Archives for November 2010

Narcissistic Personality Disorder No Longer in D.S.M. –


Narcissistic personality disorder, characterized by an inflated sense of self-importance and the need for constant attention, has been eliminated from the upcoming manual of mental disorders, which psychiatrists use to diagnose mental illness.

via Narcissistic Personality Disorder No Longer in D.S.M. –

So. blogging is normal then?  Kinda takes the fun out of it…

Man who lost his sight every time he had sex | Mail Online

A man was forced to seek medical help after going temporarily blind every time he had sex.The unnamed patient would lose his sight every time he climaxed during intercourse.

via Man who lost his sight every time he had sex | Mail Online.

And you think you have problems.

Interview with Dr. Flea « ScienceRoll

Interview with Dr. Flea « ScienceRoll.

Interesting interview with Flea, an early medblogger and the definition of beware what you blog.  Read the interview for the lowdown on that…

He’s wrong about not blogging anonymously.  I think he means not to blog like you’re anonymous, which is a different thing…

Anyway, good for Berci for getting the interview!

Sergeant Friday on the TSA searches

Just the facts, ma’am.

We could use more Joe Fridays.

amednews: Editorial – Welcome to our archives :: Nov. 22, 2010 … American Medical News

Most of that older content has been behind an access-control wall. By knocking down that barrier, we are making available 10 years of full content and several years more of selected earlier articles. All told, about 15,000 articles now can be searched and read.

We invite our readers to visit the archives and link to our articles from their own sites, blogs and posts.

via amednews: Editorial – Welcome to our archives :: Nov. 22, 2010 … American Medical News.

Thanks, AMedNews!  I suppose an I told you so would be rude, so, I won’t.

AMA Policy on Social Media

New AMA Policy Helps Guide Physicians’ Use of Social Media

For immediate release:
Nov. 8, 2010

SAN DIEGO – Millions of Americans use social networks and blogs to communicate, but when those users are physicians, challenges to the patient-physician relationship can arise. New policy adopted today by the American Medical Association (AMA) aims at  helping physicians to maintain a positive online presence and preserve the integrity of the patient-physician relationship.

It’s not surprising there is some guidance on social media from the AMA.  I suppose the only surprise is that it took this long.

Follow the link above to read the policy, which I find remarkably reasonable.  I have some litle heartburn about this one:

(e) When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.

Plenty of thoughtful people disagree with things I’ve written (and a few unthoughtful folks disagree with everything), but I’m not a fan of giving AMA blessing to harass. 

Yes, there’s some things written out there I’m not a big fan of.  I take it as a sign of strength that we can disagree but not make a federal case of it.

And, for you aspiring to get into a professional school, f) is not just for practicing physicians:

(f) Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students), and can undermine public trust in the medical profession.

You’d have to go a long way to damage the medical profession, but it takes one facebook post to damage yours.  “Dude, I was so wasted when I…” doesn’t instill confidence in you or your judgement.  Just putting that out there.

So, rare kudos from me for the ever-shrinking AMA.

Another satisfied ABEM Diplomate

I get emails after bemoaning the inefficient / laughable requirements being imposed by ABEM for continuous certification, and while I thank them for writing I’m not interested in being the Lonely Critic who Wails at ABEM.

So, allow me to publish (with their permission) someone elses’ lament at the current state of ABEM:

Thank you so much about your column about ABEM! It is making me feel like I am not the only one going thru this. We have 150 hours of CME required now, 4 through my state, 8 through my insurance, and now I find we can’t count the LLSA’s as continuous ed! Plus the articles in LLSA are horrible.

I took my CONCERT this year and the scores still aren’t out 8 weeks later for a computerized test. Someone needs to rise up against ABEM, they are not our advocates. I felt like maybe ACEP can help but I don’t think they can. ABEM I think is run by a lot of ivory tower guys who work 4 shifts a month in a University Hospital with the residents doing all the work. Thanks again for your columns!

One of my colleagues recently took the recertification test, which is now computer-based, and his description was less than flattering. “It’s like they scanned a photograph of a slide, and then uploaded that for the test”. He’s also about 8 weeks out from the test, and awaiting his scores…

I don’t want to be the anti-ABEM forum (is EMED-L still around?) but when I get emails like this it tells me I’m not alone in wanting ABEM to perform better. Significantly better.

Imagine Medicine: The Photography / Photoshop Contest

Medicine rocks! It makes the sick heal, pain go away, and healers proud and happy. Medicine is an art, where the instruments are medical technologies, warm hands, and learned minds. Many of us see medicine everyday: in ERs, ORs, ICUs, PACUs, PICUs, and SICUs. We see medicine through our eyes and our hearts. But what about your camera?Welcome to the Imagine Medicine contest! We are looking for fascinating medical photography that… imagines medicine. Nothing is off the table: portraits, group shots, happy shots, tragic shots, clinical shots, photoshop illustrations, macro, micro, and anything in between. Can you imagine medicine, showcase it as art, and make us wonder?Here’s the lowdown. The contest is open to all. Upload your photographs to Flickr, and tag them with “imaginemedicine” and “medgadget” keywords. Make sure you add at least one sentence describing your work. The deadline for submissions is 11:59pm ET on December 5, 2010. The winner will be announced on December 10th and the prize is a brand new 16GB iPad with Wi-Fi.

via Imagine Medicine: The Photography / Photoshop Contest.

MedGadget is having another contest.  This time, though, it’s not medical fiction (which was a lot of fun to read and judge) but is medical photography.

An iPad is first prize, and I’m please to be one of the judges.

Hie thee over to MedGadgets‘ place, read the rules, and get to snappin those photos!

The NNT | Quick Summaries of Evidence-Based Medicine

The NNT | Quick Summaries of Evidence-Based Medicine.

I think I blogged this before, but didn’t describe it much.  Allow me to rectify that mistake. is an ever expanding site which boils down high quality reviews of medications and interventions, and presents its recommendations in a very much more approachable grren/yellow/red/Warning triangle format rather than some ratio.

While I won’t use this as a single source to change my practice I’m going to have to do some more research on some ofht eh shibboleths of our age ( Octreotide for variceal bleeding, PPI infusions for Upper GI bleeding, etc) are just two of the studies that fly in the face of current practice.

An aside: while inhaled corticosteroids for asthma aren’t beneficial in the review, what it doesn’ tell you is that the Feds think it does, and will grade your asthma care on how many of your asthma patients get a prescription for them.  So, be aware.

Graham is behind this, and good for him.

retired doc’s thoughts: What are the plans of Don Berwick’s “leaders with plans”?

retired doc’s thoughts: What are the plans of Don Berwick’s “leaders with plans”?.

Wow.  I’m speechless.

Thanks to Retired Doc for getting this out in a cogent summary.

Happy Birthday, Marines!

I post this every year, and I still enjoy it…
original poster from:

Yeah, I was Navy, but spend 4/5 of your time with the USMC, and you identify. (Insert Stockholm syndrome joke here).

I kid, because I deeply respect. Happy Birthday, Marines.

Eye Dr DeLengocky: A second medical school in Fort Worth is a misplaced priority

…It is obvious that the priority of addressing physician shortages in the area is to develop new residency opportunities, not increasing the number of medical students. Therefore, the push for a second medical school on campus with a class size of 100 students is a travesty and misplaced effort.

via Eye Dr DeLengocky: A second medical school in Fort Worth is a misplaced priority.

A good article by a DO against a Fort Worth MD School, with a good point: what we need more are residency slots, not a new school.

This also ignores the elephant in the room, that hospitals don’t want Osteopathic residencies as there’s still a stigma (which is not justified but that is real).  I believe that’s the reason behind the allopathic push, with the not unreasonable belief that hospitals will be more amenable to opening MD residencies.

Still, a good blog post by a medblogger I was unaware of, and it makes very good points.

Scientists turn skin into blood in medical breakthrough; could help cancer treatment | The Australian

STEM cell researchers have found a way to turn a person’s skin into blood, a process that could be used to treat cancer and other ailments, according to a Canadian study published today.

The method uses cells from a patch of a person’s skin and transforms it into blood that is a genetic match, without using human embryonic stem cells, said the study in the journal Nature.

via Scientists turn skin into blood in medical breakthrough; could help cancer treatment | The Australian.

Wow.  Very cool.

I wonder if, hopefully, someday, this could be a replacement for random blood donation?

Lawmakers Discussing Dropping Health Care Program — Health Reform and Texas | The Texas Tribune

Some Republican lawmakers — still reveling in Tuesday’s statewide election sweep — are proposing an unprecedented solution to the state’s estimated $25 billion budget shortfall: dropping out of the federal Medicaid program.

via Lawmakers Discussing Dropping Health Care Program — Health Reform and Texas | The Texas Tribune.


Welcome to entitlement reality, Texas-style.  Currently 20Bn/year and going to go up with expanded eligibility, the article does say the Feds pay 60%, but doesn’t say: 1) it’s temporary, then the Federal contribution goes down or away, and 2) the Federal component doesn’t come from magical money fairies, it’s money takes from taxpayers then funneled back into a particular program.

Medicaid is not loved or respected in Medicine.  Decreasing reimbursements coupled to increasing requirements mean it’s at a minimum inefficient for both patients and providers.

I’m not against kicking Medicaid to the curb PROVIDING the state has some kind of replacement program.  Which I’m not sanguine about.

How to make Oral Rehydration Therapy fluid

Doc Gurley (who’s been going to Haiti since at least the first earthquake relief started) wrote a post today about cholera (currently hitting Haiti hard).

She found there were very few YouTube videos about how to make Oral Rehydration Therapy (ORT) fluid, which is the mainstay of cholera treatment.  Simply put, if you can replace orally what you’re losing from the far end, you get to live.  It’s cheap, it’s easy, but you have to know what to do for it to work.

ORT is super cheap and amazingly easy to make.  Thanks to Doc Gurley, there is now an illiterate (as in language independent) how to video: Recipe for Life!

While it seems graphic, I think it makes perfect sense.  Here’s hoping it helps!

Per Doc Gurley, swipe the video!  Repost it everywhere!  She says Haitians have cell phones, and the more universal this knowledge is the more likely it is to help.