Doc Rob: Unplugging

I have made a very big decision: I am going to unplug myself from the internet world for a while.  That means that I am hanging up my blogging for now.

via Unplugging.

I’m not going to swipe any more of his post, go have a read.

He’s been a good, prolific blogger with smart thoughts expounded in an entertaining way.

I speak for many that I hope he returns with his humor and voice intact, but even if he doesn’t we’re the better for having had him for this long.

Thanks, Dr. Rob, and enjoy the Llamas.

Captain Atopic : Degranulated: Full Time.

Sunday, December 19, 2010 by Captain Atopic

So this is it; During the course of this wee blog, I had several ideas about how to wrap it up- the range from just disappearing to a protracted series of farewell posts.

Like a long list of medstudent bloggers, I’m pulling the pin now that I’m finished. My aim with Degranulated was to blog weekly until graduation, and, well, that’s where I am.

via Captain Atopic : Degranulated: Full Time..

It was a good ride.  I predict Captain Atopic will return, though in the Residency form.  And if not, we still got the free entertainment.

Thanks, Captain Atopic!

Mom | The Blog That Ate Manhattan

We tried, Mom. We tried so hard.

via Mom | The Blog That Ate Manhattan.

A Beautiful, Loving Tribute.  I mourn your loss.

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!

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.

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.

theNNT.com 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.

Online doctor ratings aren’t very helpful – USATODAY.com

By Kevin Pho

When I ask new patients how they found me, frequently they say on the Internet through search engines such as Google.Out of curiosity, I recently Googled myself. Numerous ads appeared, promising readers a “detailed background report” or a “profile” of me. Among the search results was information about my practice, whether I was board certified, had any lawsuits against me, and reviews from online doctor rating sites. Thankfully, most were favorable, but some were not.

via Online doctor ratings aren’t very helpful – USATODAY.com.

Kevin, MD, who else?

Great work Kevin!  (I shook his hand once, might have been my brush with fame).

ACEP Scientific Assembly 2010 wrapup

I was a little concerned about whether I’d like going to the big yearly ACEP meeting, as I went to a couple of the spring conferences and found them lacking in experience, but the last of those was last several years ago.

This time I decided it was the right thing to do, and hoped I’d be able to socialize a bit.

Mandalay Bay was very nice, if laid out Texas-sized.  It was a 10 minute brisk walk (all indoors) to the three story conference center, which was nice and cool despite the reportedly radioactive heat outside.  There were a lot of exhibitors, and they were knowledgeable and professional.

First, the personal highlight, meeting the EM medbloggers!  I got to meet Shadowfax of Movin’ Meat, Nick of Blogborygmi, Graham of Grahamazon (and now The NNT), Symtym, Richard of his epononymously named effort, and WhiteCoat of Whitecoat Rants (who I thought had acromegaly, as opposed to Shadowfaxes’ remembrance of him as a little person…).  (We tried to take his picture but apparently he’s natively pixellated…).  We had individual and group meetups, and except for being remarkably better looking than the other attendees you couldn’t pick us out of a crowd.  Mark and Logan Plaster of EP Monthly were of course very nice (and flattering), and I also got to meet Edwin Leap, but I’m not sure he knew who I was as I didn’t use my pseudonym…

I also enjoyed the Fresno residency get-together, catching up with resident friends and faculty.  There’s something about those friends – hadn’t talked to some in years, and we picked up like we’d last talked 30 minutes before.  It’s probably the shared intense years, but it was remarkable.

Surprisingly, a few people at the meeting had heard of my blog, and one, who was also twittering from the same conference sought me out to have our picture made together!  It was interesting, fun, and humbling.

Speaking  of twitter, I tweeted the meetings I attended (I was tired and bagged the Friday morning meetings), and I guess I went a little tweet-nuts: according to @takeokun I had 281 tweets for the Tuesday, Wed and Thursday meetings.  I tried to post the highlights of the meetings; you can take from that number there were an awful lot of highlights!  For my tweets, which are part of my normal twitter stream look here, and for all 826 tweets from the Scientific Assembly, look for them under their hashtag: #sa10.

I wanted to hone-down the true practice-honing pearls, but there are so many I’ll just throw out the ones that come from the top of the mind:

  • single unit blood transfusions are now perfectly fine, the ‘two-unit rule’ is dead
  • hip dislocation reduction: use the Captain Morgan technique. Stand beside the bed, fix the pelvis to the bed, put your foot on the bed, put the patient’s affected-limb calf over your leg (right up to the knee), and reduce by flexing your ankle.
  • nursemaid’s elbow reduction: hyperpronation, not the supinate-flex manouver.
  • to more easily reduce an ankle dislocation, flex the knee first
  • in ITP, you can give Rh POS patients rhogam (the antibodies coat the platelets and help prevent splenic sequestration and destruction)
  • 90% of pts held in both ED hallway & upstairs hall preferred upstairs. “we think the other 10% liked being able to go smoke”
  • “medicine is acting for ugly people” – Greg Henry
  • Key clinical picture in thyroid storm is a tachycardia way out of proportion to their fever.
  • Lid lag in hyperthyroidism: see the sclera when pt looks down, think hyperthyroidism.
  • In thyrotoxicosis can use Li instead of iodine if they’re intolerant, as it has the same mech of action.
  • “if the patient sees nothing and the doctor sees nothing, think retrobulbar neuritis”.
  • “before you write anxiety as a diagnosis, remember, people get real anxious just before they die”.
  • “I don’t understand why you would pay money to have someone rub your back; I understand why you’d pay to rub your front.” Greg Henry.

You get the idea…

I had fun, and will be going next year.  We need to get more attendees twittering the meetings they’re in.  (My iPad was the perfect tool for the job).  EM docs, get ready for next year, and get ready to twitter while you’re there!

Why a doc might want to blog anonymously

Yesterday came another of the tiresome ‘all doctors should blog using their own names, not anonymously’ blog posts, with the predictable reasons cited: nobody will take the anonymous blogger seriously, and because I’m a doctor and I said so.  Never underestimate the Physicians’ belief that what they believe is correct, even (especially) if it’s out of their sphere of training.

If you’re a doc in private practice, trying to build a practice and make a name, use your name, and have fun.  If you have a burning desire to change the world, and feel that you have deep points to make the need to be taken seriously, use you name.  Embrace being googleable!

However if you’re a hospital-based doc, or you’re blogging to entertain yourself, you mom and 9 people with nothing to do, there’s no real reason to use your true identity, and several not to.  Your hospital, contracting company or hospital might not like the idea you’re blogging, even if you never say anything bad about your colleagues or the joint.

I tell everyone who asks how to start blogging to start anonymously, as a) you’re going to be new to it and might type out something you’ll want to disown, and anonymity can help you avoid repercussions of the permanently-cached world, and most find they have 6 posts burning in their brain, get those done, get bored and quit.  A pseudonymous blog is really easy to quit.  (Allegedly, I have yet to try myself).

I fit paragraph 3 here, by the way, and have no pretensions to change how the world works, and absolutely never want anyone who reads this blog to think it’s medical advice (hint, it’s not).  Also, you have to take my word for it I’m a doc, and it’s not all that important to me anyone think I am a doc when reading my posts.  Am I a doc?  Yes.  Do I care to drop the pseudonym to prove it?  No, why would I?

And the sadly obligatory: if you’re blogging pseudonymously to say bad words about your boss, denigrate your patients (beyond pointing out the usual irritations), because your mom didn’t love you and you need therapy, or you just love to type f-bombs, reconsider.  There’s no such thing in the long run as anonymity on the internet, and you’ll be found out if there’s enough motivation.

So, there are many ways to be a doc, and many ways to blog.  It’s not a one size fits all world.  Just do it the way you want.

SanDiegoNavyDoc

They call me “Doc…”

Tuesday, August 18, 2015 Posted by admin at 9:06 PM |

It is difficult sometimes to describe to people just what it is that I’ve done for a living in the Navy. It is especially difficult to talk to civilians about my job because they have no concept of even my basic skills, but even to people in military medical occupations it is hard to explain.

via SanDiegoNavyDoc.

In case y’all aren’t reading him, you need to.  Add him to your daily reads, please.

There’s been a Panda Sighting

I am an Emergency Physician and every day I go down the rabbit hole into the insane world of American Medicine.

via M.D.O.D.: My Favorite Year.

He’s over at MDOD.  Hasn’t lost his touch with the truth.

Running a hospital: I was wrong. I am sorry.

I’ve been able to study Paul Levy’s management of BIDMC during several classes (more on that someday), and he’s a smart guy.  Which makes this dumbfounding, if humanizing:

The Board of Directors of BIDMC today issued the following statement, which has been distributed to the media and to the entire hospital community.

The Board of Directors of Beth Israel Deaconess Medical Center, with the assistance of outside counsel, has completed its review of allegations made involving President and CEO Paul Levy. The review focused on a personal relationship with a former employee of the Medical Center. The Board found that over time the situation created an improper appearance and became a distraction within the hospital.

via Running a hospital: I was wrong. I am sorry..

Good for him, and I doubt this is going to be enough.  There’s a scandal worth and immediate $50K penalty and the threat of more in contract negotiations.

Time to call Oprah, or something, and do it All at Once.  Get it all out (and don’t hold back, a la Tiger), etc.  People will forgive bad judgment, they will pillory you for a cover up.

It’s going to come out, so Just Do It.

GruntDoc is Eight today

Eight years ago today, this inauspicious effort began.  I had no idea where it would go, where it would take me, how long it would last, or what I’d do with it.

Time hasn’t answered any of those questions, except ‘at least 8 years’.

Thanks Mom, and my other 9 readers, for checking in now and again.

Who are you, my audience?

From Alexa.com:

That’s a good crowd.  Thanks for coming!

Lesson Over a Latte // Emergiblog

Some of our patients are made, not born…

(The story you are about to read is true.)

The day was uncharacteristically warm.

via Lesson Over a Latte // Emergiblog.