I am Dr. Heather Murray, Emergency Physician and Medical Educator: How I Work Smarter

How I Work Smarter LogoIf you’re still trying wrap your mind around the Karpman triangle, the 3 Cs, and Kairos from last week’s post, don’t worry, we have some back to the basics goodness for you. Dr. Heather Murray (@HeatherM211) is an emergency physician primarily but wears many hats: Medical School Leader, Teacher of Evidence-Based Medicine, Journal Editor, Epidemiologist, and Canadian National Board Examiner. I have been told that she is a budding meme expert. But beyond titles, she clearly leaves a lasting impression with her learners. Indeed, fourth year medical student Eve Purdy nominated her to be part of the series. Dr. Murray kindly shared her pearls of wisdom with us.



  • Name: Heather MurrayHeather Murray Head Shot
  • Location: Kingston, Ontario, Canada (home of Queen’s University)
  • One word that best describes how you work: Intensely
  • Current job:  I have at least 3 jobs – I’m an academic emergency physician at Queen’s. I’m the director of 2nd year at our medical school. I’m the scholar competency lead as well (translation: I run the evidence-based medicine and research skills training program at our medical school). In my spare time I’m a decision editor at the Canadian Journal of Emergency Medicine.
  • Current mobile device: iPhone 4S (iPhone 6 in March when my plan lets me upgrade)
  • Current computer: MacBook Air


What’s your office workspace setup like?

Heather Murray Office

Double screens are the best for document editing and writing. Other essentials include a notepad – not a computer but an actual lined notepad – for daily tasks. I can’t let go of a pen – it feels good to write and cross things off manually. Like others, I use a whiteboard with active projects/deadlines listed, and can’t survive without Dropbox. Other essential items include several coffee cups, reading glasses and some nice things to remind me what’s important when I look up: pictures and notes from my kids and a canoe painting to remind me to unplug.

What’s your best time-saving tip in the office or home?

I set up my day with 3 tasks – a “must do,” a “should do” and a “nice to do.” Get those done and the rest is gravy (and I feel like a superhero).

What’s your best time-saving tip regarding email management?

I set my iPhone timer to limit the time I spend on email in a sitting – otherwise it can take over my day and I don’t do the things I need to do. So, 45 minutes at the start of the day and then I don’t open it again until I’ve finished a task. The timer really helps me avoid being hijacked. I work offline in between deluges of email.

What’s your best time-saving tip in the ED?

It’s counterintuitive, but sitting down and taking a careful history with each patient saves me loads of time. I leave the bedside with a differential diagnosis and a solid plan, and don’t need to go back and perform more exams or ask more questions. The best part? My patients are happy and I’ve established a nice bond by sitting and not appearing rushed or distracted.

ED charting: Macros or no macros?

No macros. I’m too old and set in my ways to convert. I’ve been writing on charts for decades and use that process to distill my thoughts, and I can’t give up control over my thinking to a macro. I’ll make mistakes! I worry that every chest pain and abdo pain look the same with a macro, and each one has a nuance or twist that I can capture better in free text. It’s more time consuming, but that’s a tradeoff I can live with.

What’s the best advice you’ve ever received about work, life, or being efficient?

It’s in David Sackett’s classic article “On the Determinants of Academic Success as a Clinician-Scientist.” If you haven’t read it, he talks in detail about 3 things:

  • Mentorship
  • Periodic Priority Lists
  • Time Management

This is timeless wisdom from a legendary figure.

Who would you love for us to track down to answer these same questions?

I’d love to hear from 2 non-emergency physicians and one Emergency Medicine legend:

  1. Dr. Bob Connelly (@Bob_Connelly) – neonatologist and renowned Queen’s University teacher. He is amazingly productive, technologically savvy and a design wizard.
  2. Dr. David Juurlink (@DavidJuurlink) – internist, toxicologist and clinical scientist at Sunnybrook in Toronto. His Twitter feed is filled with his practical, important research and useful tips for those of us in the ED trenches.
  3. Dr. Ian Stiell (@EMO_Daddy) – no introduction needed!

Author information

Benjamin Azan, MD

Benjamin Azan, MD

Emergency Medicine Resident

Icahn School of Medicine at Mount Sinai

Founder/Editor of foambase.org

The post I am Dr. Heather Murray, Emergency Physician and Medical Educator: How I Work Smarter appeared first on ALiEM.

ECG of the Week – 26th January 2015

These ECG's are from a 70 yr old male who presented to the Emergency Department following an overdose of unknown agent / agents.
The first ECG was performed on arrival the second ECG following intervention.  

Vital signs on arrival: 

  • GCS 8 (V=1 E=2 M=5)
  • BP 103/67
  • Temp 36.4 C (97.5 F)
  • BSL 5.8 mmol/L

ECG 1 On arrival to the Emergency Dept
Click to enlarge

ECG 2 Post Intervention
Click to enlarge

Things to think about.

  • What are the key features on the first ECG ?
  • What investigations would you want ?
  • What interventions occurred ?
  • What are the key features of the second ECG ?

US in massive PE case with @EM_ResUS.  Also, get free ebook on inkling while still available.  Limited time!!  #FOAMED

What a save last podcast by Sam Ghali!  They’re not all warm and fuzzy, though.  We make life and death decisions based on less than perfect information, and sometimes even the right decision doesn’t lead to a good outcome.  Will Dr. Ghali be as fortunate with this patient with the massive PE?  Let’s find out…….
Also, we told you last time that the ebooks were free…..forever.  But then as soon as we released the episode we heard from inkling.com that they were removing all “non-enterprise” titles from the store.  This is after we invested significant resources to get it in the store and so many people spent so much energy creating the ebooks.  SO, download it now!!  It’s in the inkling.com store until March 1st.  You’ve got just over a month to get it from Inkling and tell everyone you know to get it.  After that your only option will be through iTunes, so you’ll only be able to consume on a Mac or iPad.  It’s completely free until it disappears.  Don’t say we didn’t warn you.
Lastly, if you haven’t given the podcast a 5 star rating in iTunes it would be greatly appreciated.  Thanks for considering!
Follow us:  @ultrasoundpod
Register:  Yellowstone Course or Norway
iTunes versions if you prefer the iBooks Textbook format:

The post US in massive PE case with @EM_ResUS.  Also, get free ebook on inkling while still available.  Limited time!!  #FOAMED appeared first on Ultrasound Podcast.

ECG of the Week – 19th January 2015 – Interpretation

This ECG is from a 23 yr old female who presented to the Emergency Department following an episode of palpitations. She is fit & healthy and was asymptomatic when this ECG was performed.
Check out the comments from our original post here.

Click to enlarge

  • ~66 bpm
  • Regular
  • Sinus rhythm
  • Normal (~40 deg)
  • PR - Short (100ms)
  • QRS - Prolonged (140ms)
  • QT - 440ms

  • Discordant ST-segments changes
    • ST Elevation leads aVR, V1-3
    • ST Depression leads I, II, aVL, aVF, V5-6


  • Delta-waves lateral leads
  • Dominant S wave lead V1
    • Type B Pattern
  • Wolff-Parkinson-White Syndrome
    • Short PR segment
    • QRS Prolongation
    • Delta waves

Accessory Pathway Location

There are a number of algorithms that can be used to estimate the location of the accessory pathway (AP). Many of these algorithms can be found in smartphone apps, I use EP Mobile which contains the following algorithms:
  • Arruda Algorithm
  • Milstein Algorithm
  • Modified Arruda Algorithm
For this particular ECG are the algorithms give the same AP location which is antero-septal.
You can find an overview of each of these algorithms at ECGpedia's WPW page.

What are you going to tell your patient ?

I've put some links here to various patient information resources for WPW, I have not vetted or reviewed all these links but have chosen those from government / institutional sites.

If there are other links you feel should be added please comment and I'll add them.

References / Further Reading

Life in the Fast Lane


  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.