Briefly Noted

Another year is slipping by, and I haven't read nearly as much (non-medical) literature as I would have liked. Still, a number of noteworthy books have come to my attention, and if you're looking for a medically-themed gift for someone on your list, consider some of the following:

The Man with the Iron Tattoo: Two neurologists, John Castaldo and Lawrence Levitt, recount their lives in medicine, with interesting cases, memorable patient interactions, and some mild pontification about the importance of reaching out to one another. Well-written, and an interesting look at how medicine and standards have changed in a generation.

The Diagnosis of Love, by Dr. Maggie Leffler. I must say, this book was much better than the title or blurb (about a young female physician resolving family and relationship crises) would lead me to expect. The book featured snappy pacing and dialog, well-developed characters, and captured some of the frustration and opportunity inherent in a scientifically-trained physician interacting with some of the stubborn and less rational people around her.

Know Your Numbers, Outlive Your Diabetes by Dr. Richard Jackson and noted journalist and blogger Amy Tenderich of DiabetesMine. When I think of all the diabetic patients I see with repeat visits to our emergency rooms, I can only hope some of newly diagnosed pick up this book before it's too late. With straightforward text, and easy-to-read bullet points and tables, this book can give patients a strategy on to manage this challenging disease. And it might give the patients, and their caregivers, some hope as well.

The Alchemy of Grief by Emily Ferrara. One of my former professors has produced a book of poetry, borne of a parent's worst pain, the loss of a child. One review reads:

This is excellently controlled craftsmanship, conveying deeply felt emotion. The grief of loss is sharply poignant and real, yet never maudlin or self-indulgent. The music of the lines is subtle and fine. The tension between the controlled craft and the poignancy of the theme makes the reader participate in the poems and feel with the poet, sharing the human despair and transcendent emotions that bring us through to survival. - Daniela Gioseffi

Brought to you by Carl's Jr.

Although it's by no means a great film, there's no recent movie imagery that has lingered with me as much as Mike Judge's Idiocracy, a dystopian black comedy in which the dim-witted have conquered the planet through their fecundity.

Maybe this movie resonated with me because I'm too far removed to really 'get' MTV culture anymore. Or working in NYC emergency rooms has made me a little discouraged about our future. In any case, a reviewer has nicely captured the humor and horror when our modern hero, Joe, wakes up five hundred years in the future, and heads to St. God's Memorial Hospital:

Because language has deteriorated throughout the centuries, when Joe speaks, Dizz can barely understand him (imagine a man from the 1500s trying to speak Elizabethan English in modern-day Amarillo, Texas). Scared by Dizz's hostile grunts and disoriented from his hibernation, Joe stumbles across the hellish garbage-covered city to a hospital, still somehow convinced that he's just hallucinating.

The hospital sequence is one of the funniest parts of Idiocracy, gleefully showing how complex bureaucracies can develop even in the dumbest of societies. Joe finds that hospitals are now set up like Jiffy Lubes - you stand in line until a technician hooks you into a machine that loudly offers a pre-recorded diagnosis ("You've got hepatitis!"). When Joe finally gets to see a doctor (who offers the diagnosis "your shit may be retarded"), he begins to realize what's happened.

But I also enjoyed the little things, like the movie's clever adaptations of modern logos (NSFW), and how coarseness has become commonplace in civil institutions.

If you can't wait for that future, at least now you can drink Brawdo, the Gatorade-like beverage that threatens to destroy American civilization in 2505. Why would you want to drink it? Well, for starters, it's got electrolytes.

We will float into the mystic

The latest edition in Medscape's Roundtable series features Drs. Robert Donnell, Roy Poses and me, talking about Integrative Medicine and EBM in today's med school curricula.

I really enjoyed participating, and give thanks again to series editor Christine Wiebe for corralling us and arranging the pieces. I think we all made good, well-referenced points, and our views frame a provocative debate. See for yourself with whom you agree, and join in on the discussion.

Fluorescent and Starry

I receive several academic journals in the mail, and after browsing the articles of interest, I enjoy flipping through the 'letters to the editor' section at the end. Controversial topics are reconsidered from another viewpoint, which is always valuable to the physician in training. And even early in your career, you'll see some familiar names, from conference speakers or from the places you've trained.

And, sometimes, you might see your own name.

Allen Roberts and I were mentioned in a letter to Annals of Emergency Medicine, penned by none other than Jen Jen Oh, the founder of Lingual Nerve (who I finally had the pleasure of meeting, when she recently visited NYC and my hospital). The topic was blogging (what else?) -- specifically, Eric Berger's article on EM blogging (subscription req'd) this past spring. An interesting excerpt from Jen Jen's letter is below, sanse the effusive praise:

I too have a personal blog, located at www.spacefan.blogspot.com, which began in 2002. Although it started out by covering more social aspects of my life, its direction changed in 2003, when I reported on the SARS epidemic in my country. It was eventually mentioned on The Guardian’s Web site and garnered a favorable review. SARS-related entries from that year can be accessed via the archive links on the main page of my blog.

The pros and cons highlighted in the article, though cited by US-based doctors, are also applicable in other parts of the world. With regard to the ethical and administrative dilemmas, I’ve had my share of closed-door meetings, stern e-mails and other warnings over the years, first about revealing too much in my SARS-related posts, then about being too vocal in my frustrated rants on emergency department (ED) crowding (which the powers-that-be contend will tarnish the hospital’s image, ED staff’s sanity and morale be damned).

Preserving patient confidentiality is rarely an issue, but with our younger generation of doctors and doctors-to-be jumping on the blogging wagon, there have been times when too much was divulged, with dire consequences....

...Despite all the precautions taken, medical blogging remains a tenuous pastime, with few doctors making any form of profit from it. I personally do not know any doctor who does it primarily for money or fame. Instead, we are driven by a passion for the written word which, when combined with the adrenaline rush and emotional rollercoaster ride of the medical profession, makes for compelling — almost addictive — reading.

Aside from helping doctors connect on a national and global scale, medical blogs also provide invaluable insight for the general public, who know little about our small, exclusive community. While there will always be the occasional heckler, the majority of non-medical readers harbor a deep interest and respect for what we do, and express these sentiments when they comment on our entries. My posts on SARS elicited responses offering encouragement and sympathy from all over the world, providing a great source of comfort to myself and my fellow colleagues during our darkest days.

Last but not least, medical blogging can prove instrumental in raising the profile of various specialties, emergency medicine included. As recently as 5 years ago, few residents in Singapore applied for traineeship positions in emergency medicine, but this number has surged in the past 2-3 years, with many applicants mentioning that they read my blog on a regular basis and developed an interest in this field because of the information I provided. Medical students choose to do elective postings with us because they know where "Dr. Spacefan" works, and quite a number of them have already decided to make emergency medicine a long-term career choice...

Wow. I thought it was from all the American Idol posts, but Jen Jen always had that rock-star cachet about her. The illustrious Truman J. Milling responded to her letter.