Archives for September 2005

Best Chief Complaint of the night

"I smoked Marijuana, and now I feel funny".

Welcome Back

Okay, you’re now on the new Movable Type version of GruntDoc.  It’s not that TypePad was bad (it wasn’t), it’s just that I got tired of not having to deal with the issues of having your own blog on your own shared hosting server.  And the Tinkering (noodling, my wife calls it).

What you should notice: not much, really.  The best thing about this change is that I’m back to the native MT search function, which works terrifically well, much much better than the Technorati or Google blog searches.

There are things that don’t work perfectly well (yet), like the blogrolls not appearing in the category pages.  I’m working on it.  That’s why I switched back! 

Oh and the new NavBar above.  I’ve updated the About page, and the Archives look a lot better.

Please let me know about significantly broken things. 

AAFP and NoFreeLunch reach an agreement?

Well, it seems sanity will break out now and then…

Notes from Dr. RW: AAFP changes its mind about No Free Lunch

AAFP changes its mind about No Free Lunch
The AAFP apparently did an about face and decided to open its doors to No Free Lunch. I’ll have more to say about this soon.

Let’s see how this turns out.

MedBlogs Grand Rounds 1:52

It’s up: SoundPractice.Net.

Grand Rounds by tradition has to include at least one Sir William Osler quotation. So let’s get the quote from the ideal 20th century physician out of the way:  "The good physician treats the disease, but the great physician treats the patient."

That’s quite a good quote, but for the record, the only quotes I’ve had as a host were Monty Python.

It’s been a full year of Grand Rounds!  Congrats to all!

No Free Lunch Exposes Pro Society Double Standards (or worse)

Well, now.  I like the No Free Lunch idea, but haven’t seem anything organized where I am.  However, Dr. RW has, and it seems at least a couple of professional societies have some explaining to do:

No Free Lunch
has been knocking on the doors of exhibit halls at national doctors’
meetings lately. They believe the abundance of pharmaceutical company
displays, gifts and “detailing” at these meetings could have a bad
influence on doctors and would like an opportunity to do some counter-detailing, but so far the doctors have said “no, thanks.”
Recently the American Academy of Family Physicians refused to allow No
Free Lunch to operate an exhibit at its upcoming annual meeting.

this year the American College of Physicians (ACP) refused a similar
request from No Free Lunch to exhibit at its meeting….

Go read the whole thing.  I’m pretty sure my professional societies wouldn’t fare much better.

Physician-Desk-Reference weirdness

This is really strange, and I wonder if anyone can help me figure it out.

Scanning my Technorati watchlist (vanity: it tells bloggers who is linking to them) today I noticed quite a lot of links from a site called "Physician-Desk-Reference", which is apparently not associated with the actual PDR that’s used as a source of last resort when looking up medications.

Looking at the site it occurred to me that I’d seen these posts before, ALL of them, as I’d written them.  This site is reposting my posts with about a 5 day delay, then linking to me as "more" at the end of the entry.  I have no idea why anyone would do this.  The contact info on the front page is blank, so I cannot ask whoever set this up.  (I didn’t and this isn’t an inside job if you’re wondering).

Here’s a screenshot of one entry there:


The PDR rips off GruntDoc

So, help a blogger out.  Why would anyone do this, and what should I do about it?  It’s not really ‘objectionable content’ from the Blogger standpoint (my writing style and topics notwithstanding), so I haven’t reported the site to blogger.  Let me know why someone would do this and what, if anything, I should do about it?

Finally! A Cure for Adult ADHD

Medicine is notoriously short on cures.  Oh, we can treat symptoms, but cures for most things are hard to come by.  But, now a cure is at hand for "Adult ADHD":

One of the
toughest things about being a teacher is dealing with all the latest ‘syndromes’
in our culture of victimization. Whenever a real problem like racism diminishes,
there is always someone willing to redefine the problem to help maintain the
population of ‘disadvantaged’ Americans. This is usually followed by the
invention of a new problem that actually increases the population of
‘disadvantaged’ Americans. Consequently, victimization has become a growth
industry that supplies more jobs for social workers despite their increasing
irrelevance in relation to the real problems of modern society.

Often those fictional problems take the form of ‘disorders’ like adult ADHD.
I always know which of my students have been told that they suffer from adult
ADHD. They are often late and sometimes leave class early to go potty, unlike
most students who go potty before class begins. They blurt out the answers to my
questions constantly – always without the courtesy of a raised hand. And,
usually, they fall asleep in class (probably from exhaustion) after the
fifteenth or twentieth interruption. Later, they are awakened by the cell phone
they forgot to turn off before arriving in class.

But, fortunately, I have discovered a cure for students with this so-called
disorder, which I am now sharing (free of charge, mind you) with my readers.
Here’s how it works.

You’ll have to read it to find out.

via Shrinkette, whose carpal tunnel must be getting better (but probably not cured).

Update 5-4-06: The url moved: In case it moves again, I’ll put the whole thing in the extended entry.
[Read more…]


Well, I didn’t post a thing yesterday, and it’s because I’ve been distracted.  (Inner voice: the blog is a distraction, all that other stuff is life).  (Other inner voice: quiet, you).

I’ve been tinkering with restarting my MovableType hosted blog, and it’s ready to go.  It’s so ready you shouldn’t notice the change, as it’s very nearly identical to what you’re seeing today.  If I can get a plugin to work it’ll have some nice editing features for both me and commenters, but it’s in the ‘debug’ phase.  Yes, I was glad to go to TypePad, but miss the frustration of fiddling behind the scenes.  The reason I haven’t moved over yet is that I get non-stop 500 errors with rebuilding, and I don’t trust the blog to be hosted on MT until I can do the rebuild without serial crashes.  So, there’s some of my time.

And, I just got a mini-mac.  It’s pretty slick, and it is different.  I’m not ready for the Kool-Aid, but it’s a neat computer.  But, Safari won’t import OPML?  What the heck?  And, apple-heads, what are you using as an RSS reader?

Anyway, that’s why there’s not much going on here.  Again.

Dr. Mattox, day 14

via Code:theWebSocket:

From a social science standpoint, we are seeing a transformation in attitude
among many of our new citizen guests, only about 4000 of whom remain on site.
They have been totally treated with respect, and they are changing many mental
attitudes. Some who come from three generations of parents who cannot read or
write, are now saying, “You have treated me as a human for the first time in my
life, I wish to be a contributing member of society, can you enroll me in
school?” We then enroll them. Someone who is much smarter than me MUST began to
write up the social science part of this operation, There is an ACUTE change, an
intermediate development, and then we must monitor what is happening long term.
I recognize that there are pessimists and skeptics on this list server, but
believe me, I think this is a fantastic new beginning of a whole new wave of
social change. If we assume a welfare state, it will happen. If we assume that
with the destruction of a city (like the burning of Atlanta during the war
between the states) a new and even better society can be developed, then the
appropriate changes can occur, in health care, economics, government. Who knows,
the Napoleanic code of Louisiana government may be changed.

Go and read the whole thing.  He’s also very skeptical of the research going on now with the evacuees, and that’s worth noting, too.

(hehe.  the spellchecker doesn’t like "thewebsocket", and recommended "thwacked" as a replacement). – As Angry Patients Vent Online, Doctors Sue to Silence Them – As Angry Patients Vent Online, Doctors Sue to Silence Them.

Doctors have long accepted that their patients share opinions about the care they have received, knowing that satisfied patients will refer others while those not so happy with their bedside manner might encourage prospective customers to seek treatment elsewhere. But when William Boothe, an ophthalmologist in Texas, saw that one disgruntled former patient was posting his complaints on the Internet, he launched an aggressive response. He sued for libel and other claims, and earlier this year a state judge ordered the material removed from the Web.

The case is one of a growing number of legal battles being waged over Internet postings about medical complaints. More patients are taking their opinions of their local doctors to the Internet, and a wider audience, and that has some medical providers on edge. Several Web sites have sprung up that encourage patients to post anonymous reviews of doctors and dentists, and some frustrated patients have created entire Web sites to criticize specific physicians.

"The potential problems are huge," said Matt Messina, a dentist in Fairview Park, Ohio, and a spokesman for the American Dental Association. "My reputation is my stock in trade … and we work years and years to build that reputation. To have that shattered potentially [by an Internet posting] is a concern."

Patient advocates, meanwhile, say patients have First Amendment rights to describe their experiences with physicians. "Blogs and personal Web sites are no different than talking over the back fence," said Charles Inlander, president of People’s Medical Society, a patient advocacy group in Allentown, Pa. "Those who read it have to take it with whatever grain of salt you would take, just like a neighbor. It’s too bad if doctors are insulted by this."

I think we all have a very negative view of ‘silencing’ speech, which to me always sounds like bullying.  But, there is speech that needs to be held to a higher standard, and that’s what this is about. 

OK, I’m not a lawyer, nor do I pretend to be.  However, writing about specific, identifiable people on the internet is, to me, a First Amendment right.  It’s also confers a responsibility to get facts right, and that’s where the libel thing comes into play.  (I think chatting over the fence is fine, and that’s slander, and nobody really cares about that providing it doesn’t make a ot of waves; when your libel about a professional with a reputation at stake shows up in a Google search, that’s a whole other level).

Read the article, which except for a sexed-up title isn’t badly done at all.

via Slashdot

Real Stories of Hurricane Katrina

via MedPundit, here are several reports from medical relief workers in the Katrina area: Real Stories of Hurricane Katrina, by WebMD, which seems to be taking off.  It’s certainly supplanted the late News for me.  (Background on the AMA snark here).

Active euthanasia in New Orleans: An urban legend in the making?

Orac has put more thought into the out-of-left-field tale of active euthanasia allegedly occurring in New Orleans hospitals during the flood : Respectful Insolence (a.k.a. "Orac Knows"): Active euthanasia in New Orleans: An urban legend in the making?.

I am in agreement with him, that a lot of this just doesn’t pass the smell test, and that’s not a New Orleans clean-up joke. 

Sneezing Po has Grand Rounds 1:51

Sneezing Po has this weeks’ roundup, organized as a "virtual gallery".  Another excellent assortment.

After the Storm: ACEP and AAEM

ACEP’s recovery website: After the Storm.

ACEP continues to be concerned about its members and their families who have been affected by Hurricane Katrina. Now that the storm is over and the recovery phase is beginning, we will provide you with information to help you regain your footing, find employment, relocate, and other resources as you recover from this disaster.

It’s pretty good, and there’s lots of good information and links in there for the EM docs and residents affected, or who want to help.

Contrast that with my preferred organization, AAEM, and this terrificly informative bit on their site:

Hurricane Katrina

AAEM Board of Directors is meeting in Nice, France as part of the Third
Mediterranean Emergency Medicine Congress. A statement to the
membership about the AAEM planned relief efforts for hurricane Katrina
will be posted next week. Please stay tuned to our website for more

So, ACEP’s site is filled with useful links, and AAEM wants everyone to know they’re thinking about it from France.  Not a good way to recruit.

The Big Off

Well, it comes to all cyclists, and today I had it.  The Big Off.

There’s a long story here, but basically I had a touch of brain fade and bad luck at the same instant.  The next thing I know I’m slapping the left side of my entire body, including my over-rated head, on the concrete.  I’m fine, and except for a couple of abrasions and a forehead bruise the shape of a helmet pad, I’m none the worse for wear.

Basically, I drove off the narrow concrete path.  There was plenty of grass, but I inexplicably cut back toward the pavement and hit a nice deep groove.  It was then I rediscovered one of my brother’s sayings, ‘gravity never sleeps’, and hit the deck.  Hard.  The sound of my helmeted head hitting the ground couldn’t have been louder outside my skull than inside, and though I had a millisecond light flash surprisingly I have had no ill effects.  Not even a headache.  Finished the ride, which included adding some mileage before the turn around, and proved something to myself.

My bike, alas, looks like I dragged it over concrete.  Both Ultegra shifter covers are deeply scarred, and both rims have scratches on the left side, making interesting sounds under braking.  I figure nothing expensive was bent, which is good.  Oh, and I get to throw away the jersey I didn’t like due to the holes, so there’s always a silver lining. 

The helmet, a one-time-use item did its duty.  Its exterior shell looks like it met concrete, but the inner liner has the telltale cracks in the styrofoam, so that’s that.  I’d like to thank the nice folks at Giro, who made my helmet and will be the manufacturer of my next one.  Spend money on your helmet like your brain depends on it.  Mine did, and does.  As one of my residency colleagues used to say, "get a helmet, and wear it".

If only this immunized me from future spills.   Heh.