Redesign of Clinical Cases and Images - A Case-Based Curriculum of Clinical Medicine

ClinicalCases.org was redesigned to give credit to the authors and to streamline the front page of the website, so that it reflects the natural flow of a clinical encounter:

- History Taking and Physical Examination

- Imaging and Labs

- Procedure Skills

- Best Clinical Evidence

- Questions & Answers

Suggestions are welcome. The website has already had more than 500,000 page views and we are hopefully going for one million this year.

Feel free to submit typical clinical cases or rare case reports. Both have a place in expanding this online case-based curriculum of clinical medicine which was reviewed favorably by the British Medical Journal. With more than 800 daily visitors (and growing) from all over the world, this is our humble contribution to medical education.

ClinicalCases.org is integrated within the Cleveland Clinic intranet with links on the home pages of clinical education and the internal medicine residency program.

Nobody Owns "Web 2.0" Because It's Yours

There is no dispute that Tim O'Reilly coined the term "Web 2.0", the same way Robert Wachter first used "hospitalist" in his landmark 1996 NEJM article.

Timo O'Reilly also organized the first Web 2.0 conference but does he really own the term "Web 2.0"?

According to IHT:

"On Wednesday, a lawyer from O'Reilly Media sent a cease-and-desist letter to it@cork, a nonprofit industry group in Ireland that is holding its own Web 2.0 conference next month."

The people at it@cork thought that the O'Reilly's request was somewhat unfair since Web 2.0 is in large created by the web users themselves and does not really belong to anybody. They posted the cease-and-desist letter on their website and in no-time the post was the top story on Digg.com.

It looks like the blogosphere backlash soon made O'Reilly media changed their mind.

According to the organizer of it@cork:

"Because of Web 2.0 and blogging, I was able to put up a post and have this large multimedia organization apologize and turn around and say, 'You can use our trademark terms.'

"That's only possible because of the power blogging confers."

I should be OK to use Web 2.0 in my presentations too... :-)

Update 1/19/2007:
The new version of my presentation Web 2.0 in Medicine is available.

References:
Blogging liberates "Web 2.0". IHT.
How to Use Web 2.0 in Medicine?
Image source: OpenClipArt.org, public domain

Further reading:
Collaborative Presentation on Web 2.0. Link via Go2Web2.

Updated: 10/02/2007

Interesting Blog Posts

The questioning of career, life, family, love follows grief (taking a week off of blogging). Scobleizer. Related: Celebrating seven years of blogging. Scobleizer, 12/2007.

Vint Cerf says he’s a weird old fart... :-) Scobleizer.

The Six Habits Of Highly Effective Healthcare Bloggers. HealthcareVox.

Why can't a tattoo be a legal advanced directive? RangelMD.

Updated: 12/23/2007

No Work Blogging Allowed

Scoble, Microsoft's most famous blogger, comments on a NYTimes article about companies taking a stance against employees-bloggers:

"There's lots of companies that don't allow blogging, the New York Times reports today.

That's cool. I hope none of my competitors allow their employees to blog. Why? You'd be amazed at the number of job seekers we get simply because we blog openly...

In many companies blogging ANYTHING is a fireable offense. I’ve talked with many HR and PR teams and they can’t believe that we’re allowed to do what we’re doing at Microsoft."


Michigan University recently launched 12 blogs by medical students in effort to increase recruitement.

Work blogging, if done right, can offer a competitive advantage to many companies. It gives a human face to a corporation and it also brings a lot of Google traffic that you otherwise have to pay for through AdWords.

In today's world, Microsoft's "chief blogger" has almost as much power as the CEO. Banning blogging is a disadvantage, to say the least.

Fortunately, at the Cleveland Clinic, we do not stop any employee from writing his/her own blog. Of course, you must have the usual disclaimer: "All opinions expressed here are those of their authors and not of their employer" (see the sidebar of this blog). Protecting patient confidentiality, as described in HIPAA, is also extremely important.

All hospitals should have blogging guidelines.

References:
Interns? No Bloggers Need Apply. NYTimes.
No work blogging allowed at many co’s, NYT says. Scobleizer.
Medical Students Blogging on a "Massive Scale" at the University of Michigan
Microsoft Blogger Has as Much PR Power as CEO. What Does That Mean for Your Hospital?
Case Reports and HIPAA Rules
Simply Fired - How NOT to Blog About Your Job. Especially If You Are a Doctor
Image source: Openclipart.org

First Man with HIV Contracted the Virus from a Cameroon Chimpanzee

According to a study, published in the journal Science, it looks like the first people with HIV caught the virus from Cameroon chimpanzees that harbor a simian immunodeficiency virus (SIV).

SIV antibodies were found in up to 35% of fecal samples from wild-living P. t. troglodytes apes (chimpanzees).

The HIV epidemic started in a different place though -- in Kinshasa, the Democratic Republic of Congo. Studies have traced HIV to a man who gave a blood sample in 1959 in Kinshasa. The primate-to-human transmission likely ocurred much earlier, in the 1930s.

How did people contract HIV from chimpanzees?

The chimpanzees in that area of Cameroon are hunted for meat. One of the researchers explains:

"We know that you don't get it from petting a chimp, just like you can't get HIV from a toilet seat. It requires exposure to infected blood and infected body fluids. So if you get bitten by an angry chimp while you are hunting it, that could do it."

References:

Research suggests HIV originated in Cameroon chimps. CNN.
Chimpanzee Reservoirs of Pandemic and Nonpandemic HIV-1. Science DOI: 10.1126/science.1126531.
Tracking the Epicenter of AIDS: Africa, 1930. NPR.
Origins of HIV. Listen to an interview with one of the study authors. Time Global Health Update.
HIV's Ancestry Traced To Wild Chimps in Cameroon. WSJ (subscription required).
Retroviruses and herpesviruses found in illegally imported wildlife products (bushmeat) seized at US airports. JAMA, 2012.
Image source: Wikipedia

3C = Cleveland Clinic Canada

The Cleveland Clinic "will be opening a spectacular facility in downtown Toronto" this September called Cleveland Clinic Canada's Health and Wellness Centre.

Also in the news, Medgadget reports that the gigantic Dubai Healthcare City will be powered by Harvard Medical International (HMI), the international division of Harvard Medical School.

NEJM Video: Arthrocentesis of the Knee

Knee arthrocentesis is the latest of the NEJM Videos in Clinical Medicine. This procedure series by NEJM is an excellent learning tool. Videos are free to watch and download.

There are several articles on Joint Aspirations and Injections in AFP.

You can also review the Procedure Skills section of ClinicalCases.org.

Image source: NEJM

Cleveland Zoo in the Spring

See the Tabblo

Clinical Case: A Toddler Swallows a 40-cm Piece of Dental Floss

A 3-year-old boy had his teeth cleaned by his mother and wanted to play with the dental floss afterwards. Half an hour later, the mother could not find the dental floss.

What would you do?

Continue reading on ClinicalCases.org.

Image source: OpenClipart.org, public domain

Clinical Cases and Images is "Blog of Note" on the Front Page of Blogger.com

Blogger.com/Blogspot is the # 18 most trafficked website in the world, according to Alexa.com. Yahoo is # 1, Google is # 2.

Clinical Cases and Images - Blog is featured on the front page of Blogger.com this week as a part of the Blogs of Note series.

Thanks to Googlers/Bloggers for selecting me. I think that Google staff physician, Taraneh Razavi, helped a little bit... :-)

Great medical blogs powered by Blogger.com are KevinMD and KidneyNotes, just to name a few. Feel free to add more in the comments section.

How to Use Web 2.0 in Medicine?

This is the PowerPoint file of my talk about Web 2.0 in Medicine. I presented it to the Section of Hospital Medicine at the Cleveland Clinic on 10/17/05, internal medicine residents and faculty at the Cleveland Clinic on 1/05/06, Grand Rounds of the Department of Internal Medicine at the Cleveland Clinic on 1/25/06, and internal medicine residents and faculty at Case Western Reserve University (St. Vincent/St. Luke) on 5/18/06.

Of course, I had to make modifications for each audience but the general content was the same.

All blue links in the presentation are clickable.

Feel free to use it for your own presentations, if you find something interesting. The usual requirements for a citation and a back link apply and are listed on the last slide.

Update 1/19/2007:

The new version of my presentation Web 2.0 in Medicine is available.


My presentation on Web 2.0 in Medicine from December 2006.

References:
Web 2.0 in Medicine
Wikis, blogs and podcasts: a new generation of web-based tools for virtual collaborative clinical practice and education. Boulos MNK, Maramba I, Wheeler S. BMC Med Educ 2006;6:41.
10 Tips for How to Use Web 2.0 in Medicine. ScienceRoll.com, 2007.
Web 2.0 in Medicine Presentations by a University of Michigan Librarian
Web 2.0 and Medicine: The Slideshow. ScienceRoll, 02/2008.

Related:
Web 3.0 Concepts Explained in Plain English (Presentations). Digital Inspiration, 2009.

Updated: 06/01/2009

Tim O'Reilly Defines Web 2.0

I remember when I gave my first series of talks on Web 2.0 in Medicine at the Cleveland Clinic, people were coming to me after the presentation asking me where they can buy Web 2.0... Obviously, this speaks volumes about my presentation abilities (or lack of abilities) but it also shows how confusing the first definition of Web 2.0 was to users.

Tim O'Reilly, who coined the term Web 2.0, spread the first definition on 5 pages. I am so glad to see that the second attempt to define it is at least more concise:

A true Web 2.0 application is one that gets better the more people use it. Google gets smarter every time someone makes a link on the web. Google gets smarter every time someone makes a search. It gets smarter every time someone clicks on an ad. And it immediately acts on that information to improve the experience for everyone else.

It's for this reason that I argue that the real heart of Web 2.0 is harnessing collective intelligence.

The world of Web 2.0 *can* be one in which we share our knowledge and insights, filter the news for each other, find out obscure facts, and make each other smarter and more responsive. We can instrument the world so it becomes something like a giant, responsive organism.

I still remember calling blogs "living organisms" in my interview with Nick Genes for Medscape, so I was not far off the mark.

Update 1/19/2007:
The new version of my presentation Web 2.0 in Medicine is available.

References:
Tim O'Reilly and defining Web 2.0. Geeking with Greg.
My Commencement Speech at SIMS. Radar.OReilly.com.
Image source: OpenClipArt.org, public domain

Further reading:
Collaborative Presentation on Web 2.0. Link via Go2Web2.

Updated: 10/02/2007

The Happiness Formula

BBC tries to find The Happiness Formula starting with the fundamental question "What is happiness?" Is the answer to "Think yourself happy"? (video link).

Take a 5-question test and discover how happy (or unhappy) you are.

The website is among the Yahoo picks.

References:
Thinking About Medicine - Your Inner Peace
Six Tips for Happiness by a Harvard Teacher
20 Ways to Get and Stay Happy. Time, 2007.

Experienced happiness is largely set by personality, it will temporarily respond to changing circumstances. The Lancet, 2010. http://goo.gl/ot3Kx
Image source: OpenClipArt.org

Medpundit Stops Blogging. She Started in March 2002

Medpundit, one of the veteran medical bloggers, decided to stop blogging:

"I no longer have the time needed to devote to it. The phrase "declining reimbursement and rising overhead," is repeated so often in medicine that it seems a cliche, but it's also a reality. I'm spending longer hours at work and seeing more patients to support my office and my family. The 1-2 hours a day it takes to keep up the blog are no longer there. I don't have any hope of that getting better in the foreseeable future. In fact, I anticipate that in the next 1-2 years, I'll be adding even more office hours until I've reached the limits of my physical and mental capabilities.

I've also come to realize that I've been neglecting my family too long."

This is sad. People have been reading Medpundit for years.

Related:
Medpundit signs off. GruntDoc.com.
Sunday musings on the medical blogosphere. Notes from Dr. RW.
Medpundit calls it quits. GruntDoc.com, 01/2008.
Year's End, Blog's End. Medpundit, 01/2008.
Image source: Openclipart.com

Updated: 01/02/2008

Google Rates High Medical Blogs

Three days ago, I wrote that ACP released MKSAP 14 and now this post is # 2 on Google, second only to the official ACP page.



Similarly, the post about the ABIM results for 2005 is # 2 after the official website of the American Board of Internal Medicine. I feel sorry for the poor Mo-Media.com that pays to be listed in "Sponsored Links" section...



I am writing this not to brag how great my blog is (it is not) but because I would like to encourage more health workers to blog. You can really make a difference by sharing your experience with the world by starting a blog or participating in Google Co-op Health.

For example, I could have never imagined that my website would reach 500,000 page views -- this is almost as if you had written a book and people have read half a million pages of it.

Future medical bloggers usually start just by reading blogs and gradually gathering the courage to start one of their own. Grand Rounds is a good place to check what other medical bloggers write about and to see which one is closer to your style of writing.

Blogging is both an enriching and therapeutic experience. It can even advance your career, or it can get you fired...

You do not have to be "a blogger" to start a website using a blog service. For example, the initial website of the Section of Hospital Medicine at the Cleveland Clinic was powered by Blogger.com but it was not a blog at all.

References:
Simply Fired - How NOT to Blog About Your Job. Especially If You Are a Doctor
Case Reports and HIPAA Rules
Blogs 'essential' to a good career - The Boston Globe

Google Video and Tabblo Photo Sharing

Google Video Update

There is no need to download and install a video uploader now, everything works within the browser. Question for Google: how about fixing the extension install for Google Notebook?

The other improvement is that your video is available for viewing immediately, YouTube-style. Google editors will have to review the video before it can be searchable.

References:
Instant gratification, Google Video style. Google Blog.

Tabblo Photo Sharing

Google needs a photo sharing service badly and the newly-launched Tabblo may be the answer. It even has a Picasa plug-in.

Tabblo is a Flickr competitor and so far I like it better. I wonder what Enoch Choi thinks about it -- he had some Flickr aggravations recently. The servce is free with unlimited uploads and the "tabblos" just look good: see my photos from a recent visit to the Cleveland Botanical Garden.

See my Tabblo

Update 3/22/2007:
HP goes web 2.0, buys Tabblo. GigaOM.

References:
Tabblo Allows Its Users To Design Sleek Montages; Paying $20 for a Poster. WSJ.com.
First Look: Share Photos and Stories With Tabblo. PCWorld.com.

Physician Blogger Writes About Her Stroke

Big Mama Doc writes a funny and deeply-insightful blog about working at her family medicine practice, teaching residents and having not the best of health herself.

According to her blog, she had a stroke not a long time ago but was able to return to work with the help of several medications including Coumadin.

Unfortunately, while at a conference in San Francisco at the beginning of May, she had a series of new strokes and had to be hospitalized for surgical interventions:

5/2/06
Update
"I was admitted Friday night with several new strokes. Turns out my bad mood was nothing but poor perfusion; a few intracranial stents this afternoon should do the trick. Please forgive the brevity of this message. Typing is a challenge with limited use of my left hand."

5/3/06
Saga
By a Friend of Big Mama Doc: "The procedure last night terminated early once they saw how goopy things were in those brain arteries "

5/5/06
One Down One To Go
By "Big Mama's not so talented writer husband": "Bigmama had her procedure yesterday afternoon. It lasted almost eight hours."

5/10/06
Part Two
"Mama Doc had her second procedure."

5/14/06
Home
"Quite frankly, I'm amazed to still be alive, and I am lucky to have limited deficit. Typing is a challenge, but speech is better every day."

5/15/06
What I Remember


She is now discharged home and on the path of recovery surrounded by her loving family. It takes courage to write about you personal problems and to share you deepest fears with the world.

I wish her a speedy recovery.


Follow-up

5/26/06
Occupational Therapy
The road to recovery after a stroke in not an easy one, especially for practicing physicians. There are so many fine motor skills that we take for granted which have to be "re-mastered" after a stroke. FatDoctor has a long list for her occupational therapist...

References:
Anniversary: My Story in Ten Brief Chapters. Fat Doctor.
Blogiversary. Fat Doctor.
Image source: FatDoctor.blogspot.com

Cleveland Clinic Perioperative Medicine Summit

2006 Perioperative Medicine Summit

The Cleveland Clinic Perioperative Medicine Summit is in its second edition this year. The last year summit included more than 200 physicians, and was very well-received. The proceedings were published in a special supplement of the Cleveland Clinic Journal of Medicine which you can read for free at the CCJM website.

Summit faculty includes members of the Section of Hospital Medicine and other departments at the Cleveland Clinic along with faculty members of Harvard Medical School, University of California, San Francisco, University of Pennsylvania School of Medicine, Case Western Reserve University, Duke University Medical Center and others.


Call for Abstracts - Research, Innovations, and Clinical Vignette

This is year, the summit program includes abstracts which will be eligible for publication in a supplement of the Cleveland Clinic Journal of Medicine. The deadline for submission is June 15, 2006.

I am a member of the Clinical Vignettes Committee and I would like to personally invite you to submit your abstract to meetingassistant.com/CCPMS2006.


Blogs Do Matter

For those readers who still think that blogs do not matter, just search Google for "Cleveland Clinic Perioperative Medicine Summit" and see the first page results: the Blogger-powered website of the Section of Hospital Medicine is right there at # 3. We will be moving part of the website to the official URL of Cleveland Clinic at clevelandclinic.org later this year but Blogger.com/Google has been a great host so far.

Google Notebook To Save Search Results and More

At the beginning of the year, Google announced that the pace of innovation will increase in 2006 and they will launch many new products. And so they did, for the second part mostly. Many of the new launches look like "me-too" products without much innovation involved. Still, I (like most people) would like Google to succeed because they are the "Don't be evil"-company after all.

The newly released Google Notebook can be used to take notes when you search the web. You can also save parts of web pages for research purposes. The screenshot below shows how to save a Wikipedia article about asthma by right-clicking on the selected text:



Regular Google searches now feature a "Note this" link below each search result. The "right-click to save" function is nice but you need to install a Firefox/IE extension to use it. Once installed, I like the keyboard "Alt + N" shortcut that opens and closes the notebook.

Digital Inspiration explains how he plans to use Google Notebook: "I frequently encounter websites that I want to cover in my blog later. Now with Google Notebook, I could just create a new Notebook session called "To Do" and quickly insert the website URL with a short description in the notebook."

Check the references below for a complete coverage.

Summary:
Google Notebook is an interesting service which may need some fine tuning in order to be more useful.

Update 6/2/2007:
Web Worker Daily reviews 7 Apps for Online Note-Taking.

References:
Note this. Official Google Blog.
Google Notebook Is Live. Google Blogoscoped.
Google Notebook - the good, the bad, and the ugly. ZDNet.
Google Notebook is live: Here's how I plan to use it. Digital Inspiration.
Google Notebook First Look. Micro Persuasion.
The Basics: Google Notebook. Google Tutor, 11/2007.
Google Notebook Adds Labels and Bookmarks. Google Operating System, 11/2007.
Image source: Google Notebook.

Related:


I Can Has Bookmarklet? Google Notebook Blog, 07/2008.

Updated: 07/10/2007

Drinking Alcohol Daily Seems to Cut the Risk for Coronary Artery Disease the Most

A study published in the BMJ reports a correlation between drinking patterns and risk of coronary heart disease in women and men:

Women who drank alcohol daily had a lower risk of coronary heart disease than women who drank alcohol on less than one day a week. Little difference was found, however, between drinking frequency.

For men an inverse association was found between drinking frequency and risk of coronary heart disease across the entire range of drinking frequencies. The lowest risk was observed among men who drank daily (0.59, 0.48 to 0.71).

Doctors do not recommend people who do not drink to start using alcohol to prevent or treat any disease. If you already drink alcohol, and you have no alcohol-related problems or contraindications, you can continue using it in moderation.

References:

Prospective study of alcohol drinking patterns and coronary heart disease in women and men. BMJ, doi:10.1136/bmj.38831.503113.7C (published 3 May 2006).
Alcohol literally kills: Gary Moore had 380mg/dL in his blood, Winehouse 416mg/dL when she died surrounded by 3 empty vodka bottles. Telegraph UK, 2012. 
Rethinking Drinking - NIH interactive website
Image source: OpenClipArt.org, public domain.

MKSAP 14 Has an Online Version

The venerable Medical Knowledge Self-Assessment Program ® (MKSAP) by the American College of Physicians, which has been available as print books and a CD-ROM, now has a new online version.

MKSAP is helpful not only to prepare for the ABIM but also to stay up-to-date after you are certified.

MedStudy was a favorite among my peers when we were studying for the board because it was more concise and better illustrated. I was scoring at the 96-98th percentile on my in-service exams during residency and I am somewhat ashamed to admit that I never really felt the need to do a lot of MKSAP or MedStudy questions. However, the new online edition definitely makes MKSAP a stronger rival of MedStudy and a better solution to ABIM preparation, I think.

According to a recent series of interviews with medical bloggers done by Dean Giustini, most of us prefer Up-To-Date as a way to stay current. Self-assessment programs, like MKSAP, have the advantage of being more challenging and fun to use since they are in a Q&A format.

References:
How to Do Well on the Boards?
"ABIM Results" on Google - Guess Who's Number Two in the Search Results?
Image source: ACP

BBC Search Adds Audio & Video

BBC award-winning website is one of the largest in the world and the challenge is to find what you want in this huge pile of information. They just launched a new search system which looks promising. The most useful addition seems to be the direct links to audio & visual content in the right sidebar. I wish Google provided something similar. This is a sample search for pneumonia on BBC.

Time-shift Your Favorite Programs

I have always enjoyed listening to BBC, especially since they launched their Listen Again page which allows me to choose when to listen to the programs I select. Time-shifting is the key to turning busy people into listeners and NPR knows it better than most -- NPR podcasting directory is one of the most comprehensive in the industry. See the section for Health & Science podcasts.

References:
BBC revamps website search system. BBC.
Text-to-Speech Programs and Continuous Medical Education
Image source: OpenClipArt.org, public domain.

Microsoft Blogger Has as Much PR Power as CEO. What Does That Mean for Your Hospital?

Via Micro Persuasion:

"Google Trends is also a killer tool for measuring the impact that bloggers have on a brand. Take a look for example at the graph below. It charts Microsoft CEO Steve Ballmer against it's most well-known corporate blogger, Robert Scoble. Note how close the lines touch."


Scoble, Microsoft blogger = blue; Ballmer, Microsoft CEO = red

This is one more reason why it might be a good idea for hospitals and physician practices to have blogs.

In today's consumer-driven world, the internet search is often the force that brings patients to your hospital. If a blog can get as much web exposure as press releases, you should probably have one.

Talking about trends, you can see clearly that "good" beats "evil" anytime, as if you had any doubt.... :-)

On a more serious note, you can see how hospitals compare in this "Google battle" of PR impact:

Cleveland Clinic vs. Mayo Clinic

Cleveland Clinic vs. University Hospitals

The Top 4 Hospitals in America in Google Trends

I work at Cleveland Clinic and we think we provide some of the best patient care in the world overall. Obviously, Mayo Clinic is doing a slightly better job at marketing and they are winning the "Google battle" for now. Blogs, like this one, may be one way to show the world how good we really are.

U.S.News & World Report ranks The Cleveland Clinic 4th Among the nation's 6,000+ hospitals in 2005. Cleveland Clinic Heart Center was ranked No. 1 in the nation for 11th consecutive year.

References:
Google Trends First Look. Micro Persuasion.
Hospitals Use Websites to Attract Patients
Google Trends comparison among the nation's top 4 hospitals
Google Press Day 2006 highlights. Googling Google.
Google Trends Examples. Google Blogoscoped.
25 Things I Learned on Google Trends. Micro Persuasion.
Google Trends - a Non-Scholarly Approach. MSSP Nexus Blog.
Blogs amplify the power of hospital critics. Kevin, M.D.

Updated: 11/18/2007

Medical Blogging in the Spotlight at the 2006 Consumer Directed Health Care Conference

Dmitriy of HealthVoices.com gave a presentation about medical blogs at the 2006 Consumer Directed Health Care Conference:

"The slides are attached, so you can download and see for yourself what caught the attention of consumer-directed healthcare leaders.

Nearly everyone I talked to immediately got the transformative power that blogging and open media will have on behavior of healthcare consumers."

You can download the PowerPoint file.

Image source: OpenClipArt.org, public domain

Google Health is Part of Google Co-op

Google wants you to help organize the world's information

Google Co-op is human-powered vertical search, according to the press release:

"Google Co-op beta is a community where users can contribute their knowledge and expertise to improve Google search for everyone.

For example, a doctor can label web pages related to arthritis, and users who subscribe to that doctor's information will receive options at the top of the results for more specific information such as "treatment," "symptoms," or "for health professionals" when they enter a relevant query."

It sounds a bit complicated... If I want to direct my patients to a collection of trusted links, I prefer to list them on my own website.

Google Health

Nobody is certain what the best model for a health search/portal is. I tried the prototype of Google Health and I found it useful although on the surface it looks similar to the other health search engines. I would like Google to launch another game-changer rather than a "me-too" product.

See the search results for "pneumonia."

As usual, Google wins with speed, dept of page index and accuracy.

The source websites included in Google Health have been recommended by:

National Library of Medicine,
Centers for Disease Control and Prevention
Health On The Net Foundation
Harvard Medical School
Mayo Clinic
University of California, San Francisco
Kaiser Permanente

Google Health still covers blogs as you can see from the query for "pneumoperitoneum, sexual activity." It shows the clinical case I presented at the annual meeting of the Society of Hospital Medicine last week.

Google has a history of refining their beta products with users feedback. Even the current version of Google Health is better than the current search interface, so this is definitely a step in the right direction.

Final verdict:

The newly-launched Google Health is a helpful product with great potential. I am planning to use it and I would probably recommend it to my patients when they search for medical information.

Update 3/28/2007:
Adam Bosworth, Vice President of Engineering at Google Inc. covers similar topics in: How do you know you're getting the best care possible?

Update 5/31/2007:
A medical librarian does not find the health-related Google Co-op very useful: How Doctors Think and consumer health, Google.

References:
Medical Search Engines
Google Co-op First Look. Micro Persuasion.
How to Use Google Co-op. Google Blogoscoped.
Enoch Choi is an individual contributor to Google Health Co-op
Health care information matters. Google Blog, 11/30/2006, Adam Bosworth.
Image source: OpenClipArt.org, public domain

Related:
An easy way to add new features to Google. Matt Cutts: Gadgets, Google, and SEO, 02/2008.

Updated: 02/26/2008

Physician Bloggers Talk to a Medical Librarian

Via University of British Columbia (UBC) Academic Search - Google Scholar Blog:

Part I
The humble me

Part II
Top Med Student Blogger, Graham Walker

Part III
Dr. Joshua Schwimmer of KidneyNotes.com

Part IV
Blogger Dr. Kevin is Part of Medicine's New Wave

It is interesting to see that 3 of us recommend the "What's New" section of UpToDate. The other trend is that although we like Google Scholar, Pubmed is still the place for a comprehensive medical search. I think that Dean should do a formal survey among physician bloggers in order to detect interesting trends like the ones above.

KraftyLibrarian also finds some insights in the interviews from a medical librarian perspective.

Image source: OpenClipArt.org, public domain.

Pediatric Grand Rounds is Launched

Medical Grand Rounds is a weekly summary of the best posts in the medical blogosphere and has been around for a while -- almost 2 years.

Pediatric Grand Rounds is in its second edition and the future looks bright. Blog submissions doubled from issue one to issue two, which is always a good sign.

Keith Richards of Rolling Stones Had Surgery for Subdural Hematoma

When I first read than Keith Richards fell from a coconut tree (?!), I immediately thought that the good-old-rock-and-roll boy was still young at heart. The injury turned out to be more serious than initially suspected though, and the famous Rolling Stones guitar player reportedly had brain surgery to evacuate subdural hematoma. This type of hematoma is usually seen after trauma in elderly people. The brain shrinks with age and some of the surrounding veins are left unsupported by brain tissue in the subdural space making them more vulnerable to tear in trauma, e.g. a fall.

The bottom line is that "time waits for nobody" and our rock-and-roll heroes from the 60's are not getting any younger.... Keith did very well after the surgery, he has already been discharged from the hospital and he is looking forward to joining Rolling Stones on their world tour.

References:
Report: Rolling Stone Keith Richards out of his tree, in a hospital. CNN.
Skull surgery for Keith Richards. CNN.
Image: Left subdural hematoma

Interesting Blog Posts

Do student doctors really need to know anatomy and that other basic science stuff?

Yes, they do. But if you do not agree with me, feel free to check Rangel M.D.' post who thinks that physicians learn too much basic science. Kevin, M.D. is also concerned that reportedly some doctors do not know where the prostate gland is. Dr. RW supports teaching of basic science in medical school and does not want to be "relegated to the status of “provider.”


Colonoscopy: High-Fiving Where the Sun Don't Shine

A physician writes about his experience of having 3 colonoscopies and this is before he even finished residency.


How Much Should Doctors Make?

Ezra Kline compares physician salaries in different countries and writes that "being a doctor shouldn't be about the money anyway."


Can Bloggers Make Money?

They certainly can, according to Jason Calacanis, who is interviewed for the WSJ. It all depends on the number of page views: "if you can do 500,000 pages a month -- which isn't easy -- you can make $1,500 to $5,000 a month."

I doubt that it is that simple, at least not for medical blogs, very few of them can achieve this level of traffic and in addition, people who visit medical blogs do not click on the ads much.

Digg for Medicine: Nature Publishing Group Launches Dissect Medicine

Digg.com is a tremendous success. Webmasters dream of their pages being "dug." A news or blog story which makes it to the front page of Digg brings tens of thousands (millions?) visitors to the linked website. People vote passionately for the stories they like or dislike.

Dissect Medicine is a website of Nature Publishing Group. They first tried it out with a service called Pligg which now redirects to the new website:

"Dissect Medicine is a collaborative medical news website. Users submit stories for review but rather than allow an editor to decide which stories go on the homepage, users do by voting for stories.

The ideas behind Dissect Medicine come from Digg.com, a technology news website that employs non-hierarchical editorial control. Dissect Medicine takes this concept and adds extra features to tailor it to the needs of a medical audience."

It looks interesting. Give it a try. If nothing else, you can submit your own blog post to see what others think about it.

The real question is how many people are going to use Dissect Medicine to digg medical stories. The "wisdom of crowds" concept works when you have a crowd.

Social websites need a critical mass of users and this is one of the reasons why I am posting the link to Dissect Medicine here.

Update 4/4/2007:
David Rothman writes about 3 separate efforts to create a “Digg for medical literature”: MediNews: Digg for Medical Literature, Part IV.

Digg Song


Kina Grannis created the “Digg Song” and became an almost instant viral success, so much so that a record company has been in touch with her. Link via Dr Shock MD PhD. Song chorus:

"Gotta digg, gotta digg, gotta digg
Gotta make this story big!"

References:
Digging Grand Rounds

Updated: 01/01/2008

Interesting Articles in Medical Journals

Is there a doctor aboard?
The Lancet 2006; 367:1397-13981 (free registration required)

What happens if 4-5 doctors show up to help a sick patient? Who is in charge among them? Does "Good Samaritan law" apply when the plane is over the Sahara desert?


Are women better or worse doctors than men?
The Lancet 2006; 367:1391 (free registration required)

Image source: OpenClipArt.org, public domain

A Guide for Doctors Planning to Relocate Abroad

BMJ Career Focus features several articles with advice for physicians planning to pursue their career in different parts of the world:

Australia and New Zealand

So you want to be an Aussie doctor? sBMJ
Stairway to New Zealand

North America

Working in the US. "Working hours during residency are just under double the hours we work in the NHS... A typical day starts at 5:30 am and finishes at around 6 pm ... Salaries are low...." It doesn't sound very encouraging, does it?

Europe

Living and working in Sweden
I am desperate to work in Italy as a doctor. Any suggestions?
I am contemplating temporary work in Spain. How do I go about registering as a doctor there?

Related:
Student BMJ: International Experience
Australia operates "closed shop" to restrict doctors from overseas, say critics - BMJ http://bit.ly/1eeQJX

Australia may consider ending 10-year moratorium that was "forcing overseas doctors into bush" http://goo.gl/Y8ZHN

Who would you give the job to? Verbatim excerpts from the application letters of overseas doctors seeking a job in Australia. Life in the Fast Lane, 2011.
Image source: Openclipart.org