EMRAP Bouncebacks Makes Me Nauseous


I am a self-confessed EMRAP addict. If I end up being half as much of a Captain Cortex with one-tenth the witty repartee as Billy Mallon, I’ll consider myself a success. Being from Kansas, I wouldn’t mind having an Australian accent, but I think that just may confuse people.

But am I the only one who just feels perpetually sick to my stomach when they’re listening to a Bouncebacks case? A teenager dead from PID, an older patient dead from cerebral edema who had peripheral vertigo and a positive Dix-Hallpike test? I send these things home all the time. Maybe it’s just a recall bias, but it’s often the same day that I listen to the talk I will have just had a very similarly-presenting patient the day before.

Is “Bouncebacks” supposed to significantly change my practice? I don’t think so–but don’t think it’s supposed to. I’m a “First, Do No Harm” kind of guy, and feel like if I practice to find the completely outlying one-in-a-million case, I’m going to be hurting many more people along the way. But at the same time, the cases stick in my head for the next month and definitely make me think harder about the case and broaden my differential, which is never, ever a bad thing. Maybe I order an image. Or a lab test. Or repeat the physical exam. Or arrange closer follow-up.

We shouldn’t practice based on our own personal lists of “burns”–patients that went bad–but these cases should make us practice a little differently. And that’s what Bouncebacks is great for. Maybe the nausea it induces is really just that same feeling I get when a colleague says “Hey, remember that guy you had,” and my stomach sinks. Hopefully, I learn something with each one of those encounters: I read up on the topic more, I decide to get the EKG a little faster, I check that aspirin level, or I push on the belly one more time after the CT is negative.

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