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Hazing is defined as committing acts against an individual or forcing an individual into committing an act that creates a risk for harm in order for the individual to be initiated into or affiliated with an organization. Hazing is an enduring activity with roots that date back to the ancient and medieval eras. It has become increasingly prevalent in fraternities and sororities, high school and college athletic organizations, the military, professional sports teams, and street gangs. Scant information is available in the medical literature regarding hazing. This article reviews the history of hazing, provides statistics regarding its prevalence, presents information on specific hazing practices and consequent traumatic injuries, and assesses alcohol's influence on hazing. It also offers recommendations on how to recognize victims of hazing in the Emergency Department and proposes guidelines for their treatment. Current legislation and information on the prevention of traumatic injuries from hazing are discussed.

Dr. Michelle Finkel: Today’s case is that of a 32-yearold woman in her third trimester of pregnancy who presented by ambulance to the Emergency Department (ED) in respiratory distress. Her adolescent daughter had awakened to find the patient in the bathroom extremely short of breath. Initial information via radio indicated that the patient was seated on the toilet in severe respiratory distress with altered mental status when the paramedics arrived on the scene. The patient was initially noted to have an oxygen saturation of 80% on room air. She was intubated and brought to the ED. Her past medical history was significant for systemic lupus erythematosus; however, no other medical history was available. Her gravida/para status was unknown as was her prenatal course. Her medications, allergies, and social history were also unknown. Are there any initial questions? Dr. Andrew Reisner: With regard to the airway management, what medications were given by the paramedics? Dr. Finkel: The paramedics administered 2 mg of midazolam and intubated the patient with an 8.0 endotracheal tube (ETT). No paralytics were used. Rapid sequence intubation was not used here but would have been an acceptable alternative. Dr. William Zirkin: The patient’s fetus had passed the viability threshold and should have been carefully considered. Did the paramedics obtain a fetal heart rate? Dr. Finkel: The paramedics reported that they were unable to find a fetal heart rate. After receiving the radio call we immediately informed the obstetrical service of the patient’s imminent arrival. Dr. Won Chung: When was the patient last seen? Had she been ill or was this a sudden change in her health? Dr. Finkel: We did not have that information at the time. We believed the patient had been in her usual state of health until her daughter found her that morning. The patient arrived in the ED intubated, obtunded, and unarousable. We placed her on her left side. The heart rate was 160 beats/min, blood pressure 188/136 mm Hg, and oxygen saturation 100% with ventilation. The HEENT examination demonstrated reactive and equal pupils bilaterally without any evidence of head or oral trauma. Endotracheal tube (ETT) placement was confirmed by end tidal CO2 detector. The neck was supple with jugular venous distension. The patient’s heart was tachycardic without murmurs, gallops, or rubs. The lungs demonstrated rales bilaterally throughout all lung fields. The abdomen was gravid with an approximately 32week uterus. There was bilateral pitting edema to her knees. The neurologic examination demonstrated occasional spontaneous movement of all extremities. Are there any questions about the initial presentation? Dr. Zirkin: It is impossible to ignore the patient’s elevated blood pressure. In a patient in her third trimester of pregnancy, any blood pressure above 140/90 mm Hg must be considered abnormal, and pregnancy-induced hypertension (PIH) must be assumed. The altered mental

At its root, medical professionalism is service delivered according to patient's interest. It is essential to reinforce this notion because financial pressures threaten the integrity of the patient-physician relationship. Excessive commercialism directly contrasts the ideals of medical professionalism. This fact necessitates re-examination and reaffirmation of professional behavior. If historical standards of professionalism give way to market-driven incentives, the provision of medical care will become a commodity and the practitioners will be only agents of service delivery. Such a model not only threatens the the physician's identity, but also threatens the patient's interests. Medicine can never succeed as a transaction; it can only succeed as a partnership, a trusting exchange with patients, which is the hallmark of professionalism.

Study objective Attrition rates in emergency medicine have been reported as high as 25% in 10 years. The number of women entering emergency medicine has been increasing, as has the number of female medical school graduates. No studies have identified factors that increase female emergency physician career satisfaction. We assess career satisfaction in women emergency physicians in the American College of Emergency Physicians (ACEP) and identify factors associated with career satisfaction. Methods The survey questionnaire was developed by querying 3 groups: (1) ACEP women in the American Association of Women Emergency Physicians, the (2) Society for Academic Emergency Medicine Mentoring Women Interest Group, and (3) nonaffiliated female emergency physicians. Their responses were categorized into 6 main areas: schedule, relationships with colleagues, administrative support and mentoring, patient/work-related issues, career advancement opportunities, and financial. The study cohort for the survey included all female members of ACEP with a known e-mail address. All contact with survey recipients was exclusively through the e-mail that contained a uniform resource locator link to the survey itself. Results Two thousand five hundred two ACEP female members were sent the uniform resource locator link. The Web survey was accessed a total of 1,851 times, with a total of 1,380 surveys completed, an overall response rate of 56%. Most women were satisfied with their career as an emergency physician, 492 (35.5%) very satisfied, 610 (44.0%) satisfied, 154 (11.1%) neutral, 99 (7.1%) not satisfied, and 31 (2.3%) very unsatisfied. Significant factors for career satisfaction included amount of recognition at work, career advancement, schedule flexibility, and the fairness of financial compensation. Workplace factors associated with high satisfaction included academic practice setting and sex–equal opportunity for advancement and sex–equal financial compensation. Conclusion Most of the ACEP female physicians surveyed were satisfied with their career choice of emergency medicine. Opportunities for career advancement, fairness in financial compensation, and schedule flexibility were key factors in career satisfaction among female emergency physicians.