Grand Rounds took a break this week, for the first time in its history. We probably should have done it on earlier occasions, but in the past there was no shortage of willing hosts or participants.
Now is a different story. Recent hosts have remarked to me about sparse submissions and a decline in traffic -- it seems to vary week-to-week, and there are notable exeptions, but the trend is unmistakable. One new blogger (and recnt host) asked, "Does blogging even matter anymore?"
I don't have a great answer. It seems like most everyone still has a blog, if only to have something to link back to on tweets. Blog traffic and comments don't seem to motivate writers as much as followers, fans and retweets.
For years I've considered Twitter and Facebook as less flexible, and more lacking in meaningful content, compared to blogs. But it's clear that this is how the vast majority of online readers prefer to learn about quality health writing. And since the mission of Grand Rounds has always been to showcase excellent medical writing and creative writers, we're going to have to do more with these new platforms.
They might be giants
This year, I learned about the death of two physicians that were pretty important to me.
The first was my pathology teacher, Dr. Guido Majno. In addition to just being a tremendous person, kind and curious... He and his wife wrote the best textbook I've ever read.
The second death was that of my pediatrician growing up, Dr. Thomas Peebles.
Funny, although he followed me from birth to high school, my family never knew about his incredible research background. We learned it in the many obituaries.
It's worth reflecting on their accomplishments and the manner in which they conducted their lives and practice -- especially in this era, when doctors are encouraged to develop their social media presence and be proactive about online reviews.
Would they have used these new tools? Would they even have needed them? Would they have found the idea of trading links to medical stories on Twitter to be interesting? Stimulating? Or maybe distressing, or distasteful?
I never thought to ask them.
The first was my pathology teacher, Dr. Guido Majno. In addition to just being a tremendous person, kind and curious... He and his wife wrote the best textbook I've ever read.
The second death was that of my pediatrician growing up, Dr. Thomas Peebles.
Funny, although he followed me from birth to high school, my family never knew about his incredible research background. We learned it in the many obituaries.
It's worth reflecting on their accomplishments and the manner in which they conducted their lives and practice -- especially in this era, when doctors are encouraged to develop their social media presence and be proactive about online reviews.
Would they have used these new tools? Would they even have needed them? Would they have found the idea of trading links to medical stories on Twitter to be interesting? Stimulating? Or maybe distressing, or distasteful?
I never thought to ask them.
Time won't let me go
Before the App Store, way back in the spring of 2008, I jailbroke my refurbed first generation iPhone. I claimed it was for the cool native apps but also liked the customization that was possible (even now, animated backgrounds and control over device sounds is not allowed through official channels).
The innovation came at a price -- the phone became slower and more crash-prone.
When the App store was available, I quickly upgraded to the Apple-approved iPhone OS 2.0 and all my jailbreak hacks and apps disappeared.
Except, strangely, one hack.
The innovation came at a price -- the phone became slower and more crash-prone.
When the App store was available, I quickly upgraded to the Apple-approved iPhone OS 2.0 and all my jailbreak hacks and apps disappeared.
Except, strangely, one hack.
There must be some kind of bad connection
A reader of my EMPractice LLSA review on paracentesis (still available, buy yours today!) wrote my editor with a question. Not, thankfully, on anything factual in my writeup, but rather on an issue of word usage.
Is there a definitive answer?
This is picayune but a start. 2010 LLSA 4 paracentesis refers to a \"Z tract\" as a technique to avoid leakage. When I learned this years ago I thought it was Z track-as the pathway (track) left when the needle was removed. I thought using tract was just sloppy language. Checking Roberts for procedures I read Z tract-OK-solved. BUT then Roberts' Illustrative Guide calls it Z track. So, evidenced-based mavens which is it?!!!Our editor referenced the original NEJM article on which my review was based. The NEJM uses the term “Z-tract.” But further Googling turned up varied usage, and "Z-track" was far more popular.
Is there a definitive answer?
When all is well and well is all
Slate's Juliet Lapidos recently reviewed a new book by Allan Metcalf on the story of OK ("America's Greatest Word"). Key graf:
The only etymology with hard evidence behind it, he says, is that OK began as a joke—a joke so bad, so boring, that I won't cover it in detail. Briefly: In the spring of 1839, the Boston Post ran an article tweaking the Providence Daily Journal, which included the phrase "OK—all correct." Get it? OK started as an intentionally misspelled abbreviation of all correct (oll korrect). It sprang, more generally, from an 1830s fad for abbreviations, like NG for no good and OW for oll wright or all right.
I've heard about this silliness before, and in fact referred to it whenever someone around me bemoaned the spelling of, say, "Gorillaz" or "Flickr." The current trend in spelling hijinx doesn't portend the end of civilization or reflect a decline in education, but rather, continues a longstanding English tradition.
But the part about the review that I really liked focused on the inscrutability of "OK" (more below):
You made me like it
Grand Rounds, the weekly rotating carnival of healthcare blogs, is in its seventh year.
This week we're trying something different.
Grand Rounds will be hosted on a blog, as usual, but this time it's a Facebook site (The fact that this is our first veterinarian host is noteworthy as well).
Earlier this year we launched an online presence for Grand Rounds on Facebook (and Twitter). The justification? Facebook is now the #1 website in the US, accounting for one in four pageviews. This is simply where a lot of people spend a lot of time online. Facebook already drives more traffic to media sites than Google; it stands to reason that smaller sites like blogs would also benefit from FB's social referrer approach, alongside the Grand Rounds showcase or Google's PageRank valuation.
But what about blogs that make their home in Facebook's Pages? It was really just a matter of time. The original blog carnival model guaranteed a weekly spotlight and flood of traffic to the host. Some people would visit, maybe browse the archives, and add the host blog to their bookmarks or RSS readers. There's nothing about that scenario that's not possible with Facebook blogs, and their "Like" feature is arguably more intuitive and manageable than earlier ways of subscribing.
I had said before that Facebook, by virtue of its accounts being tied to real names, would encourage an era of more reasoned and responsible blog commenting. I expected that quantity of comments and posts might fall, the quality would rise -- an antidote for the trolling and choir-preaching that substitutes for real conversation at many sites today. This week's host, however high-quality her posts, is not a real person. The team behind "Amanda Brown, DVM" can write at will, and leave comments on other pages, with some level of professional protection.
What that means for the future of online healthcare discourse is not clear, but the I suspect this degree of anonymity, plus the ease of "Liking" and the fact that so many of people visit FB regularly already, will encourage more people to use Facebook as a platform for their healthcare musings. And they'll be welcome to host Grand Rounds.
This week we're trying something different.
Grand Rounds will be hosted on a blog, as usual, but this time it's a Facebook site (The fact that this is our first veterinarian host is noteworthy as well).
Earlier this year we launched an online presence for Grand Rounds on Facebook (and Twitter). The justification? Facebook is now the #1 website in the US, accounting for one in four pageviews. This is simply where a lot of people spend a lot of time online. Facebook already drives more traffic to media sites than Google; it stands to reason that smaller sites like blogs would also benefit from FB's social referrer approach, alongside the Grand Rounds showcase or Google's PageRank valuation.
But what about blogs that make their home in Facebook's Pages? It was really just a matter of time. The original blog carnival model guaranteed a weekly spotlight and flood of traffic to the host. Some people would visit, maybe browse the archives, and add the host blog to their bookmarks or RSS readers. There's nothing about that scenario that's not possible with Facebook blogs, and their "Like" feature is arguably more intuitive and manageable than earlier ways of subscribing.
I had said before that Facebook, by virtue of its accounts being tied to real names, would encourage an era of more reasoned and responsible blog commenting. I expected that quantity of comments and posts might fall, the quality would rise -- an antidote for the trolling and choir-preaching that substitutes for real conversation at many sites today. This week's host, however high-quality her posts, is not a real person. The team behind "Amanda Brown, DVM" can write at will, and leave comments on other pages, with some level of professional protection.
What that means for the future of online healthcare discourse is not clear, but the I suspect this degree of anonymity, plus the ease of "Liking" and the fact that so many of people visit FB regularly already, will encourage more people to use Facebook as a platform for their healthcare musings. And they'll be welcome to host Grand Rounds.
1010 Wins
Calendar trivia has always interested me. And we've lived though some special dates, from the turn of the millennium to 9-02-10 day last month.
Today is no exception. And like 1/2/03 at 4:56, today we could experience a couple of memorable minutes.
But a few moments' thought on the matter leads me to believe that the high frequency of notable dates we've been enjoying is going to come to an end soon.
Another endangered calendric item: those plastic eyeglass-like frames that attain ubiquity every New Year's Eve, since the 1990 (or even earlier). In fact, for most of my life, each year has featured at least two bulbous numbers, ideal for making zany celebratory glasses (if I'm not explaining this well, see here).
I think this comes to an end for 2011. The impact on the economy is difficult to estimate.
Today is no exception. And like 1/2/03 at 4:56, today we could experience a couple of memorable minutes.
But a few moments' thought on the matter leads me to believe that the high frequency of notable dates we've been enjoying is going to come to an end soon.
Another endangered calendric item: those plastic eyeglass-like frames that attain ubiquity every New Year's Eve, since the 1990 (or even earlier). In fact, for most of my life, each year has featured at least two bulbous numbers, ideal for making zany celebratory glasses (if I'm not explaining this well, see here).
I think this comes to an end for 2011. The impact on the economy is difficult to estimate.
Common disaster
I love this town. In the event of another disaster in NYC, I want to be able to help. So, years ago, I signed up for the NYC Medical Reserve Corps.
While I thought my services as an emergency physician might be of benefit someday, now I wonder if the most pressing need was for an interface & usability expert. Either that, or years of Google and Apple interfaces have spoiled me to the point where navigating forms online is pretty much unbearable.
The way I understood NYC Medical Reserve Corps (MRC) is this: you sign up. You give some details about yourself and your skill set. You give contact info. The city calls or emails you periodically to verify your info. We all stand ready to help.
Members recently got a flurry of emails about some kind of upgrade. New logins would be necessary, more features, etc.
Here's one small section of the process:
But first you've got to get a ServNY userID:
It goes on and on like this, forcing you to refer to info from multiple websites and emails. As you fill in the fields, there's often no indication when something worked or didn't. I thought I completed the process on several occasions, only to be unable to login later, or receive a reminder email asking me to repeat the same steps.
To be fair, NYC MRC has offered to help, and set up phone numbers and better step-by-step guides. But I'm also not sure why we're even being forced to re-register. Don't they already have my contact info? Isn't that pretty much all that's needed?
I think, like with many systems and institutions, something got lost along the line, and a simple volunteer network became a massive bureaucracy. The simple act of offering to help, and providing contact information, is now insufficient. There's too many hoops to jump through, for the privilege of helping New Yorkers.
While I thought my services as an emergency physician might be of benefit someday, now I wonder if the most pressing need was for an interface & usability expert. Either that, or years of Google and Apple interfaces have spoiled me to the point where navigating forms online is pretty much unbearable.
The way I understood NYC Medical Reserve Corps (MRC) is this: you sign up. You give some details about yourself and your skill set. You give contact info. The city calls or emails you periodically to verify your info. We all stand ready to help.
Members recently got a flurry of emails about some kind of upgrade. New logins would be necessary, more features, etc.
Here's one small section of the process:
- Scroll down to “To become a volunteer, click on the Join Now button.”
- Enter NYC MRC ID and ServNY password, Click on ‘Log In’.
- When prompted, enter NYC MRC PIN, Click on ‘Continue’.
- To “Confirm your identity”; Enter last 4 digits of phone number or 5 digit zip code.
- Click on ‘Continue’. You have now ‘claimed’ NYC MRC records. Continue to Step 3.
But first you've got to get a ServNY userID:
- Change drop down box “NYC MRC ID” to ‘Yes’.
- Enter NYC MRC ID and NYC MRC PIN from Go Live/Welcome letter. Case-sensitive. NOTE: PIN is listed as “password” in Go Live/Welcome letter.
It goes on and on like this, forcing you to refer to info from multiple websites and emails. As you fill in the fields, there's often no indication when something worked or didn't. I thought I completed the process on several occasions, only to be unable to login later, or receive a reminder email asking me to repeat the same steps.
To be fair, NYC MRC has offered to help, and set up phone numbers and better step-by-step guides. But I'm also not sure why we're even being forced to re-register. Don't they already have my contact info? Isn't that pretty much all that's needed?
I think, like with many systems and institutions, something got lost along the line, and a simple volunteer network became a massive bureaucracy. The simple act of offering to help, and providing contact information, is now insufficient. There's too many hoops to jump through, for the privilege of helping New Yorkers.
Brothers in arms
It's happened again.
Almost every day, I get a brochure or three about courses, credentialing, or some educational opportunities for doctors. I thought it would let up when I passed the boards, but no.
On many of them, there's stock photography like this:
Everyone one of these pictures, and most of these brochures, feature a doctor with his or her arms crossed. Often, they're looking at the camera, with an air of seriousness and, I daresay, a trace of disapproval.
I can understand maybe patients seeing us this way -- we have some experience and education, and a lot our workload comes from theoretically preventable disease. So a doctor with arms folded might work if you're trying to sell treadmills or grape nuts.
But is this an image that works on other doctors? Are we more likely to sign up for a board review course if it's offered to us by a stern, standoffish colleague?
Then I think back to medical school, and realize: of course.
Almost every day, I get a brochure or three about courses, credentialing, or some educational opportunities for doctors. I thought it would let up when I passed the boards, but no.
On many of them, there's stock photography like this:
http://www.fotosearch.com/UPC005/tre01014/
http://www.fotosearch.com/RBL008/a01394/
http://www.fotosearch.com/BLD131/cb0408awh_0528/
http://www.123rf.com/photo_3193578.html
http://www.istockphoto.com/stock-photo-8149905-lady-doctor-standing-with-her-arms-crossed.php
http://www.fotosearch.com/OJO105/pe0007596/
http://www.istockphoto.com/stock-photo-11943832-female-doctor-smiling-with-arms-crossed.php
http://www.istockphoto.com/stock-photo-10361626-happy-mature-doctor-with-his-arms-crossed.php
http://www.istockphoto.com/file_closeup.php?id=12217867If you're too lazy to click the link, that's ok, I'm too lazy to import the pics. I'll save you some time:
Everyone one of these pictures, and most of these brochures, feature a doctor with his or her arms crossed. Often, they're looking at the camera, with an air of seriousness and, I daresay, a trace of disapproval.
I can understand maybe patients seeing us this way -- we have some experience and education, and a lot our workload comes from theoretically preventable disease. So a doctor with arms folded might work if you're trying to sell treadmills or grape nuts.
But is this an image that works on other doctors? Are we more likely to sign up for a board review course if it's offered to us by a stern, standoffish colleague?
Then I think back to medical school, and realize: of course.
Get it together
Bill Simmons sometimes pokes fun at the journalism cliche of collocated words that rarely appear apart from each other -- you don't often see the word 'ruffled', and when you do, you know the word 'feathers' is likely to be close by.
There's a similar phenomenon in medicine, though I stubbornly have refused to acknowledge it.
Consider the followed dialog that transpired during a recent overnight ED shift:
Of course, the resident was using hyperemesis to denote hyperemesis gravidarum. But really, hyperemesis just means lots of vomiting. Just because it's rarely used outside the context of pregnancy, it doesn't mean it's not a useful term (indeed, cannabinoid hyperemesis is another entity we sometimes see in the ED.)
What other terms get truncated like this? Anorexia nervosa comes to mind -- saying "the patient has anorexia" literally just means there's a lack of appetite, not a lethal eating disorder.
I'm sure there are countless others, but I'm wondering: could any of these medical terminology shortcuts lead to particularly dangerous misunderstandings?
I don't think anyone would mistake a triad for a joint if a colleague said, "they've got Charcot..." On the other hand, abbreviating the confusing term "superficial venous thrombosis" could lead to a mixup in therapies...
There's a similar phenomenon in medicine, though I stubbornly have refused to acknowledge it.
Consider the followed dialog that transpired during a recent overnight ED shift:
Resident: "I have a 32 year old woman with hyperemesis. I'd like to start antiemetics and IV fluids."
Me: "Is she pregnant?"
Resident, befuddled: "Um, yeah? I said she has hyperemesis."
Of course, the resident was using hyperemesis to denote hyperemesis gravidarum. But really, hyperemesis just means lots of vomiting. Just because it's rarely used outside the context of pregnancy, it doesn't mean it's not a useful term (indeed, cannabinoid hyperemesis is another entity we sometimes see in the ED.)
What other terms get truncated like this? Anorexia nervosa comes to mind -- saying "the patient has anorexia" literally just means there's a lack of appetite, not a lethal eating disorder.
I'm sure there are countless others, but I'm wondering: could any of these medical terminology shortcuts lead to particularly dangerous misunderstandings?
I don't think anyone would mistake a triad for a joint if a colleague said, "they've got Charcot..." On the other hand, abbreviating the confusing term "superficial venous thrombosis" could lead to a mixup in therapies...
Program Note
Bora's back hosting Grand Rounds this coming Tuesday at his site, Blog Around the Clock -- but I'm going to help him collect submissions over the weekend. Please email me a link to your best recent material at nick /at/ blogborygmi.com (a little blurb is helpful, too)! Deadline is Monday night.
How'd you get to be happiness
Somebody at Apple likes Goldfrapp.
They've used her latest album for this tutorial (scroll down) and the sublime Seventh Tree was pictured on the first Apple descriptions of the Remote app.
It's nice when a monolithic institution shows a little personality.
Of course, my interest in Goldfrapp is mostly professional -- who else has sung as well about ending up in an emergency department?
They've used her latest album for this tutorial (scroll down) and the sublime Seventh Tree was pictured on the first Apple descriptions of the Remote app.
It's nice when a monolithic institution shows a little personality.
Of course, my interest in Goldfrapp is mostly professional -- who else has sung as well about ending up in an emergency department?
Independent point of view
Here's a confession: Despite my steadfast advocacy of medical blogging as a means to promote understanding and education, I continue worry a lot about professional liability. Not just whether the things I write could hurt my career, but, in terms of academic output, is blogging a waste of time? What view does my department's leadership take on blogging?
Still, I've continued to support medical blogging as a useful academic endeavor, hoping that someday this support would be borne out. When sites like Sermo and Facebook came along, I despaired that more physician opinions were going to be hidden behind walled gardens, available only to select colleagues or friends.
Then, last week, some revelations -- I discovered a member of my department's leadership was blogging, or at least, had commented on a blog. How about that!
The other revelation? Facebook may be the last great hope for academic discussions to flourish on blogs.
Still, I've continued to support medical blogging as a useful academic endeavor, hoping that someday this support would be borne out. When sites like Sermo and Facebook came along, I despaired that more physician opinions were going to be hidden behind walled gardens, available only to select colleagues or friends.
Then, last week, some revelations -- I discovered a member of my department's leadership was blogging, or at least, had commented on a blog. How about that!
The other revelation? Facebook may be the last great hope for academic discussions to flourish on blogs.
Citations from Edelman's New Media Academic Summit
I spoke today at the panel on transparency at Edelman's New Media Academic Summit. Ben Boyd was the moderator and Ellen Miller from the Sunlight Foundation was my fellow panelist.
Reviewing some of the #nmas10 tweets from the audience, I figured I should provide some links for the anecdotes I mentioned:
Reviewing some of the #nmas10 tweets from the audience, I figured I should provide some links for the anecdotes I mentioned:
- BID CEO Paul Levy's blog is still the starting point when talking about transparency in medicine today. I had the chance to speak with him, a few years ago.
- Ed Bennett has done an extraordinary job following hospital social media adoption and highlights effective new media policies, as well.
- Hospitals are using twitter and billboards to broadcast ED waiting room times. This is not without risk, as billboards may not clarify the triage process, where seriously ill patients will be seen right away
- ACEP president Angela Gardner's Twitter feed and ACEP's blog.
- A recap of Better Health bloggers' meeting with Rep. Jack Ryan last summer during the healthcare reform debate.
- Recent articles from NEJM and JAMA articles on med students and social media.
- A lot of the developments in openness in peer review, and the world of grant funding, are chronicled at Nature's Peer-to-Peer blog. Bora Zivkovic has been and active and articulate defender open publications, as well.
Warm impermanence
I'm back from SAEM's Annual Meeting, and catching up on a boatload of emails and unread items in my RSS feed. Something's gotta give when social media use goes into high gear, but one of the things I missed was my own article in EPMonthly on using technology to keep current. Kind of embarrassing.
Anyway, some of the resources I highlighted were the same that Graham Walker mentioned in his comprehensive review of E-learning for EM. We're definitely entering a golden age for electronic resources in our specialty, and the tools to archive this material and make it quickly accessible are also coming along nicely. It's also reassuring, when others point out the mental risks from internet info consumption, that I've met so many accomplished and sharp people taking the plunge into this new media. What is it with early adopters, anyway? This quote comes closest to explaining the phenomenon, among any I've read:
Anyway, some of the resources I highlighted were the same that Graham Walker mentioned in his comprehensive review of E-learning for EM. We're definitely entering a golden age for electronic resources in our specialty, and the tools to archive this material and make it quickly accessible are also coming along nicely. It's also reassuring, when others point out the mental risks from internet info consumption, that I've met so many accomplished and sharp people taking the plunge into this new media. What is it with early adopters, anyway? This quote comes closest to explaining the phenomenon, among any I've read:
I find that the early adopter mentality is widely misunderstood: Journalists going for a sociological angle on the people in line for iPads, for example, focus on a desire for status or attention, or to be first on the block. They completely miss the point. They don't understand that the desire is for the thing itself and for what it can do; that we imagined this device before it was announced; that we're constantly bumping up against the limitations of what's available today; and that when these things finally appear in stores, we say "At last!" And then we buy them, and use them, and immediately get frustrated with its shortcomings and start waiting for the day when the next model comes out.This text was waiting for my in my RSS reader, and when I came across it I naturally tweeted the link, as well as added it to Evernote, before reprinting it here.
Can't buy a thrill
Many of the peculiar terms and phrases we learned in medicine have found a new use in cyberspace, as titles of websites (consider 10 out of 10, The Central Line, or this blog -- and that's just emergency medicine sites).
But that's the virtual world -- what about the real world? This past week I saw a couple of products that make me think medical parlance could sell physical products. Consider:
OK, fine, it won't really be a trend until Wendy's is selling STEMI-burgers or we see Throckmorton-branded condoms. But I wonder if this could someday happen, given the improving economics of niche marketing. Or maybe the general public, through realistic TV shows and, yes, blogs, has picked up on enough of our lingo to make this work?
But that's the virtual world -- what about the real world? This past week I saw a couple of products that make me think medical parlance could sell physical products. Consider:
- This is Spinal Tape (via Joshua Schwimmer)
- Drug of Choice coffee (via Rob Lamberts)
OK, fine, it won't really be a trend until Wendy's is selling STEMI-burgers or we see Throckmorton-branded condoms. But I wonder if this could someday happen, given the improving economics of niche marketing. Or maybe the general public, through realistic TV shows and, yes, blogs, has picked up on enough of our lingo to make this work?
I can't say. But I'd like to remind readers that you can enjoy your Drug of Choice in a lovely, professionally-designed mug, on sale now in storeborygmi.
Pad & Pen
My piece on the iPad's potential in emergency departments is now up at EP Monthly. Check it out -- especially the ambitious developers who've left comments.
The speculation about this device in healthcare has gotten a little more detailed -- and optimistic -- as people have had the chance to use it this week. Other insightful comments are available from Larry Nathanson, Chilmark Research, and John Lynn.
The speculation about this device in healthcare has gotten a little more detailed -- and optimistic -- as people have had the chance to use it this week. Other insightful comments are available from Larry Nathanson, Chilmark Research, and John Lynn.
A new kind of tension
There's an adage I often think about: "A physician's job requires the expression of confidence. The researcher's role is to express doubt."
This was never more apparent than when I transitioned from the research environment into the clerkships of medical school. The language of decision-making had abruptly changed -- in the lab, a year's worth of experiments is summarized with "seems" and "suggests," and every assertion is carefully calibrated to acknowledge uncertainty and a high standard for proof.
As a student on clerkships, I couldn't quite wrap my head around the residents' ambitious plans for patients:
But in the residents' perspective, I came to understand the head CT was just an expected component of the patient's management -- it had nothing to do with likelihood ratios or pertinent life-threatening conditions that must be explored -- it was simply part of the story for certain patient scenarios, and couldn't be omitted without raising a lot of questions.
This was never more apparent than when I transitioned from the research environment into the clerkships of medical school. The language of decision-making had abruptly changed -- in the lab, a year's worth of experiments is summarized with "seems" and "suggests," and every assertion is carefully calibrated to acknowledge uncertainty and a high standard for proof.
As a student on clerkships, I couldn't quite wrap my head around the residents' ambitious plans for patients:
- "Check CBC, electrolytes, chest X-ray, EKG, oh, and, he needs a head CT."
But in the residents' perspective, I came to understand the head CT was just an expected component of the patient's management -- it had nothing to do with likelihood ratios or pertinent life-threatening conditions that must be explored -- it was simply part of the story for certain patient scenarios, and couldn't be omitted without raising a lot of questions.
- "We should also check a TSH level."
Few patients ever needed a TSH level, as far as I recall -- this wasn't something that would hold up discharge, for instance. But checking thyroid function was often something that should also be done. Again, not because the residents had a firm grasp of the prevalence of thyroid disease in certain populations, but rather, because it demonstrated a thorough workup and, while not an essential or expected part of management, was nice for the attendings to see.
Over time, I gradually adjusted to this very nosocomial interpretation of "need" and "should." Now that I'm an attending, and the students' and residents' plans are a lot more hypothetical (until they get my approval), I'm hearing a little more "want" and "think" and "maybe." For me, it's a welcome return -- a language more in line with my background, and one that acknowledges the uncertainties of medicine.
Over time, I gradually adjusted to this very nosocomial interpretation of "need" and "should." Now that I'm an attending, and the students' and residents' plans are a lot more hypothetical (until they get my approval), I'm hearing a little more "want" and "think" and "maybe." For me, it's a welcome return -- a language more in line with my background, and one that acknowledges the uncertainties of medicine.
Some inner truth of vast reflection
I've seen a couple of examples of this now, so I've decided it's a trend. Naturally I'm going to excerpt something from which to base this post:
A pithy observation is shared, and of course, a link to a prior discussion on Metafilter.
After all this deliberation, I've got to conclude this trend has pros and cons, and a lot of unappreciated nuance. I just hope it turns out alright.
This sentence claims to follow logically from the first sentence, though the connection is actually rather tenuous. This sentence claims that very few people are willing to admit the obvious inference of the last two sentences, with an implication that the reader is not one of those very few people. This sentence expresses the unwillingness of the writer to be silenced despite going against the popular wisdom.I've got further evidence to back this up from this humerous video (though I won't embed it for stylistic reasons).
A pithy observation is shared, and of course, a link to a prior discussion on Metafilter.
After all this deliberation, I've got to conclude this trend has pros and cons, and a lot of unappreciated nuance. I just hope it turns out alright.
Into a void we filled
I had a bunch of difficult shifts midweek last week and a lot of charts to complete, afterward. That, plus some other obligations, and I had fallen behind on emails -- to say nothing of the news. So while I had heard a little bit about the earthquake in Haiti, I hadn't really reflected on it.
Gmail had grouped the following messages last week from CNN -- all sent within a few hours of each other -- into a thread:
This isn't necessarily new territory. But, much like with Katrina, the enormity really only sinks in, for me, when I read physician's accounts from the front lines. Something about comparing the challenges of working in my electronic ED with the endless supplies, state-of-the-art equipment, and an army of readily available specialists, to what these doctors are going through, conveys the horror more than a thousand breaking news updates or footage of crumpled buildings.
Some informative, and responsible, medical accounts are available online (1,2).
Here's a dispatch from a former colleague with ties to the area:
Gmail had grouped the following messages last week from CNN -- all sent within a few hours of each other -- into a thread:
- CNN Breaking News: Hundreds of thousands of people have died in Haiti's earthquake, the prime minister told CNN today.
- CNN Breaking News: President Rene Preval tells CNN that Haiti lacks capacity to hospitalize quake victims, asks for medical aid.
- CNN Breaking News: R+B singer Teddy Pendergrass has died at age 59, CNN has confirmed.
This isn't necessarily new territory. But, much like with Katrina, the enormity really only sinks in, for me, when I read physician's accounts from the front lines. Something about comparing the challenges of working in my electronic ED with the endless supplies, state-of-the-art equipment, and an army of readily available specialists, to what these doctors are going through, conveys the horror more than a thousand breaking news updates or footage of crumpled buildings.
Some informative, and responsible, medical accounts are available online (1,2).
Here's a dispatch from a former colleague with ties to the area:
My husband and I hitchhiked it to port au prince from the domincan republic; the devastation is of incredible magnitude; [X] and I both have family here; his father was pulled from the rubble alive after having been trapped for 16 hours; fractured ribs hand and leg ; his brother and stepmother killed; we are still looking for 2 nephews; [X] and I stay on opposite sides of town since food and water are scarce; we are helping our families to ration; at night we sleep on the roads the only safe place since after shocks are still being felt daily; hospitals have turned away thousands so I care for whomever I can in the meantime; I delivered a baby on the sidewalk this morning; please send this email out to our colleagues and ask them to send whatever resources they can; the various teams deployed have still not covered a large portion of the city that is in need of assistance; I have still not been able to get in contact with my medical mission group for lack of communication.People have been bellyaching about disaster journalism cliches for close to 40 years, but the physician-as-reporter is a new wrinkle that's coming under some scrutiny. From my perspective, I find the physician dispatches very helpful for contextualizing the disaster -- at least, until these doctors' heroics start to become the focus of the story, instead of the lens from which to view it.
Comment te dire adieu
A longtime reader wrote to ask if I had removed comments because they were a relic in this age of facey-spaces and tweety-pages.
That's when I realized my comments had disappeared.
Haloscan, which had faithfully been providing free commenting to this site long before Blogger.com could, is now under the control of another company. There was a warning sent to my email before the holidays that I promptly forgot about. And then sometime after Grand Rounds last week my comments were gone; not with a bang but a whimper.
There was a brief period of panic but fortunately, my login still worked on Haloscan.com and they let me download the 1279 comments blogborygmi has accumulated over the past six years. Folks are working on ways to import these old comments to Blogger. In the meantime, I've enabled Blogger's new (to me, at least) comment features.
Of course I understand after a growth phase, there's a need to convert resource-intensive services into sources of profit, even if it means charging for something that used to be free. I just wonder if the new owners of Haloscan (JS-Kit? Echo?) carefully thought this through:
- They had a small group of early adopters who wanted comments on our blogs, long before a major platform offered them.
- We were happy enough with their service to stick with it, for the better part of a decade, even after more robust (and free) versions were offered by competitors.
- For various reasons, they needed to move us to a flashy new system.
Were they really counting on us to start paying for this unnecessary new service? Or, put it this way: was there no other way to offset the cost of making a few blog veterans happy? It seems like they could upgrade us to the new platform for free and maybe get some positive, genuine word-of-mouth publicity, which I'm told is something bloggers have a knack for. Or, I don't know, maybe they could offset the cost by including advertising -- I've read there's some money in that.
Oh well. An opportunity for them has been lost, and for me, some old lessons have been reinforced. What about you? Feel free to leave a comment below.
Oh well. An opportunity for them has been lost, and for me, some old lessons have been reinforced. What about you? Feel free to leave a comment below.
My one lucky prize
GruntDoc's got a neat little post up how he infers his hospital's census:
These sorts of indicators are fun -- almost as elegant as the Ambient Orb sitting on the desk of Beth Israel Deaconess CEO Paul Levy, gently alerting him to the status of the emergency department waiting room.
Though I can access my emergency department's information system from home, and thus check ED crowding before my shift (if I see lots of admitted patients waiting for upstairs beds, the hospital's pretty full), I rarely do so. I'd much prefer the Orb's distilled, wordless updates to the information overload from our EDIS.
The other day, I got a new kind of indicator about the hospital's census. I had admitted a patient with a history of MRSA to an isolation bed, only to learn a short while later he was ready to go upstairs. This was surprising, as isolation beds are in short supply and patients frequently wait many hours in the ED for one (if not a day or more). In fact, the floor nurse was suspicious I had listed him incorrectly to a regular room, with a vulnerable roommate.
I called our bedboard to make sure they got the right listing. They told me the census was low enough to permit them to turn double-bed rooms into single isolation rooms (in college we called these "dingles"). I don't think I'd ever heard of that happening in our hospital, before -- though like GruntDoc I realized this, too, would pass.
My way to work goes through one of our myriad basement areas, the one where empty beds are stored. I’ve seen literally none, and a lot.
The other night there were so many I couldn’t believe it. Our count is down. This, too, shall pass.Follow the link for dramatic photo evidence.
These sorts of indicators are fun -- almost as elegant as the Ambient Orb sitting on the desk of Beth Israel Deaconess CEO Paul Levy, gently alerting him to the status of the emergency department waiting room.
Though I can access my emergency department's information system from home, and thus check ED crowding before my shift (if I see lots of admitted patients waiting for upstairs beds, the hospital's pretty full), I rarely do so. I'd much prefer the Orb's distilled, wordless updates to the information overload from our EDIS.
The other day, I got a new kind of indicator about the hospital's census. I had admitted a patient with a history of MRSA to an isolation bed, only to learn a short while later he was ready to go upstairs. This was surprising, as isolation beds are in short supply and patients frequently wait many hours in the ED for one (if not a day or more). In fact, the floor nurse was suspicious I had listed him incorrectly to a regular room, with a vulnerable roommate.
I called our bedboard to make sure they got the right listing. They told me the census was low enough to permit them to turn double-bed rooms into single isolation rooms (in college we called these "dingles"). I don't think I'd ever heard of that happening in our hospital, before -- though like GruntDoc I realized this, too, would pass.
Grand Rounds Volume 6, Number 15
Welcome to Grand Rounds, the weekly collection of the best in medical blogging, featuring works from physicians, nurses, researchers, students, patients and healthcare professionals.
It's a new year and I'm very happy to be involved again in organizing this "carnival of the caregivers." Many thanks to Dr. Colin Son for his role in scheduling hosts, and for writing the Pre-Rounds column for Medscape.com over these past 18 months. Special thanks to Dr. Val Jones of Better Health who will continue to promote and plan GR.
This is the 327th edition of Grand Rounds, and navigating web is pretty different compared to when I first hosted. I've been stubbornly resisting social media to help spread the word about each week's location for Grand Rounds, figuring quality writing will find a way to reach interested readers. But when you consider that the Grand Rounds community of patients, providers and pundits is its own kind of social network, it only makes sense to adopt these new tools.
And so, this week, in addition to the RSS feed and Google Calendar, we're rolling out the @grandrounds twitter account, and a Grand Rounds fan page on Facebook.
These (still comically underdeveloped) resources are hardly groundbreaking innovations in 2010, but then again, the blog carnival concept wasn't new when Grand Rounds started in 2004. Your suggestions to keep Grand Rounds accessible and relevant are always welcome, and your continued participation -- as readers, contributors, and hosts -- is essential. Thank you for your involvement over the years, and be assured, even with this expanded social presence, the purpose of Grand Rounds will always be to showcase excellent writing from independent voices in the medical field.
I've loosely organized bloggers' contributions in the categories below, but first wanted to take a moment to highlight my favorite post of the week:
Editor's Choice
Medical News and Reviews
Healthcare Policy Views
Good Medicine for the New Year
Thank you for checking out this first Grand Rounds of 2010. Please visit DrRich at the Covert Rationing Blog for next Tuesday's edition!
It's a new year and I'm very happy to be involved again in organizing this "carnival of the caregivers." Many thanks to Dr. Colin Son for his role in scheduling hosts, and for writing the Pre-Rounds column for Medscape.com over these past 18 months. Special thanks to Dr. Val Jones of Better Health who will continue to promote and plan GR.
This is the 327th edition of Grand Rounds, and navigating web is pretty different compared to when I first hosted. I've been stubbornly resisting social media to help spread the word about each week's location for Grand Rounds, figuring quality writing will find a way to reach interested readers. But when you consider that the Grand Rounds community of patients, providers and pundits is its own kind of social network, it only makes sense to adopt these new tools.
And so, this week, in addition to the RSS feed and Google Calendar, we're rolling out the @grandrounds twitter account, and a Grand Rounds fan page on Facebook.
These (still comically underdeveloped) resources are hardly groundbreaking innovations in 2010, but then again, the blog carnival concept wasn't new when Grand Rounds started in 2004. Your suggestions to keep Grand Rounds accessible and relevant are always welcome, and your continued participation -- as readers, contributors, and hosts -- is essential. Thank you for your involvement over the years, and be assured, even with this expanded social presence, the purpose of Grand Rounds will always be to showcase excellent writing from independent voices in the medical field.
I've loosely organized bloggers' contributions in the categories below, but first wanted to take a moment to highlight my favorite post of the week:
Editor's Choice
- Evan Falchuk of See First blog brilliantly deconstructs the popular new National Geographic chart on health care spending and life expectancies across the world, bringing clarity and nuance to a gross oversimplification.
Medical News and Reviews
- In a timely post for air travelers, Dr. Ves Dimov of the amazing CasesBlog website examines the radiation exposure from full-body scans used for advanced airport security screening.
- The Blog That Ate Manhattan has the definitive take on the new mammography guidelines.
- What killed Franklin Delano Roosevelt? Dr. Ramona Bates sifts through the photos and reviews the evidence behind "FDR's Deadly Secret" over at Suture for a Living.
- Healthline's Teen Health 411 blogger (and recent GR host) Nancy Brown, PhD, reviews new data and concludes parents shouldn't panic about "sexting."
- Smile! Inside Surgery looks at tetanus, part of the continuing series of concise summaries of commonly occurring medical conditions.
- What just happened? Doc Gurley condenses all the medical news of the past year into a hilarious recap: Top 10 Health Lessons of 2009. Read it, lest you be doomed to repeat that bizarre year.
Healthcare Policy Views
- If you're concerned about a nursing shortage, David Williams of Health Business Blog wants to reassure you, by welcoming robots and immigrants to fill the nursing shortage.
- In the latest from his Careful What You Wish For series at InsureBlog, Henry Stern contrasts his wife's recent mammography scare in the US to shortcomings in the UK's NHS system.
- In the US, electronic health record adoption is getting a boost from the government -- providers will receive incentives for "meaningful use" of EHRs. David Harlow of HealthBlawg thoughtfully reviews of the new definitions for meaningful use – a must read for those of us in health care informatics.
- You've heard about patients in Canada or the UK who endure long waits to see specialists -- but did you know that less-educated patients wait longer? Over at Colorado Health Insurance Insider, Louise looks at why socioeconomic status influences wait times.
- Dr. Val has a call to action for preventive health, asking readers to channel their frustrations over healthcare reform into staying fit and trim for the new year. That'll show 'em!
Case Reports / Notes from the Front Lines
- What happens when a son tries to 'drop off' his father, and treats a hospital like the adult Humane Society? The Happy Hospitalist becomes unhappy, and is forced to explain hospital admissions.
- Emergency Medicine blogger Chris Nickson at the Life in the Fast Lane blog writes about an unexpected ending to a family meeting about a dying patient, in his post: Bad News Broken.
- In a very personal post, Todd C. Williams reflects on his wife’s medical care and draws comparisons to his own work in project management.
- Dr. Charles has examined his recommendations for exfoliating soap -- we can scrub off dead skin, but those little plastic microbeads from the soap will come back to haunt us, in surprising and sad ways.
- At a blog called Own Your Health, medical journalist Roanne Weisman reflects on lifestyle choices and a family member's death, and concludes: she didn't have to die.
Good Medicine for the New Year
- Sad that the holidays are over? You can still give the gift of information (and peace of mind). Paramedic, author and businessman Greg Friese describes four methods people can use to compile medical history and emergency contact info.
- A blogging therapist named Will Meek (prediction: large inheritance) reflects on some common blurred thinking from a psychotherapeutic perspective, and offers some simple checks to keep folks grounded.
- Julie from The Doctor’s Rheum brainstorms some creative and inexpensive ways to address excuses for lack of exercise in the new year.
- Dr. Jolie Bookspan recaps readers' success stories from the past year in her Fitness Fixer Reader Hall of Fame.
Thank you for checking out this first Grand Rounds of 2010. Please visit DrRich at the Covert Rationing Blog for next Tuesday's edition!
Call for submissions -- Grand Rounds @blogborygmi on Tuesday January 5
The first Grand Rounds of the year will appear here, at blogborygmi.com, on Tuesday morning.
The deadline for submissions will be Monday 1/4/0910 at 11:59 PM EST.
Please review the ancient but still relevant submission guidelines and email a link to your best recent writing to nick -at- blogborygmi.com, with a short description.
Also, please -- if you'd like to try your hand at hosting, or know of a blogger who'd make a great Grand Rounds host, please let me know. It's a wide-open year ahead of us.
Finally, if you've got suggestions for improving Grand Rounds -- social media integration, organization, anything -- I'm happy to listen.
The deadline for submissions will be Monday 1/4/
Please review the ancient but still relevant submission guidelines and email a link to your best recent writing to nick -at- blogborygmi.com, with a short description.
Also, please -- if you'd like to try your hand at hosting, or know of a blogger who'd make a great Grand Rounds host, please let me know. It's a wide-open year ahead of us.
Finally, if you've got suggestions for improving Grand Rounds -- social media integration, organization, anything -- I'm happy to listen.
Subscribe to:
Posts (Atom)