25 Alex Koyfman
Kevin Klauer:

Hmmmm. I don’t want to sound self promoting at all, but you know what you are close to. I think the ACEP ED Directors Academy is great! Harvard Business Review has great leadership articles also. Personal experience is key. Get involved. If you are already, then get involved in new ways, pushing your comfort zone

  Kevin Klauer
2:26
[Comment From GuestGuest: ]

How do you avoid inflammatory documentation? For instance, if I page a consult 10 times, and they don’t reply. Can I document, “Paged consult resident 10 times, still no reply. Will now page Attending on call” OR “Consult resident refuses to see this patient.”

Tuesday September 2, 2014 2:26 Guest
Kevin Klauer:

Just stick to the facts. They cannot be refuted. No emotion or frustration in the medical record.

  Kevin Klauer
2:29
[Comment From Alex KoyfmanAlex Koyfman: ]

What are parts of your job that you didn’t enjoy at first, but now embrace?

Tuesday September 2, 2014 2:29 Alex Koyfman
Kevin Klauer:

Conflict resolution. I wanted everyone to be happy. Well, somedays, everybody isn’t happy. So, I knew if difficult conversations needed to occur, I tried to develop the skill to do this effectively, but not kindly. Effect does not = mean or insensitive

  Kevin Klauer
2:30
[Comment From GuestGuest: ]

How do you deal with mild/moderate/severe unprofessional behavior from someone senior to you?

Tuesday September 2, 2014 2:30 Guest
Kevin Klauer:

RUN!
Actually, it depends on the reporting relationships and your position, as well as your relationship with them. If you can go to them, then one on one is best. If you both report to the same person, let that person know that the behavior is interfering with your ability to do your job.

  Kevin Klauer
2:32
[Comment From GuestGuest: ]

How do you teach documentation to residents at your institution?

Tuesday September 2, 2014 2:32 Guest
Kevin Klauer:

This is a frequently overlooked, but important educational component of one’s training. Many heavily academic sites are great at training academicians. However, most will take community, non academic ED positions. Teaching needs to include the why, how, regulatory requirements and the practical application of how to get it done in the real world

  Kevin Klauer
2:36
[Comment From Alex KoyfmanAlex Koyfman: ]

What are the 3 most challenging cases you encounter in the ED?

Tuesday September 2, 2014 2:36 Alex Koyfman
Kevin Klauer:

Used to be elderly delirium, but now the eval has become fairly routine. It was unsettling to not be able to get a history. When you accept it and go with what you can get, no more frustration.
Now, it is end of life. I tend to be pushing the envelope, I believe on behalf of my pts. If they will not survive or will have false hope, etc. I am frequently amending advanced directives to meet their needs and withdrawing care in the ED. Those not used to this, wonder why we aren’t “doing all that we can.” We should do the “best that we can” which sometimes means intentionally not doing all that
we can.

  Kevin Klauer
2:39
Adaira Landry:

Question from Twitter world: “what are some tricks of the trade for being promoted?”

Tuesday September 2, 2014 2:39 Adaira Landry
Kevin Klauer:

Some have said that 90% of life is showing up…..
Not exactly true, but pretty close. Be someone that others can rely upon. Never enter a conversation with a complaint or concern without twice as much to say about solutions. Think of others first. Selflessness shows you are always trying to the right things. Be that person, and you will find yourself in a great place in 10 years, despite the fact that expected destination was likely much different.

  Kevin Klauer
2:40
Kevin Klauer:

I’m drinking diet mountain dew and type really, really fast…. So, keep the questions coming

Tuesday September 2, 2014 2:40 Kevin Klauer
2:42
Adaira Landry:

How have you prevented yourself from burnout?

Tuesday September 2, 2014 2:42 Adaira Landry
Kevin Klauer:

Adaira, you make the assumption that I have…

Fortunately, you’re correct. Find out what fulfills you and seek opportunities that meet those goals. Even so, you need time to recharge. Please manage your personal relationships. They are precious and can bend but will break. There is no fulfillment living a life of solitude (just my opinion)

  Kevin Klauer
2:44
[Comment From Alex KoyfmanAlex Koyfman: ]

How do you strike a balance b/t work and family and still accomplish all you do?

Tuesday September 2, 2014 2:44 Alex Koyfman
Kevin Klauer:

If you ask me, I’d say I’m a master at knowing the limits. But, opinions do vary. I have
been married for 22 years. My wife has her frustrations with me and what I like to do professionally. However, she and my 3 kids have no doubt I love them and they are #1. Words and actions. Either alone is not good enough

  Kevin Klauer
2:47
[Comment From GuestGuest: ]

Related to your earlier comment about how we currently train academic EPs in residency, should we focus more on training EPs to have great community skills? How can we accomplish that?

Tuesday September 2, 2014 2:47 Guest
Kevin Klauer:

Here is a crazy thought. Why don’t we assess on the front end what people want? Certainly, there are basics that everyone needs to know about, clinically and administratively. However, if we know a career path early on, we should tailor the educational experience to the needs of the learner. One size does not fit all in EM education!!!

  Kevin Klauer
2:50
Baker Hamilton:

i recently graduated from residency & have some job interviews coming up. what are the important but not obvious questions i should be asking??

Tuesday September 2, 2014 2:50 Baker Hamilton
Kevin Klauer:

Loaded question!
Every action you take in the initial phase should be geared toward getting the interview. Of course, be honest, etc. However, if you are being interviewed, they are ready to hire you (or they are foolish for spending the time, energy and money on the process with you). At the interview, it is very reasonable and important to ask important questions to make certain you and your family or S.O. are going to be happy. You should ask respectfully, but they should expect important questions from you. If I am interviewing you and everything is superficial, I would suspect a lack of interest or engagement issues down the road if you are interested.

  Kevin Klauer
2:52
[Comment From Alex KoyfmanAlex Koyfman: ]

Who are several folks in EM who have influenced you greatly?

Tuesday September 2, 2014 2:52 Alex Koyfman
Kevin Klauer:

There have been mostly good influences. I’ll stick to those.
The most wonderful man and friend I have ever met in EM who has influenced me personally and professionally is my friend Rick Bukata. A rare combination of selflessness, intellect and kindness

 

  Kevin Klauer
2:54
Adaira Landry:

For female EPs who are pursing academic jobs, do you have any advice (from a male’s perspective) on how we can advance our careers in a predominately male dominated environment? What strategies have you seen worked? What have you seen fail?

Tuesday September 2, 2014 2:54 Adaira Landry
Kevin Klauer:

In today’s environment, gender should not matter, but we have all seen it may. I would say, differentiate yourself from others, but avoid the temptation to overcompensate for this cultural enigma that has no bearing on your abilities.

  Kevin Klauer
2:57
[Comment From JohnGreenwoodMDJohnGreenwoodMD: ]

Who are several folks outside of EM who have influenced you greatly?

Tuesday September 2, 2014 2:57 JohnGreenwoodMD
Kevin Klauer:

1. My father: The youngest pilot ever hired by Delta airlines at 21 y/o and the youngest 4 engine captain for Delta. He’s 73 now and retired. Great communicator.
2. Mother: Always able to see what others could not in individuals, including me.
3. Wow, I’m getting weepy now. next question please 🙂

  Kevin Klauer
2:59
[Comment From CoryCory: ]

What is the most memorable experience you’ve ever had with a patient thus far?

Tuesday September 2, 2014 2:59 Cory
Kevin Klauer:

It’s interesting how we have the wonderful opportunity to look into another person’s life at a time of great vulnerability, but to later let the memories fade.

One case I recall is a guy with traumatic aortic injury and LeForte 3 who needed an awake cric. Survived and I saw him about a year later in the same ED for a minor illness.

  Kevin Klauer
3:03
[Comment From CoryCory: ]

….Any notable bad outcomes worth sharing with the group (for teaching purposes)?

Tuesday September 2, 2014 3:03 Cory
Kevin Klauer:

Cory, Let me think…I recall a pediatric resuscitation in a newborn. Perhaps, the outcome was predetermined. I believe the resuscitation was carried out appropriately. However, it helped me to understand that the family is equally important as the patient. I am a fan of family witnessed resuscitation and involving them at the bedside if they want to be.

  Kevin Klauer
3:06
[Comment From Alex KoyfmanAlex Koyfman: ]

Have you ever thought about transitioning into an academic environment fully?

Tuesday September 2, 2014 3:06 Alex Koyfman
Kevin Klauer:

Alex,

My career began in formal academics and have continued to teach as I have pursued other opportunities. I could easily see myself in a formal academic setting in the future.

  Kevin Klauer
3:09
[Comment From Alex KoyfmanAlex Koyfman: ]

I know you don’t like looking ahead, but I’ll ask anyway… what pieces of EM do you hope to shape in the future?

Tuesday September 2, 2014 3:09 Alex Koyfman
Kevin Klauer:

Dude! I love looking ahead. I just don’t always like what I see. We need to expand the scope of EM to be what others cannot and are not willing to be. We are the home for the homeless, the arbiters of end of life decisions at the right time, the interface for those with chronic conditions, etc. Now, we just need the resources to meet the demand. The patients have selected us. The federal and state governments need to recognize and respect that choice!

  Kevin Klauer
3:11
[Comment From Alex KoyfmanAlex Koyfman: ]

How do you motivate learners to be curious about the pts in front of them on a regular basis?

< span class=”bottomdate”>Tuesday September 2, 2014 3:11 Alex Koyfman
Kevin Klauer:

Show them something new. Also, show them the impact they can have just by their interactions. Medicine is not about expensive tests and journal articles. It is about the art of communication and understanding fears and needs of our patients, while motivating them to help themselves.

  Kevin Klauer
3:12
[Comment From Matt DMatt D: ]

How do you deal with a lazy nurse?

Tuesday September 2, 2014 3:12 Matt D
Kevin Klauer:

CAUTION. If any nurse feels you are unsympathetic to nurses, that can tank your reputation. If there are performance issues, use the established chain of command (e.g. ED Medical Director, ED Nurse Manager). Bring examples, not complaints

  Kevin Klauer
3:19
[Comment From AnonymousAnonymous: ]

I’m a medical student thinking about doing medical malpractice…would you recommend defending doctors or patients?

Tuesday September 2, 2014 3:19 Anonymous
Kevin Klauer:

Insightful question. I would advise not doing (committing) medical malpractice. It’s messy and not a lot of fun. Just kidding of course.

This really depends on what you are after in life and what motivates you. I have to be honest here.
1. The plaintiff’s side is where the big money is.
2. However, defending your colleagues in a system that is fraught with challenges that they are often not trained or equipped to deal with, is a wonderful pursuit.
3. If you become a plaintiff’s attorney, try to make certain you are doing the right thing, as you will know the medicine and cannot claim you don’t

  Kevin Klauer
3:24
Adaira Landry:

Question from my co-resident: How do you tell a co-worker they made a mistake somewhere along their clinical care? When do you decide which errors are worth reporting to higher ups?

Tuesday September 2, 2014 3:24 Adaira Landry
Kevin Klauer:

First, we have to define error vs. practice style. I may do things differently than you, but both approaches may be appropriate. Those, I would let go. Second, determine the appropriate authority or person to deliver that news. Often times, this is a physician in a supervisory role. Provide them with the intel and let them do your job. When you take this on, it can be misunderstood and competitiveness. You can end up with a target on your back.

  Kevin Klauer
3:27
Adaira Landry:

Question from Twitter world: how do you balance being involved while overseeing residents and micromanaging? what are some signs of micromanaging?

Tuesday September 2, 2014 3:27 Adaira Landry
Kevin Klauer:

The balance between autonomy and educational intervention is a critical skill for any educator to master. Gradually letting go is important, while seizing the opportunity to impart knowledge that is novel to the learner. With new learners, much of what you know will be novel. So, you will be more involved. Training an EP and graduating them is one thing. Preparing them for autonomous practice is quite another

  Kevin Klauer
3:29

How long does the average lawsuit take to conclude?
2 days

 ( 0% )

3 years

 ( 0% )

2 years

 ( 33% )

4 years

 ( 67% )

 

Tuesday September 2, 2014 3:29 
3:31
Kevin Klauer:

Because I have EM induced ADHD, I ended the poll. The average is 48 months. Even if you have an 80-90% shot at a defense verdict, who wants to spend that kind of time dealing with the pain?

Tuesday September 2, 2014 3:31 Kevin Klauer
3:32
[Comment From Alex KoyfmanAlex Koyfman: ]

How do you see our field changing and how do we adapt to these changes?

Tuesday September 2, 2014 3:32 Alex Koyfman
Kevin Klauer:

Alex, I’ll reflect on my previous thoughts and comments, regarding out
expanded scope of practice. If we expect to see traumas and MIs only, we are in the wrong business.

  Kevin Klauer
3:34

How much money has to be paid out on your behalf (from a claim or lawsuit) for it to be reported to the national practitioners databank?
$10,000

 ( 33% )

5 cents

 ( 33% )

$100,000

 ( 0% )

50% of your monthly paycheck

 ( 0% )

The price of a small boat

 ( 0% )

$1000

 ( 33% )

 

Tuesday September 2, 2014 3:34 
3:38
Kevin Klauer:

I’m surprised that so many got it right. 5 cents is the closest. Most people seem to think the number is around $10K. Not all of you. You’re way too smart. Any amount paid on your behalf for indemnity to the patient (requirement = claim must be filed) requires a report to the databank. Not to worry. If it is really low, everyone knows it was a nuisance claim.

Tuesday September 2, 2014 3:38 Kevin Klauer
3:40
[Comment From GuestGuest: ]

Five tips to being organized at work?

Tuesday September 2, 2014 3:40 Guest
Kevin Klauer:

Clinically?
1. The disposition is the most golden thing ever. If you can dispo, do it.
2. No unecessary tests that cloud your mind and your judgment and slow things down.
3. Dispo
4. Dispo
5. Dispo

  Kevin Klauer
3:43

What percentage of immediate acting opioids are prescribed from US EDs?
50%

 ( 0% )

75%

 ( 25% )

10%

 ( 25% )

60%

 ( 25% )

35%

 ( 0% )

5%

 ( 25% )

 

Tuesday September 2, 2014 3:43 
3:47
[Comment From mikemike: ]

a few days ago we had a trauma patient come into our bay that refused labs, IV, and removal of clothing. He had a potentially life threatening injury but just kept refusing. No calm voice, reasoning or anything would allow it. He was A&OX3. We tried to get to the root cause but there was nothing. he just said “i dont want you to help me.” what would you do?

Tuesday September 2, 2014 3:47 mike
Kevin Klauer:

Establish whether or not he has medical decision making capacity (not drunk or head injured, orientated, understand everything), then you technically can’t do much. However get to the root, it is likely fear. Police, pain, being reported to family???? Then negotiate a limited work up. When in doubt treat (when reasonable) If the patient’s behavior is incredibly unreasonable, and no one would likely make the same decision, they may not have medical decision making capacity. Recent court ruling on rectal exam for head trauma pt. He was fine and oriented and said no. Court ruled in favor for defense.

  Kevin Klauer
3:47
Kevin Klauer:

OK. Back to the poll. Split! The number, per the FDA is 4.7%. You are not the problem. You can help fix it, but don’t claim responsibility for it!!!!!

Tuesday September 2, 2014 3:47 Kevin Klauer
3:50
[Comment From MedstudentMedstudent: ]

What other fields did u consider aside from emergency medicine?

Tuesday September 2, 2014 3:50 Medstudent
Kevin Klauer:

I was a paramedic before going to medical school and during. So, my fate was sealed. However, in my second year at LSU, I was offered a neurosurgery spot after someone vacated the spot. I thought about it, but just couldn’t change.

  Kevin Klauer
3:51
Adaira Landry:

Kevin can you elaborate on that rectal exam case (we occasionally do screening rectal exams on our minor trauma patients)….just wondering what occured in your case?

Tuesday September 2, 2014 3:51 Adaira Landry
Kevin Klauer:

Hit in the head and brought in as a trauma. No LOC. He was fine. Full ATLS type of work up. They said rectal, he said no way and he sued as they did not have consent to do the rectal.

  Kevin Klauer
3:52
[Comment From Alex KoyfmanAlex Koyfman: ]

Thanks for your time. Any last words of wisdom?

Tuesday September 2, 2014 3:52 Alex Koyfman
Kevin Klauer:

All out of wisdom Alex, but I certainly hope there was some along the way. I appreciate the opportunity to participate.

Sincerely,

Kevin

  Kevin Klauer
3:53
Adaira Landry:

Thanks everybody for participating and a SPECIAL THANKS to Dr. Kevin Klauer DO, EJG (@Emergidoc) for taking the time to answer our questions. We hope to see you all again at the next AMA!

Tuesday September 2, 2014 3:53 Adaira Landry

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