Wednesday, May 30, 2007

The Big Donor Show

Just when I think I've seen it all in reality television, Amsterdam, Netherlands has something totally new and off-the-wall. The prize is not $1,000,000 or glamorous trips around the world. The prize? A kidney. Yes, that's right, a kidney.

According to this Associated Press story, the show centers around a person that they're calling "Lisa." Lisa is a 37 year-old with an inoperable brain tumor and subsequent terminal illness. During the show, she will talk with and interact with three individuals who are candidates for kidney transplants.

Producers of the telecast (called the "Big Donor Show") want to highlight the shortage of kidney and other organ donors. One government official would like the Dutch parliament to block the broadcast. A network official had this to say...
"We know that this program is super controversial and some people will think it's tasteless, but we think the reality is even more shocking and tasteless: waiting for an organ is just like playing the lottery," Laurens Drillich, chairman of the BNN network, said in a statement.

He said waiting lists in the Netherlands are more than four years long and 200 patients die annually for lack of a donor.
If that's not bad enough, the article goes on to say that "Lisa's" wishes may not even be observed and carried out...
A spokeswoman for BNN said that there could be no guarantees the donation would actually be made, "but the intention is" Lisa's donation would be carried out before she died.

That is because her wish to donate to a particular candidate "wouldn't be valid anymore after her death" under Dutch donation rules, Marieke Saly said. If Lisa does donate one kidney while living, the other kidney may still be awarded to someone else on a national donation waiting list under the country's organ allotment system.
Wait. It gets even better and more outrageous than that. If you can believe this, government weezels are hesitant to block the broadcast in the following statement in the AP article.
Education Minister Ronald Plasterk, addressing parliament on behalf of the government because the health minister was ill, replied that there were serious questions about whether the transplant would actually go through as BNN has advertised it — but that there was no way to stop the program from airing.

"The information I have right now tells me that the program is unfitting and unethical, especially due to the competitive element, but it's up to program makers to make their choices," he said.

"The constitution forbids me from interfering in the content of programs: let there be no mistake about that, that would be censorship."
Censorship? Are they kidding? Is it censorship to have a game show to determine who gets the kidney of a terminally ill patient? Is it censorship to parade out a terminally ill patient, and have her interview three individuals with kidney failure, only to have her wishes potentially denied?

This is ridiculous and scary if you ask me. It will be interesting to see how this Big Donor Show all plays out. I wonder if network executives in this country would touch a concept like this one. What's sad is that they are probably watching this Dutch story closely to see if there is any public outrage over there. If not so much, then maybe someone in the US would try this stunt of a game show.

Tuesday, May 29, 2007

Fat Doctor Is Back

If you haven't heard already, Fat Doctor, the self-described famine resistant family physician, is now back up and running over on wordpress. In case you haven't seen, she's also posted on the I'm A Blogaholic blog as well in the past week. So, head on over and say hello. She'll be glad to hear from you.

In other news, I joined this evening. At the request of my fair lady FD, I checked it out. It looks like of interesting. I don't know if I'll use it that much, but we'll see. I'll even put it in my sidebar like other people have done to see how much interest there is. I would encourage you to check it out, and check out my twitter profile as well.

The Kevorkian Effect

To some, Dr. Jack Kevorkian is a hero, and to others he is a villain. But, no one can dispute that he brought the issues of end-of-life care and physician-assisted suicide into public debate.

According to this article from the Associated Press, he will be released from prison on June 1st after serving more than eight years of a 10-25 year sentence for the death of a Michigan man.
He used a machine he'd invented to administer fatal drugs and dropped off bodies at hospital emergency rooms or coroner's offices, or left them to be discovered in the motel rooms where he often met those who wanted his help.

At the time, some doctors didn't want to give dying patients too much pain medication, fearing they'd be accused of hastening death.
Kevorkian said that he would be happy to go to jail for his beliefs. But, what effect has he really had in the area of physician-assisted suicide? Up to this day, only one state, Oregon, has a law allowing physician assisted suicide.
Experts say that's because abortion opponents, Catholic leaders, advocates for the disabled and often doctors have fought the efforts of other states to follow the lead of Oregon, where the law took effect in late 1997.

Opponents defeated a measure in Vermont this year and are fighting similar efforts in California. Bills have failed in recent years in Hawaii, Wisconsin and Washington state, and ballot measures were defeated earlier by voters in Washington, California, Michigan and Maine.
I remember having pretty heated debates in my medical ethics classes while in college in the early 1990's. "Kevorkian" not only was a name, but also used as a verb - both positively and negatively - depending on which side of the debate you were on. Back then, predictions were made that a majority of the states would eventually have physician-assisted suicide laws.

As one looks back over the past 10 years or so, you have to ask yourself this question: What was the real effect of Jack Kevorkian? Personally, I think he did raise awareness of end-of-life issues - although in kind of shocking way.

But, did he really influence public policy? I guess that will be debatable for a long time. Some will say he is a failure because only one state has physician-assisted suicide legislation. Others will say that he indirectly influenced other legislation having do with end-of-life issues. We'll have to see how history ultimately judges Dr. Jack Kevorkian.

Tuesday, May 22, 2007

Don't brush your teeth

Yes, you heard me right. Don't even think about brushing your teeth, that is, if you have toothpaste that originated in China. The New York Times is reporting in today's paper that Chinese authorities are investigating whether two companies exported tainted toothpaste overseas.
No tainted toothpaste has been found in the United States, but a spokesman for the Food and Drug Administration said yesterday that the agency would be taking “a hard look” at whether to issue an import alert.

Authorities in the Dominican Republic said they seized 36,000 tubes of toothpaste suspected of containing diethylene glycol, an industrial solvent and prime ingredient in some antifreeze. Included were tubes of toothpaste marketed for children with bubble gum and strawberry flavors sold under the name of Mr. Cool Junior.
I guess Mr. Cool is not so cool after all. The article gets better. Apparently, people in the country of Panama are very familiar with the substance called diethylene glycol.
Diethylene glycol is the same poison that the Panamanian government unwittingly mixed into cold medicine last year, killing at least 100 people. In that case, the poison, falsely labeled as glycerin, a harmless syrup, originated in China, shipping records show. Diethylene glycol is generally less expensive than its chemical cousin glycerin.
Not to worry, US authorities are all over this situation and are giving brilliant insight on how children could possibly ingest poisonous toothpaste from China (allegedly).
Dr. Douglas Throckmorton, deputy director for the Center for Drug Evaluation and Research at the F.D.A., said diethylene glycol levels found in some Panamanian toothpaste were nearly 50 times what is deemed safe. “Kids swallow toothpaste,” Dr. Throckmorton said. “That is going to be a concern to you.”
Let this serve as a warning to all of you out there in blogland. In case you go to your local discount store and pharmacy and see that "Mr. Cool Junior" toothpaste on sale - think twice. Avoid the "good tasting" bubble gum and strawberry flavors - stick to the yucky stuff. It'll be safer for your kids. HA!

Monday, May 21, 2007

Chip Implants: Ethical or not?

Would you want your loved one to have a radio frequency identification chip placed in her/his forearm? This is the debate that is going on at Alzheimer's Community Care in West Palm Beach, Florida. (AbcNews.Com)
The chip, which is slightly larger than a grain of rice, is implanted under the skin of the right forearm. Each chip will contain a unique 16-digit number that, when scanned in an emergency room, will link to the patient's medical records.
Seems pretty simple and straightforward to me. Taking care of Alzheimer's patients, I've always found it difficult to try to get all the information that I need when the patient presents to the emergency room in the early hours of the morning. Going through photocopies of information from the nursing home can be very confusing and time consuming. And, family members are not always available immediately to answer questions.
"This whole medical trial … really raises some pretty important issues about informed consent," said Katherine Albrecht, the founder of the advocacy group Consumers Against Supermarket Privacy Invasion and Numbering.
Officials at the facility state that this program is voluntary and issues of informed consent will be addressed with the patient and families before any procedure is performed. Ms. Albrecht continues...
"There are other technologies that are far less invasive and can achieve the same goal," she said.

Albrecht promotes the MedicAlert bracelet as the ideal way to solve the problem of Alzheimer's patients who cannot relay their medical information reliably. MedicAlert bracelets bear a recognizable medical symbol on the outside and have the patient's medical conditions listed on the back.
The article goes on to interview a couple of medical ethicists about their opinions about the placement of an identification chip.
But he [Jeffrey Spike of Florida State University] worries because the chip program has not yet been evaluated by a review board. Such a board, Spike said, would need to look at potential risks both physical and psychological -- and let prospective participants know their right to withdraw by having their chip removed or deactivated.

"If this has not been reviewed by [a review board], then it's natural to be suspicious that it has been carefully thought out," said Spike.
Presuming that the ethical and logistical details can be worked out (and I assume that they will), I don't see a problem with placing these identification chips in these patients. The wave of the future will be to somehow have your entire medical history easily accessible. I don't know if these ID chips are the answer, but they are certainly worth a try.

Saturday, May 19, 2007

Going home

It's been a long week here in Lexington. And, it was a great conference. I didn't talk about it much more because of all the other stuff going on this week.

And, what a week for the "other stuff." What happened this week in the medical blogosphere is going to have repercussions for a long time. The silver lining is that there is more of an awareness now than ever before of the benefits and risks of medical blogging.

In case you were curious, I believe that the new blog is going well. If you haven't had a chance to check it out, I would encourage you to do so. We're accumulating quite a troupe over there and it's a good time. Join us for the fun!

Have a great weekend! It's time to head home (image credit). Hopefully, I'll be resuming "normal" blogging (whatever normal is) next week. Ek! I have to go back to work next week. That'll be fun....

Friday, May 18, 2007

Midwife reality check

Although I do not deliver babies or perform prenatal care, many of my family physician colleagues do. Some even perform C-sections. You probably didn't know family docs could do all that, huh. Well, with malpractice premiums going up and payment/reimbursment going down, it's getting harder and harder to find any docs doing maternity care. Even some ob/gyn docs are dropping the ob (obstetrics/maternity care) part and doing more gyn (gynecology).

A story in today's Washington Post is outlining the reality of the medical economic environment for midwifes. Apparently, there are two huge birthing centers that are going to be closing in the Washington area. Seven other birth centers have closed their doors over the past decade.
"There are countless women scrambling to find out-of-hospital birth support," said Mary Beth Hastings, 39, a board member of the new Birth Options Alliance. The group, with about 300 members, will advocate "for a full range of birth options" in the Washington area...
Now, in my experience, most women I've talked with have no problem giving birth at the hospital with their midwife at their side. What's interesting about this article is that it highlights the small percentage of women who are anti-hospital, anti-doctor, pro-birthing center, and pro-midwife. Here is the reporter's bias coming out...
For a relatively small but devoted group of women, the idea of giving birth in a hospital with a physician connotes unwelcome images of being tethered to machines, talked out of natural childbirth or talked into a non-emergency Cesarean section.

A birth center, they say, provides a more relaxed, homelike environment without anesthesia or C-sections. Others say they want the option of an epidural for pain relief in a hospital but believe midwives will provide more personal support and be less likely than physicians to intervene with machines, surgery or medication.
Like I said above, I don't deliver babies nor do I perform C-sections. But, I'm definitely insulted by the statements above. These people want it both ways. Sure, treat my pain and/or if there is a problem - well then I'll see a doctor. Other than that, keep doctors away from me. Why is the perception that midwifes are "better?" Well, it's because they see the less complicated cases - thus the birthing experience may be seen as "easier."
Most midwives treat only healthy women with low-risk pregnancies. Anesthesia, such as an epidural block, and medications to speed up labor are available only in hospitals, and only physicians may perform C-sections.
Here we go. You saw this coming. Starting to make the case for "those bad doctors." It's the bad doctors who are driving the midwifes out of business. Yes, it's the doctor's fault. Here is more bias...
Those same [financial] pressures are felt throughout the health-care industry, but birth centers are particularly hard hit because they operate on slimmer profit margins than most physicians, midwives said. Several also cited problems unique to midwifery, including the growing popularity of C-sections, which they don't perform. Moreover, unlike obstetricians and gynecologists, midwives can't offset lower health insurance reimbursements for office visits with higher-paying surgeries.
This article is so politically motivated it makes me sick. The columnist wants you to think that there is a lack of access to maternity care in the Washington area and that physicians are to blame for this. With smoke and mirrors, it's subtily making the case that midwifes, in an effort to increase access to maternity care, should be given everything from C-section to epidural privileges.

And, oh by the way, doctors should decrease midwife malpractice premiums and increase payment/reimbursement to midwifes. Like physicians have any control over that. Want to make an impact in that, well do what everybody else does and go up to Capitol Hill and lobby Congress like the rest of us have to. Good luck with that.

For too long, physicians have always been the punching bag for the press - and I'm sick and tired of that. Physicians have been the target of every "health care provider" and the reason why physician's scope of practice has slowly been eroded away - especially in primary care. I'd better get off my soapbox now. Suffice to say, I didn't like this Post article and I hope people see through it for what it really is.

Dr. Dork goes private

Very quietly this morning, Dr. Dork now is "open to invited readers only." Am I still an alarmist? Do people still think I'm making up the seriousness of this situation? You be the judge....

Thursday, May 17, 2007

FD Sighting

Perception IS Reality

Comments and analysis on the events of May 16, 2007 continue. Some are going to all this a juvenile analogy, but to me, it's feeling like Star Wars: Episode 3 when all the good guys are being eliminated - thus leaving the bad guys to take over the universe. (Yeah, I know, kind of cheezy.)

In reading Kevin, MD this morning, he has an interesting grouping of opinions of the meaning of what happened yesterday (and the trend of medical bloggers leaving the blogosphere). What's more interesting is the comment section. Some have made the accusation that this situation is being blown way out of proportion.
Has even one person filed one claim against a doctor for putting their info out? Can you guys be any more dramatic?
# posted by Anonymous : 9:18 AM

I am sorry to see that blog go, but it is not the death knell of med-blogging, the end times, nor dogs and cats, living together, nor physicians stripped of their first amendment rights.
# posted by For whom the blog rolls : 10:09 AM
I'm not going to respond to these, because the "comeback" comments are a lot better than what I could have written. I encourage you to check them out. I admit that in the big scheme of things, people like me may be causing some unnecessary hype.

But, when it comes to the medical blogosphere, I think that we're in the midst of the aftershocks of a seizmic event that culuminated with what happened yesterday. What does it all mean? I think people are still trying to figure it out. But, in trying to sense some trends, many medical bloggers are perceiving a problem out there and I really do believe that Perception IS Reality.

Here are two comments from the grassroots which really concern me:
This week I chanced across a blogger whom I recognise. Whilst I'm pretty sure they haven't yet recognised me, I'm certainly not going to take the chance of waiting and hoping. These betrayed bloggers ought to be evidence enough that it's better to be safe than sorry. For this reason, on the afternoon of Sunday the 20th, I'm going to make this blog private. (from Tea at Ten)

Wow. This reiterates why I am “anonymous”. But I do fear what has happened to Flea and Fat Doc. People are jealous, vindictive, and generally out to make others miserable while trying to make a buck off you. It makes me consider making my blog by invitation only. Which I would hate to do. (comment made on Emergiblog)
Perception IS reality. The "demise of the medical blogosphere" will not occur with the already established blogs with lots and lots of traffic. Their future is secure. What I am concerned about are those smaller blogs with less traffic (like mine), those who have just started blogging, and those who are considering starting a medical blog.

The demise will occur because of the lack of growth of the medical blogosphere from the grassroots. These people will (or already have) changed to private blogs. And, those who have not started blogging - they will be more hesitant to publically blog, or even blog at all. That's another reason for the "I'm A Blogaholic" blog - to try to catch these people before they leave the public blogosphere or to welcome those considering medical blogging (or any blogging for that matter) in a group environment.

Will the I'm A Blogaholic blog work? Who knows? Am I still blowing this problem out of proportion? Possibly. But, I feel that people are going to be voting with their feet - leaving or not even entering the public blogosphere and we won't hear about it until most of medical blogging has already been wiped out.

Wednesday, May 16, 2007

Time To Be Proactive

Wednesday, May 16, 2007 is a day that will be remembered in the history of the medical blogosphere. The demise of the Dr. Flea blog and the closing of the Fat Doctor blog is still rippling through blog land. Reactions that I've seen include the following: Moof, Kevin, Scalpel, Scanman, SuperStenoGirl, TBTAM, Rita. (sorry, i probably forgot a lot of other people out there)

This whole day I've had this negativity going through me - feeling sad, feeling scared (who will be next, me?), feeling defeated. Well, I'm here to tell the world that I'm not going to take it anymore. (image credit)

It's been more than a year since blogging found me and almost a year since I've had my own blog. Sure, I had my tough time a few months ago. Sure, I almost stopped blogging as well.

But what happened then? It's the same thing that's happening now. We're coming together to support our fallen bloggers. I still think that the medical blogging community is a strong one. We've seen a lot and we've been through a lot.

There are some out there who say that it's only a matter of time until the entire medical blogosphere fades away. "The lawyers are picking you off, one by one," someone sent me in an e-mail today. In my heart, I think that our community too strong to allow that to happen.

To try to get out of this negativity and to try to be proactive, I have an idea. I don't know if it's going to work, but I'm going to try it anyway. I want to try to reach out to those fallen bloggers out there who still have the urge to blog.

Curious and intrigued by this concept? I invite you to my new blog where people will gather for the love of blogging. Don't worry, I'll still have this blog (for the time being - HA!) The name of the new blog? It's simple -- I'm A Blogaholic. Check it out and join in the fun. You'll be glad that you did.....

Fat Doctor Gone Too

What the heck is happening out there? Just twelve hours ago, I posted about the demise of Dr. Flea. Thanks to a tip from Xavier Emmanuelle - I was notified that Fat Doctor has also closed up her blog.

Someone in my department printed out my blog and showed it to my boss. He tells me he didn't read it and won't interfere in what I do with my own time as long as I do a good job at work.

Still, I'm heartbroken.

Why, whoever did this, did you not come to me?

It's been fun, folks. I will miss you all.

What's going on out there? Who will be next? Hopefully, not me. Blog land is getting scary out there. I may have more to say about this later. Meanwhile, back my bored review lecture...

Bored Review - Day 4

After two days of sun and warm temperatures, today, it's raining and a little cooler. This is a perfect day to be stuck indoors for another eight hours of didactic lectures. (image credit)

Had some psych topics this morning - especially psychiatric illnesses in children and adolescents. I have some patients in my practice at home, but I really wasn't aware of the nationwide impact of these diseases.

In surfing the news today, I came across a and an article entitled, "Push To Achieve Tied to Suicide in Asian-American Women." Here's the alarming statistic from the Department of Health and Human Services:
Asian-American women ages 15-24 have the highest suicide rate of women in any race or ethnic group in that age group. Suicide is the second-leading cause of death for Asian-American women in that age range.
The article from CNN goes on to theorize that Asian-American families put a lot of pressure on their children to academically achieve. According to the researcher in the article, females are more affected than males. There are also cultural differences in which, "you don't question parents."

Growing up in an Asian family, with both my parents being Asian, I can definitely relate to some of this article. Of course, I cannot give an objective view of my family, but although I felt some pressure to do well in school, I did not perceive an overwhelming pressure to academically excel.

In talking with my friends through the years, I personally don't believe that this is a cultural thing isolated to Asians. A lot of people I've met from different nationalities have reported being pressed by their family to receive high grades. But, I do admit, anecdotally, of those who perceived parental pressure, most of them have been of Asian descent.

I guess the question is this: Does parental pressure to excel in school directly relate to suicide? This is an interesting question. The right answer for questions like this is always "multifactorial." However, I would agree with the author in that in the Asian culture there is perceived pressure being felt by Asian-American children/adolescents/young adults to excel academically. Is this good or bad? I guess it depends you to talk to.

Dr. Flea Disappears

Here's what Medgadget posted on January 19, 2007 in reference to the 2006 Medical Weblog Awards:
The winner of Best New Medical Blog is...

Flea, a weblog by an anonymous pediatrician "in solo practice in the Northeast U.S." On his website, Flea tackles many issues facing pediatricians today: from childhood obesity to anti-vaccination moonbats and their websites that scare parents with pseudo-scientific proclamations. Congratulations, Dr. Flea! Job well done.
Now, if you click on over to the Flea blog or on the Flea profile, you'll see that it's all gone (Thanks Carrie for the heads-up). If you have been following over there, you know that Dr. Flea is/will be going through some litigation.

It was actually an interesting series that he was putting together over there. But, probably his lawyer or the lawyers from the other side somehow found out about his blog and pulled the plug.

This is a concerning trend. There's been previous mention of Barbados Butterfly (in Grand Rounds) leaving the blogosphere. Cathy recently had her blogger URL hijacked. Now, there's no Dr. Flea. What's going on out there in blog land?

I know that I'm not going to be the only one saying this, but I'm going to very much miss Dr. Flea and his witty rantings. Dr. Flea, if you're still out there, you have an open invitation to guest post on my blog any time. Best of luck in your court case. We're all pulling for you.

The Interactive Novel

Here's an interesting question: Can docs write novels? Well, this is your chance to be the judge. Dinah, from the Shrink Rap blog and one of My Three Shrinks, has started The Interactive Novel and is seeking feedback. Dinah writes....
Sunday's New York Times had an article on the unpredictability of the publishing industry: The Greatest Mystery: Making A Bestseller. The jist of the article is that publishers aren't good at guessing in advance what will sell, and the industry has surprisingly little feedback and interactive responses from its market.

So I thought, what if I try to see if I can get some feedback on Double Billing, my novel-of-the-moment, either use the feedback, or let prospective agents know that 50 million people read the first few pages and now want more? So here goes, the first chapter, the set up for the rest of the novel. If you want to make suggestions on how it would be better, please feel free to comment.
Personally, I don't know if anyone has "the magic formula" on what makes a best selling novel, a hit song, a blockbuster movie, or anything else successful in the entertainment industry. I'll have to delve into that NYT article more carefully.

So, take a read over there and leave some feedback (and vote in her poll). I'll turn the comments off over here, because I'd like to focus the feedback over there. I've already left a constructive criticism (not mean, just some feedback). If you can help out Dinah, I'd appreciate it. Thanks!

Tuesday, May 15, 2007

Bored Review - Day 3

The above slide was my favorite one of the day. The topic was irritable bowel syndrome. I hope you're not offended; the slide was not meant to be demeaning. Actually, I may even use this to try to better communicate with my patients. The speaker tells her patients, "So you have Bristol Type 3 then, right?" That's interesting. (image credit)

Being in full-time private practice, it's really difficult for me to try to keep up with the latest and greatest medical literature. Attending this conference really has reminded me of just a thirst for knowledge. Back at home, it's just a rat race sometimes -- just trying to complete all the tasks of my day before I fall asleep.

I've come to miss a little bit of the academic slant of medicine. One of the buzz words these days is "evidence based medicine." A better way of saying that is this: Why do you make the treatment choices you do in medicine? Is there medical literature (ie - research evidence) to back up why you make your choice?

In day-to-day practice, I'm busy dealing with paperwork, insurance companies, medicolegal stuff, etc. It's really difficult to keep up with the medical knowledge that is constantly changing on a daily basis. I know what my patients are reading, because I keep up with the popular press. But, sitting down and going through research studies -- this take a lot of brain power on my part to really break it down. There are (too often) times that I'm too tired or not enough time to do that.

On another kind of related topic, I did get to visit a friend of mine here in town. (Yes, I did skip part of the conference. Oh well.) He works at the medical school and I got to see him in action teaching a little bit. I've never seen the "work side" of this guy before - we're usually socializing and making fun of people at the bar at meetings that we go to.

My experience this afternoon reminded me how much I miss teaching medical students and residents. That's a really good time (at least for me). Maybe someday when I've gotten really cynical of private practice, maybe a career change to academics could work. We'll see.

Sorry for the rambling. It's kind of been a little different blogging this week. Like I've said before, I like a little different change of pace sometimes. Hope you're week is going well so far.


This post is in honor of my good friend HP from Australia. I encourage you to read iPodphobia before reading this post. A few months ago (I cannot remember) -- either I posted my current iPod list or mentioned that I would. Here's what HP posted today:
I remember Dr. Anonymous used to post his current iPod playlist but suddenly ceased to do so. Did he fall victim to iPodophobia? *wink* Should we initiate treatment? Download him anything Icelandic to increase his cool factor?
The back and forth banter over the past few months has been amusing - to say the least. So, at the risk of analysis of my psyche by my good friends out othere in blogland, here is the most current list that I put together for May 1st, 2007 on my iPod -- Enjoy! (BTW, this would probably be a good meme idea. But, since I'm on a meme break, I'll pass on tagging anyone.)

Some quick remarks about the list below: I always try to mix what's currently on the iTunes Top 100 list with some of my favorites. Actually, I made this list for the meeting I was a part of earlier this month. I'm into some positive visualization and putting myself in a positive frame of mind -- or even psyching myself up before getting into the spotlight. That's reflected in the middle section of this list. This is also good driving music. Of course, as always, please obey all posted speed limits. HA!

Makes Me Wonder by Maroon 5
Never Again by Kelly Clarkson
Single Fire by Snow Patrol
Hells Bells by ACDC
Right Now by Van Halen
Better Man by Pearl Jam
In The Air Tonight by Phil Collins
Vertigo by U2
Desire by U2
Pressure by Billy Joel
Don't Mean A Thing by Borialis
Clocks by Coldplay
Harder to Breathe by Maroon 5
Round Here by Counting Crows
A Long December by Counting Crows
Home by Michael Buble
Cupid's Chokehold by Gym Class Heroes
Don't Matter by Akon
What I've Done by Linkin Park
Better Than Me by Hinder
Give It To Me by Timbaland
Over It by Katherine McPhee

Monday, May 14, 2007

Bored Review - Day 1/2

Yes, I'm still here. Someone commented that my lack of more posts yesterday signified that things were getting a little better. I guess that's accurate. Here are some random thoughts from the last couple of days.....

One of the things I really liked was receiving a choice of either a HUGE 200+ syllabus or a SMALL USB drive that I could put into my computer and take notes on the slides there. Very nice. If you're planning a meeting out there, please make this option available. My shoulder got sore in past meetings lugging around a huge three ring binder.

I'm always interested in who actually attends these things. I would say about a third of the attendees are males in their 60s. They have a smile on their face when they tell me, "Yeah, this will be the last time I take this stupid board review exam." I hope to get there some day.

Here are some questions: Why do presenters insist on squeezing as many words on each slide as they can? And, why do they insist on reading from their slides? If you make a presentation, please don't do this. And, please pick bright colors for your powerpoint slides. It is much appreciated.

The free internet in the meeting room. Plain and simple, every meeting should have this. I don't care what the meeting subjecct is. If you're offering CME and have net access, you're attendance will be pretty good.

Near the end of the day, I'm thinking to myself, "How did I get through all those years of college and med school, because after 6-8 hours of didactic lectures, I'm pretty tired." Yeesh!

That's it for now. If you want to try to keep me awake during the next 3-4 days (Yikes!), continue to send me e-mails and comments. I have to say, the stuff that has been sent already has been hilarious. Thanks a lot!

Sunday, May 13, 2007

Mother's Day Brunch

"That's the end of our morning session," the hostess with the mostest said, "We'll reconvene in an hour." So, I'm trying to find a place close for lunch. For some reason, I really didn't want to leave the hotel.

I go down to the hotel restaurant, get seated, and wonder why all these people are dressed so nice today. "Is it some kind of holiday today," I asked myself. Then it hit me (again). Duh! It's Mother's Day.

I know I looked kind of strange sitting there by myself, with my trusty iBook at my side as I'm munching down on my brunch meal (Why do they call it brunch anyway?) I'm sitting there with all these families around me - some taking pictures - all wearing their Sunday best.

Just so there is no question - I did see mom yesterday before I left. Why anyone would schedule a meeting to begin on Mother's Day is beyond me. I had to try to explain this to mom, but was not that successful. I do feel bad that Mom's dad had to be rescheduled for one day earlier, but oh well.

This kind of "real time" blogging is kind of interesting. Isn't that how blogging started in the first place? I know all you blogging historians out there can help me out.

Thanks so much for those of you who have sent me e-mail and left comments already. I really appreciate it. I may give some day one thoughts later. But, overall, things have been going good. It's 67 degrees in downtown Lexington right now and cloudy. Perfect golfing weather. AHHHHH! Oh well, time to refocus.

We do have a break in two hours. Maybe another post from me then. We'll see....

Bored Review

So, I'm in Lexington, Kentucky for the next few days getting educated. I just arrived last night. As I alluded to in an earlier post, I have a new project. My new project is getting ready for my Family Medicine Board Review Exam which will be in about fourteen months.

Standardized exams have always caused me some angst and stress. So, I figure I would ease into things by taking a Board Exam Review course (which at times does makes me bored) to try to get into the swing of things.

I'm in the lecture room right now and they have free internet in here - Yay! So, I can continue my internet, e-mail, and blogging obsession while trying to learn something - although I have to try to not be too distracted.

So, send me an e-mail or post a comment. At least, I'll have something to do when I'm seeing all these powerpoint slides. Yeesh!

Update: NY radio hosts fired

Three weeks ago, I talked about two radio hosts in New York City who made Asian racial slurs. The post was called, "Asians: The New American Villan." It generated an interesting discussion and even an award from The Rising Blogger. Yesterday, according to the Associated Press, these two radio hosts have been fired.
One month after CBS Radio fired radio host Don Imus, it has permanently pulled the plug on a pair of suspended New York shock jocks for a prank phone call rife with offensive Asian stereotypes.

"The Dog House with JV and Elvis," hosted by Jeff Vandergrift and Dan Lay, "will no longer be broadcast," CBS Radio spokeswoman Karen Mateo said Saturday.
I have to be honest here. I never thought that these guys would be fired. Sure, I wrote a provocative post. But, as I said previously, either a dangerous precedent is being set here in that no one can say anything about anyone without being fired - or, CBS radio is in such a disarray that they'll do anything at this point to get out of the PR tailspin that they're in right now.

One thing I do know is this -- The entertainment industry will be an interesting moving target to watch over the next few months. I mean, hey, even Shrek is being attacked these days. Excuse me, uh, Shrek is a cartoon character. Gimme a break!

Happy Mother's Day

Thursday, May 10, 2007

The Poet Laureate

In this Rust Belt town, there are few young people left because they have all moved away looking for work and looking for a better financial future than what's left here. This leaves a healthy percentage of older people to take care of.

I don't mind taking care of the older population of this town. In fact, I enjoy talking with them, if for anything else, to try to get a sense of how this town used to be "back in the day."

Mrs. Highland came in to see me. She's definitely part of the "old money" of this town. She's a poet and through the years, has published a number of books which highlight her work.

Like many other people her age, she has about a dozen medical diagnoses in her chart and at least one medication to go with each of the diagnoses. She proudly shows me her blood sugar log and blood pressure readings over the past three months.

"How did you get out of being weighed again," I asked jokingly. "It's not polite to ask a woman her weight, you know," she retorted. I smiled because we go through this banter every time she comes in.

After the "business" of our meeting today is completed (meaning talking about her health problems), I start to write her prescription refills, and she pulls out a book.

"I wanted to give you this for being my favorite doctor," she sheepishly said. "I found it as I was going through some things at home." I looked at the book and it was something that you would find in the best antique shops in town - except, the book was in pristine condition, like it's never been open before.

"I can't accept this," I said. "Of course you will, because I said so," she barked back at me in her authoritarian voice. Then, she smiled, "We've talked a lot about poetry, and I wanted you to see how a real poet writes."

As I opened the book, there was her signature inside. Above it, there was the date and the following text was written out, "To My Favorite Doctor." I was so moved that I was initially speechless. All I could do is look her straight in the eye and say, "Thank You."

Peace Blogger of the Day

I was pleasantly surprised to be named peace blogger of the day by Mimi Lenox. She not only is the "Queen of Memes," but also the "Founder of the Peace Globe Movement." Thanks Mimi for this honor. I really appreciate it!

Last fall, the blogosphere was a buzz on Peace Globe Day 2006 which took place on November 6. I don't think anyone really knew the impact this movement would have until, on that day, you just kept clicking and clicking, and saw globe after globe after globe. I was quite moved by that day. Here's what I wrote...
Peace on Earth is more than just a day someone picked out and a graphic that you put on your blog. Yes, it's idealistic, but it's an idea of hope - In a world that needs all the hope that it can grasp.

Thanks Mimi for your leadership in all of this - for having an idea and passionately making sure that it is followed through. I'm looking forward not only to seeing this graphic scattered all over the blogosphere, but also, hopefully, someday, seeing your dream come true of Dona Nobis Pacem -- Peace on Earth.
Now, the Mimi and the Peace Globes are making a comeback. The date this time is June 6, 2007 - less than a month away now. Mimi has been doing her best to try to promote her BlogBlast For Peace to anyone who will listen. I admit that I haven't been helping out that much - until now.

So, it's less than a month from now. I'm encouraging all the Doctor Anonymous readers out there to pick up a Peace Globe (see my sidebar or the link above) and place it on your blog. I also admit that I'm not one to decorate the PG graphic. I'm more into the classic yet elegant look of simplicity.

Don't forget to make a full-fledged post on Peace Globe Day on June 6th. Don't think about it - Get a globe today! Be part of blogosphere history next month. Good Luck Mimi! I know we'll come through for you again.... Peace!

Wednesday, May 09, 2007

Update: The Ashley Treatment

I first talked about The Ashley Treatment back on January 5, 2007. Please check out that post for all the background details. The case took an interesting turn Tuesday. According to the Seattle Post-Intelligencer, the hospital was required to obtain a court order before performing surgery on Ashley.
According to a report released Tuesday by a non-profit advocacy group, Ashley's constitutional and common-law rights were violated when she underwent a hysterectomy as part of her treatment. Washington law requires a court order before sterilizing a developmentally disabled child.

The decision for treatment went before the hospital's board of ethics, which agreed with the decision, but recommended it be reviewed in court.

But an attorney told Ashley's parents in a letter they didn't need a court order for the hysterectomy, said Deborah Dorfman, director of legal advocacy for the Washington Protection and Advocacy System, which conducted the investigation.
Ah ha! I knew there would be some kind of legal angle to this story eventually. So, let me get this straight, after the parents of a child come to a treatment decision with their doctor or doctors, they must ask the state if it's ok? Ridiculous!

The hospital is now in a pretty political pickle now, and in the situation of reparing their damaged credibility, and appeasing their critics.
Children's has agreed to appoint a disability rights advocate to its ethics committee and bring in experts as needed to make decisions about medical care for people with disabilities. It will require a court order for growth-stunting procedures, when it involves a child with a developmental disability. The hospital will also give the Washington Protection and Advocacy System notice of any sterilization or other growth-limiting procedures on persons with disabilities so it can act as a watchdog.

Dorfman said the group won't seek legal action against the hospital, but the Washington Department of Health, which is in charge of licensing hospitals and physicians, is planning to investigate further to see what actions, if any, may be taken against the hospital or physicians, said Steven Saxe, director of facilities and services licensing for the department.
Even if this group won't take legal action, I predict that the political hacks out there across the country will be sharpening their knives and getting ready to dive into this case for political points. According to political calculations, it's still ok to go after doctors and hospitals.

Now, I want to clarify, I'm not defending this hospital. Especially from a legal sense, hospitals have the responsibility to make sure that all the details have been taken care of. Someone on the inside dropped the ball, and they should be given the necessary consequences.

However, from a media standpoint, this story will be energized (I can see this now with the hits on my site), and the hype will begin again for this family - That's the real tragedy here...

Tuesday, May 08, 2007


I'm still in kind of a weird blogging place right now, so bear with me. The self-reflective posts continue (at least for now). I've been feeling like this since I've gotten back.

It's hard to describe where I'm at with things in general right now. I can't quite put into words, but I'll try. I just completed a long fourteen month project which culminated in last week's meeting.

I was on the planning committee, and I had a lot invested in this project - especially from an emotional standpoint. From a professional standpoint, I was kind of putting myself out there on a limb, since I was one of the key contacts/presenters for the meeting.

Being the "go-to" person on site has its ups and downs. While I got most of the complaints from the people that attended, I also received some compliments. I'm a detailed oriented person (imagine that), and there were nights where I couldn't sleep trying to anticipate all the problems of the next day.

When all was said and done, at the end of the last day, I did feel relieved that the entire thing was over. There were no disasters that occurred (at least from what I heard), and for the most part, people got a lot out of the meeting.

Now, I'm not perfect, and I believe I made some mistakes - or, at least, I felt that some things could have been done better. But, at some point during the meeting, I had to surrender and let go of the things that I could not control. I said my serenity prayer, and moved on.

Even when I attend meetings that I do not plan (just an attendee), I go through this "post-conference" let down. And, I guess that's where I'm at this week. Physically and emotionally, I feel drained - even to the point of not blogging how I usually do.

This week really has made me reflect a little bit. Being focused on the day-to-day tasks here at home really has made me forget about just letting my mind go free sometimes - and think about - just about anything. Is life really about completing tasks until you're too tired to stay awake? Probably not.

I begin a new fourteen month project next week. I will give it all of my heart and soul, as I do with all of the projects that I strongly believe in. I'll make my to-do lists and complete the tasks one by one until all of them are completed next summer.

Hopefully, I'll have more weeks like this where I'm not so focused - and maybe a little bit random and scattered. Changing the routine every once in a while is good for the body, mind, and spirit. I really believe that....

Grand Rounds

Grand Rounds 3.33 is now up and running at The Blog That Ate Manhattan. Because of my busy schedule last week, I wasn't able to write anything, and subsequently not able to contribute anything to the festivities this week.

I wouldn't say that there's a GR theme this week, like has happened in other weeks. TBTAM dedicated this week's Grand Rounds to a fallen blogger....
This week's grand rounds is dedicated to our favorite surgery registrar, Barbados Butterfly, whose blog was unceremoniously taken down not too long ago. I will not write here of the circumstances of her leaving the blogosphere, or posit the details thereof. I wish only to celebrate her as the quintessential medical blogger that she was.

Barb's blog was everything a medical blog is supposed to be - well-written, thoughtful, honest, educational, entertaining, heartwarming, humorous, heart wrenching and above all, real. I only hope that I occasionally achieve what Barb did with every post of her blog. She was (and is) the best. Barb, this one's for you.
If you don't know what Grand Rounds is, it is a weekly compilation of the best posts from the medical blogosphere that moves to different sites each week. And, who doesn't like reading about medicine and science?

The location of next week's Grand Rounds has not yet been revealed yet by the Grand Poobah of GR - Nick Genes. In the mean time, check out The Blog That Ate Manhattan - It's Grand Rounds!

Monday, May 07, 2007

The meeting escape

I was at a meeting last week, and that's why I wasn't posting anything. And, actually, I'll be a meeting next week as well. Forgive me if this post is kind of out of sorts. When you don't post for a few days, it's difficult for me to get back into things. And, I've been feeling a little self-reflective lately.

What is it about meetings that makes me think and reflect? Am I in such a rat race at home that I've forgotten how to open my mind? Am I so focused on the next task at home that I cannot see the big picture?

I also have to admit that my blog was causing me a little stress before I left. I was feeling the pressure to post - which I know is ridiculous, but that was where I was at. Absence does make the heart grow fonder (or however that saying goes). I knew blogging was calling me back today. So, here I am.

I have found that I really need to pace myself at meetings. Ten years ago, I could wake up early, go all day, go out to the bars until early in the morning, and then start again the next day.

Now? I have learned that sleep is very important at meetings, particularly if you're presenting a session. And, having one or two drinks the night before a presentation may not be the best choice.

Is anyone still reading this? If you are, thanks, because I'm just rambling. If for anything else, it was nice to get out of town for a few days and to think about something other than work.

I dreaded coming back home, but knew that it was necessary. The good news is that I'll be leaving town again at the end of this week. I haven't taken this much time off in a while. Sorry for the babbling. I'll try again tomorrow for a more cohesive post....

Tuesday, May 01, 2007

Grand Rounds

Grand Rounds 3.32 is now up and running at the Shrink Rap blog. Their theme is pretty simple: BYOB - Bring Your Own Brain. I love the above picture that they have accompanying their post. Thanks to the shrink rappers for including my post this week:
  • Our friend, Dr Anonymous, posts The Baby Emilio Debate, about a 17-month old child who "has a rare genetic disorder which will eventually end his life. An ethical debate is taking place in Texas and around the country having to do with end of life issues and who has the final say in these issues."
If you just cannot get enough of Grand Rounds, there is even a podcast about it this week by My Three Shrinks. Thanks to MTS for including my little audio clip in their podcast (I'm at about 28 minutes). I definitely had a lot of fun making the clip.

I was all set to give them a huge congratulatory comment on all of their hard work. Unfortunately, they have the comment feature turned off for some reason. Anyway, great job with the 50 posts. Sheesh that was a lot! And, there were even two posts about ducks. Imagine that....

If you don't know what Grand Rounds is, it is a weekly compilation of the best posts from the medical blogosphere that moves to different sites each week. And, who doesn't like reading about medicine and science?

Next week, GR moves to The Blog That Ate Manhattan. Great posts recently over there about a road trip to Athens, Georgia including pictures and great storytelling. Check it out.