Newer airbags less effective in protecting drivers than older airbags?

Video. CNN.com

Should Doctors ‘Prescribe’ a Drink a Day? No.

From the NYTimes:

The evidence regarding wine versus other beverages like grape juice is mixed.

For most people, low-risk drinking is not harmful to health — and may be helpful. However, I would discourage people from drinking in order to improve their health.

Compared with non-drinkers, men who consumed wine, beer, or spirits had a 36% lower risk of all-cause mortality and a 34% lower risk of cardiovascular mortality.

Before you recommend wine for cardiovascular risk reduction, consider this:

- One in five men at risk of drinking problem during their lifetimes

- Women have an 8 to 10 percent chance of becoming dependent on alcohol during their lifetimes

- Men have 15% lifetime risk for alcohol abuse, 10% risk for alcohol dependence. Each cuts your life short by 10-15 years.

- Heavy drinking increases risk of depression by 40%, and 80% of people dependent on alcohol are smokers

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. 

References:

Should Doctors ‘Prescribe’ a Drink a Day? NYtimes, 2010.

A glass of wine daily may prolong life. How can you predict which patient will have a bottle daily though?

Before you recommend wine for CV risk reduction, consider this: 1 in 5 men at risk of drinking problem
Rethinking Drinking - NIH interactive website
Image source: Wikipedia, public domain.

Comments from Twitter:

OMC ‏ @charlesayanleke: That's a recommendation most peeps can get behind

Tibor Banyai ‏ @tibor75: Do u tell your AF pts to be 100% abstinent? Curious RT @drjohnm: RT @DrVes: Should Doctors ‘Prescribe’ a Drink a Day? No.

John Mandrola, MD ‏ @drjohnm:  No I don't rec abstinence but I don't feel that alcohol adds to health. Mild intake prob neutral. Worry about cancer risk

Fennel & Lentil Soup

Tonight has been the perfect evening. Came home from work just in time to make it to my body-building class at my gym. Indulged in some fitness magazines on the treadmill after the class. Came home and warmed up some of this yummy soup. Lit some delicious-smelling candles and listened to some amazing ladies (Alicia Keys, Brandi Carlile, India Arie, Regina Spektor, & Meshell Ndegeocello) while reading cookbooks. I couldn't be happier. Hope you had a wonderful and relaxing Thursday evening of your own!

2 leeks
1 fennel bulb, chopped (I used the entire bulb & stalks, but saved a few of the feathery leaves for a garnish.)
2 sweet potatoes, chopped
1 cup lentils (I used French green lentils, but you can use whatever strikes you!)
3 cubes veggie bouillon* (you can use more or less depending on how strong you like your broth)
5 ribs celery, chopped
2 Tbs apple cider vinegar
6 cups water (you can use more or less depending on how much broth you like)
2 Tbs olive oil
2 cloves garlic, minced
salt and pepper to taste

Start by preparing your leeks. Cut off the roots and dark-green outer leaves. Cut the leeks in half (length-wise), then chop into pieces. I like to wash them after I've chopped them because this is the best way to remove the dirt that gets trapped in their layers.

Add the olive oil to a medium pot and place on medium heat. Add your leeks and saute for about 5 minutes. Add the garlic, celery, fennel, and sweet potatoes. Saute for about 5 minutes.

Next, add the water, bouillon cubes, and apple cider vinegar. Bring to a boil and add the lentils. Cook on medium heat for about 45 minutes, until lentils are soft. Add salt and pepper to taste. Serve and garnish with the feathery fennel leaves if desired.

Soy-free, Gluten-free (double-check your bouillon if you are worried about soy or gluten)*

High deductible health insurance can be bad for your health

See why:

"The individual health insurance policy they bought to replace Janie's group coverage at work has such a high deductible that they've sharply cut back doctor visits, skipping some routine care and going only when absolutely necessary.

Freelancers Janie and Chris Peterson love the freedom of life without a boss. But it comes with a high price -- dwindling savings, erratic cash flow, and a ton of financial anxiety."

References:

Financial planning for freelance workers - Mar. 11, 2010. CNN.

Image source: United States one-dollar bill. Wikipedia, public domain.

Feminist Parenting: When to encourage

All year the kid has been talking about how she wants to join cheerleading. Yes, her school has a cheer program for grades 1-8. One of her BFFs is in it this year and the kid has told me time & again that she wants in too.

*sigh*

I tried out for cheerleading, so I'm not totally opposed to it. But cheerleading has gotten far more athletic than back in my day. Which is why I would let her try out. She's great at gymnastics! Plus the thought of cheerleading helping to get the kid to be more vocal in public, well, that's a bonus too. But then I think about how sexualized cheerleading has also become with all the sexy dances...I start to gag. I also don't want her to learn that girls cheer for boys and no one else.

I've tried to find out if the cheerleaders cheer for both boys and girls basketball, if the squad does routines appropriate for all 1st - 8th graders and if the coach is certified. I'm willing to try this out.

The thing is that the kid's tune has changed! She doesn't want to try out. I think she's fearful of the trying out aspect. I get that.

Now I wonder, should I be more encouraging, even thou I have no idea if this cheer thing is actually beneficial? What if I encourage her and I hate it? But do I really let her not try something out of fear? Ay!

I keep reminding myself that the kid is in gymnastics, soccer and theater. Does she really need one more thing? No. So that's where I land. I've ruled out cheerleading solely on the basis that she doesn't need one more thing to do. And I really don't want to ever push her to do anything.

So why I do I feel so damn guilty?

Book Review: My Little Red Book *GIVEAWAY*

My Little Red Book by Rachel Kauder Nalebuff is a cute book about first periods. It's not scholarly but nor is it a "Hey, you got your period? AWESOME!" book either. It's nicely in the middle.

I'm fairly certain that I would have killed for this book as I was awaiting the arrival of my period many, many, MANY moons ago. I know I sent away for one of those books that you could request from a tampon box. But the information was still just as technical as my medical encyclopedia. I wasn't one of those lucky gals who got to flip thru her mom's worn copy of Our Bodies Ourselves either. 

While my daughter will get to flip thru at least two copies of OBOS, have easy access to feminist health providers and well, I'm her mom, I'm so keeping this book on the bookshelf in the living room. I've already told the kid that within the next year, all the books in the living room will be free for the taking. No questions asked, grab one, read it. I'm keeping the more mature issue books in my home office. The stories in MLRB are funny, sad and sometimes both. Stories from women who experienced their first period decades ago and some young women who had theirs just a few years ago. So get yourself a copy!

And the fun part! GIVE-A-WAY!! You get a period book...You...and YOU!

Actually, the first ten people to comment here gets a copy for themselves. Just leave your email in your comment! It's that easy. No need to tell your tale...unless you want. Sorry...Only US and Canada addresses and NO PO Boxes. You'll be contacted by the book folks, so I won't get your info.

Want to buy your own copy? Send one to a young woman in your life? Please buy your copy at an indie bookstore or Powells.com.

Disclaimer: The only payment I received was the copy of the book. 

"The doctor in literature: Private life" by Solomon Posen at Google Books

"This is a structured, annotated and indexed anthology dealing with the personality and the behaviour of doctors, and doctor-patient relationships - ideal for medical humanities courses."

Medical school letters of recommendation have formally been replaced by tweets

Doctor_V's tweets in Brizzly (click to enlarge the image) - read from the bottom of the screenshot.

Doctor_V:

If you are a medical school I highly suggest you admit @beccacamp .@LeeAase I don't know if Mayo School of Medicine takes Twitter recommendations but I formally recommend @beccacamp. Medical school letters of recommendation have formally been replaced by tweets.

Indeed. And if the tweets are by Doctor_V, they should be strongly considered in the admission process... :)

The men behind famous eponymous diseases

From CNN:

"Having a disease named after you is a decidedly mixed bag. On the one hand, your scientific developments are forever commemorated. On the other hand, though, you're stuck with the knowledge that no patient will ever be happy upon hearing your name."

Daniel Elmer Salmon (1850 – 1914) was a veterinary surgeon. He earned the first D.V.M. degree awarded in the United States, and spent his career studying animal diseases for the U.S. Department of Agriculture. He gave his name to the Salmonella genus of bacteria, which were discovered by an assistant, and named in his honor. Image source: Wikipedia, public domain.

New medical conditions that are being discovered are not named after scientists or physicians anymore. The eponymous system is non-descriptive and generally confusing.

References:

The men behind famous diseases. CNN.

Chunky Marinara Sauce

I've been on this gluten-free adventure lately and came across Trader Joe's Organic Brown Rice Spaghetti Pasta. I have tried other gluten-free pastas before, but this one is now my top favorite. First of all, it tastes amazing (you would never think this is rice!) and second, the ingredients are simple: Brown rice and water. That's it! Over the weekend I cooked up a super quick and simple chunky tomato sauce to go with it. I also added in some Brussels sprouts and Lima beans. This would also go well with some broccoli or bell peppers, or any of your favorite veggies.


1 medium yellow onion, diced
1 garlic clove, minced
1 can diced tomatoes
1 Tbs Italian herbs
1 Tbs dried basil
2 Tbs red wine vinegar
1 Tbs olive oil
salt and pepper to taste

Put the olive oil in a pan and place on low-medium heat. Saute the onions for about 5 minutes until translucent. Add the garlic and tomatoes (with juice), herbs, red wine vinegar, salt, and pepper. Simmer for about 5 minutes. If you are adding other vegetables or beans, I would recommend cooking them separately first, then adding them in when you add in your tomatoes.

Gluten-free, Soy-free

3-gram reduction in daily salt intake would decrease coronary heart disease, stroke, and death

The U.S. diet is high in salt, with the majority coming from processed foods. Reducing dietary salt is a potentially important target for the improvement of public health.

Reducing dietary salt by 3 g per day (1200 mg of sodium per day) is projected to reduce the annual number of new cases of CHD by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. Such an intervention would be more cost-effective than using medications to lower blood pressure in all persons with hypertension.

The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels.

References:

Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease. NEJM, 2010.
http://content.nejm.org/cgi/content/short/362/7/590
Sweat Bees prefer sweaty people because the human diet is so salty that their perspiration is saturated with that essential nutrient. WSJ, 2012.

Image source: Single-serving salt packets. Wikipedia, GNU Free Documentation License.

Fish out of pills - Pharmaceuticals in drinking water

Fish out of pills - Pharmaceuticals in drinking water, NationalGeographic, April 01, 2010. Design Editor Oliver Uberti shows what went into the making of an information graphic about pharmaceuticals that make their way into our watersheds and end up in fish. Click here to see the full-size illustration.

A vast array of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones — have been found in the drinking water supplies of at least 41 million Americans. The concentrations of these pharmaceuticals are tiny, far below the levels of a medical dose but the long-term consequences to human health are unknown.

The pharmaceutical industry points out the amount of medication in the water supply is the equivalent of a single pill in an Olympic-size swimming pool. Still, if you a have glass of water in Philadelphia, you are drinking tiny amounts of at least 56 medications.

References:

Antibiotics, anticonvulsants, antidepressants and sex hormones in drinking water of 41 million Americans http://goo.gl/HiXa

AP Probe Finds Drugs in Drinking Water. Associated Press.

Drugs in water causing troubling problems to fish, wildlife. CNN.
In U.S., bottled water lacks drug safeguards. CNN.

Pollution: Fish Pharm. NGM Blog Central.

Related reading:

Fish Pharm: Pharmaceutical Waste and the Environment. BitingTheDust, 2010.

Fishing For Answers: How To Choose Fish and Seafood | Summer Tomato http://goo.gl/0OBf
Something in the water - fluoxetine in this river, antihypertensives in that lake - BMJ, 2011.

FDA: High-dose simvastatin increases risk of muscle injury - caution with lower doses plus Amiodarone, Verapamil, Diltiazem

Based on review of data from a large clinical trial and data from other sources, the U.S. Food and Drug Administration (FDA) is informing the public about an increased risk of muscle injury in patients taking the highest approved dose of the cholesterol-lowering medication, Zocor (simvastatin) 80 mg, compared to patients taking lower doses of simvastatin and possibly other drugs in the "statin" class.

The muscle injury, also called myopathy, is a known side effect with all statin medications. The most serious form of myopathy is called rhabdomyolysis. Patients with myopathy generally have muscle pain, tenderness or weakness, and an elevation of a muscle enzyme in the blood (creatine kinase). The higher the dose of statin used, the greater the risk of developing myopathy. The risk of myopathy is also increased when simvastatin, especially at the higher doses, is used with certain drugs (see Simvastatin Dose Limitations below).

The data come from the SEARCH study, in which myopathy was seen in nearly 1% of patients taking the 80 milligram dose of Zocor but in only 0.02% of patients taking the 20 milligram dose of Zocor.

Update 6/2011: FDA Restricts Use of Simvastatin 80 mg, due to increased risk of muscle damage http://goo.gl/K9O5v

Rhabdomyolysis was rare in the SEARCH study. It happened in only 11 of 6,031 patients (0.02%) in group taking the 80 milligram dose of Zocor, but was not seen in patients taking the 20 milligram dose.

New data also suggest that people of Chinese descent should not take Zocor at the 80 milligram dose -- and should be careful even when taking lower doses -- if they also take niacin-containing products.

Simvastatin Dose Limitations

These limitations apply to ALL patients taking simvastatin.

Do not use simvastatin with these medications:

Itraconazole
Ketoconazole
Erythromycin
Clarithromycin
Telithromycin
HIV protease inhibitors
Nefazodone

Do not use more than 10mg of simvastatin with these medications:

Gemfibrozil
Cyclosporine
Danazol

Do not use more than 20mg of simvastatin with these medications:

Amiodarone
Verapamil

Do not use more than 40mg of simvastatin with this medication:

Diltiazem

References:

FDA Drug Safety Communication: Ongoing safety review of high-dose Zocor (simvastatin) and increased risk of muscle injury. FDA.
FDA Warns of Zocor Risk to Muscles. WebMD.

FDA Restricts Use of Simvastatin 80 mg, due to increased risk of muscle damage http://goo.gl/K9O5v

Image source: Simvastatin. Wikipedia, public domain.

Blissful Beet & Berry Smoothie

I haven't been feeling the best the last couple of days and I think I might be fighting something off. Yesterday my stomach was hurting really bad and it made me remember one of my favorite cures for a stomach ache: aloe juice. I know it might sound weird, but I've used it the past couple of years for stomach pain, heart burn, and general indigestion. It's amazing! You can read more benefits about it here, but I highly recommend it! I learned this morning that it also neutralizes toxins in your body, regenerates tissues, improves the immune system, and helps fight cancer. You can't go wrong there.

You also can't go wrong with a beet & berry smoothie! I found this recipe on one of my new favorite blogs: Diet, Dessert, and Dogs. It was absolutely delicious! I left out the stevia and substituted spinach for kale. Drink up!

1 medium beet, baked until soft, peeled and cut in chunks
1 cup mixed fresh or frozen berries
3 large or 4 medium kale leaves (or spinach)
1/2 medium cucumber, cut in chunks
juice of 1/2 lime
1 scoop of rice protein powder (or hemp)*
1 cup rice milk (or hemp or almond)*

Place all ingredients in a high powered blender and blend until smooth. (Note: if you use fresh berries, you may wish to add 1-2 ice cubes for a cold smoothie). Drink immediately. Makes 1 large or 2 small servings.

Soy-free, gluten-free (make sure you are using soy & gluten-free milk & protein powder)*

If you wish to make this smoothie raw, substitute fresh apple juice for the milk and throw in some raw almonds instead of protein powder. If your blender can handle it, you can use raw beets, or you can use beet juice instead of apple.

Occupation may be a key factor in lung cancer

While cigarettes are by far the most important cause of lung cancer, chemicals and other on-the-job hazards "play a remarkable role" in lung cancer risk.

5% of lung cancers in men are job-related. Men in the known to be risky occupations were 74% more likely to have been diagnosed with lung cancer.

The strongest associations were seen for ceramic and pottery jobs and brick manufacturing, as well as for those working in manufacturing of non-iron metals.

A CXR shows a right upper lobe (RUL) mass due to lung cancer. Source: Finger Clubbing due to Lung Cancer. Clinical Cases and Images.

References:

Occupation a key factor in men's lung cancer risk. Reuters, 2010.
http://www.reuters.com/article/idUSTRE61E53920100215

Hockey-puck-on-a-rod test checks for concussion after head trauma

From NPR:

The hockey-puck-on-a-rod test was invented by a Michigan high school student.

It works like this: Tester suspends the device while injured athlete sits with forearm on table, fingers loosely circling the stick. Without warning, tester drops stick. Athlete grabs stick as fast as possible. Place where athlete grabs gives an instant readout of reaction time.

It all happens in milliseconds - too fast to measure with a stopwatch. Athletes with concussions had reaction times that were 15% slower.

References:

Teenager's Science Project Leads To Simple Concussion Test. NPR.

Comments:

Nicholas Genes - Neat idea. I like how it's free of stopwatches and all the variability they introduce. But it seems that athletes would need to have a baseline measurement pre-trauma to really compare (maybe they can do it when they're signing waivers at the start of the season...)

Book Review: Rapunzel's Revenge by Shannon Hale and Dean Hale

Normally I put this at the end of my review, but I'm gonna get right to it:

BUY Rapunzel's Revenge by Shannon Hale and Dean Hale at an indie bookstore or Powells.com.

I bought this book for my daughter after seeing it on the 2010 Amelia Bloomer list.  Since getting pregnant I've been on the hunt for feminist fairy tales. In the last month I've been a bit obsessed. I had to special order this from Women and Children First and I picked it up around 6 pm on Wednesday. By 11:30 I was done.

Yes this is a graphic novel and it's for kids, so not too hard right? I read it in one night not because it was easy to read, but because it was soooo damn good!

Hale takes an old tale and puts an amazing spin on it, gives Rapunzel brains and guts and WAM! We have ourselves an amazing adventure. I can't wait to read this to the kid. But we do have a few other books to get through first. It is a bit scary for a 6 1/2-year-old, but hey, she's reading The Sisters Grimm too.

And damn, there's a sequel to Rapunzel! Next time I'm in the bookstore, I'll have to order that one too. But really, they should stock this baby in their children's graphic novel section.

No disclaimer on this review since I bought this baby with my own money.

Red Lentil Soup for the Planet

Happy Earth Day! As someone that strives to be eco-conscious, I feel a tad guilty that I'm not out planting a tree today (or really, every day.) However, I am at home thinking about my energy consumption as I make this vegan soup... that's gotta count for something, right?

I took an online quiz about my ecological footprint today. I think that was when the environmental guilt set in. If everyone on the planet lived my lifestyle, we would need 2.13 Earths. Eek. (You can find out your ecological footprint here.) I felt better for a moment knowing that my results were extremely low compared to our national average. Then I realized that meant as a country we're wasting resources faster than we can count.

This led me to check out the EPA's Earth Day site where, you too, can pick 5 actions you're committed to that will improve the planet. Here are mine:

1. Pass on gas! Take public transportation, carpool, plan your day to reduce trips and vehicle emissions.
2. Learn about composting, try it out!
3. Reuse. Upcycle! Take something that is disposable and transform it into something of greater use and value.
4. When purchasing goods, opt for sustainable, recycled or reused resources. Choose items in less packaging.
5. Cut back on the amount of "stuff" that could later end up as waste.

I'm an avid recycler, composter, and bus commuter. I do try to buy things used when possible, but I have a weakness for (sigh) kitchen appliances. If you happen to catch me in a kitchen store, you're welcome to remind me of my pledge to not buy "stuff." I'll try to comply. :)

Now, back to the soup. This red lentil soup is light and the lemon makes it taste like spring. It also cooks up quickly (gotta love lentils!) and besides some chopping and stirring, is effortless.

2 cups red lentils
2 vegetable bouillon cubes*
2 Tbs apple cider vinegar
salt & pepper to taste
1/2 tsp dried dill
5 stalks celery, diced
3 carrots, diced
1 medium yellow onion, diced
2 cloves garlic, minced
juice from 1 large lemon
1 Tb olive oil
6 cups water

Add the olive oil to a pot and put on medium heat. Add your onions and saute for about 5 minutes. Add the garlic, diced carrots, and diced celery and saute for about 5 minutes. Next, add the water, lentils, bouillon cubes, and dill and bring to a boil. Reduce heat to low. Simmer for about 20 - 25 minutes, until the lentils are fully cooked. The soup will begin to thicken so it requires occasional stirring (or the lentils will stick to the bottom and burn). Add the lemon juice, apple cider vinegar, and salt and pepper to taste. Depending on how much broth you like, you can add a little more water if necessary. Garnish with fresh herbs (if desired) and serve!

Soy-free, gluten-free (double check that the bouillon cubes are soy-free & gluten-free)*

Rock legend Ronnie James Dio is fighting stomach cancer

On 25 November 2009, Dio's wife and manager announced that he was diagnosed with stomach cancer:

"Ronnie has been diagnosed with the early stages of stomach cancer. We are starting treatment immediately at the Mayo Clinic. After he kills this dragon, Ronnie will be back on stage, where he belongs, doing what he loves best, performing for his fans. Long live rock and roll, long live Ronnie James Dio. Thanks to all the friends and fans from all over the world that have sent well wishes. This has really helped to keep his spirit up." -- "He has had a few hiccups between Christmas and New Year's," she said in a statement to fans. "He has had a blood clot, a trip to the emergency room, and a three-day stay at the hospital."


ArtisanNewsService — April 13, 2010 — "One of heavy metal's premiere vocalists Ronnie James Dio shares his thoughts on his battle with stomach cancer at the Revolver Golden Gods awards."

On 14 March 2010, Dio's wife and manager Wendy posted an online update on his condition:

"It has been Ronnie's 7th chemo, another cat scan and another endoscopy, and the results are good - the main tumour has shrunk considerably, and our visits to Houston (MD Anderson Cancer Center in Texas) are now every three weeks instead of every two weeks."

Ronnie James Dio passed away on May 16, 2010 at age 67. The music lives on: http://www.ronniejamesdio.com

References:
Ronnie James Dio. Wikipedia.
Black Sabbath, Dio singer Ronnie James Dio gives cancer update. NME.com.

Eddie Trunks Metal show with guests Ronnie James Dio & Geezer Butler, May 30, 2009.

Metal legend Ronnie James Dio dead at 67. USA Today, 2010.
Ronnie James Dio, Rock Singer, Dies at 67. NYTimes, 2010.
Ronnie James Dio died at age 67. YouTube.
Ronnie James Dio Remembered By Metallica's Lars Ulrich. MTV.
The Lighter Side of Ronnie James Dio. NYTimes.
Lars Ulrich's letter to Dio.

Dio, another day. Nigel Britto, TOI Crest, May 22, 2010.
Dio monument in Bulgaria - source one, two, three (in Bulgarian), 10/2010.

Updated: 10/24/2010

500 repetitions of 4 cardiac murmurs improved auscultatory proficiency of medical students

According to a 2004 study in Chest, the ability of medical students to recognize heart murmurs is poor (20%), and does not improve with subsequent years of training.

Five hundred repetitions of four basic cardiac murmurs significantly improved auscultatory proficiency in recognizing basic cardiac murmurs by medical students. These results suggest that cardiac auscultation is, in part, a technical skill.

Related resources

The Heart Sounds Tutorial by Blaufuss.org is a fancy flash-based simulator with animations. The McGill University Virtual Stethoscope is another useful website. Click here for more web-based teaching resources for hearts sounds from UCLA and breath sounds from Loyola University.

References:

Mastering cardiac murmurs: the power of repetition. Barrett MJ, Lacey CS, Sekara AE, Linden EA, Gracely EJ. Chest. 2004 Aug;126(2):470-5.

http://www.ncbi.nlm.nih.gov/pubmed/15302733

Image source: Modern stethoscope. Wikipedia, public domain.

Physical Examination Videos

Book Review: Waking Up in the Land of Glitter by Kathy Cano-Murillo

I love glitter! I love crafting with it. I love wearing it. I love it period!

Waking Up in the Land of Glitter: A Crafty Chica Novel by Kathy Cano-Murillo is like being in a tub of glitter. Pure fun. 


I'm not one to read a book just for fun. I'm not usually a summer book kinda gal. But this was good fun. Sure, there's a good debate about craft versus art, but it's far more a story about a couple of women trying to find their way in life and love. 


If you know Crafty Chica's arts and crafts, the book is the same fun. 


Did I mention that the book is fun? Cause it is. 


In Chicago, we're barely into spring, but it doesn't mean it's too early to grab this summer reading book for your beach bag. Or heck, get it now and pretend it's summer time. Buy your copy at an indie bookstore or Powells.com.

Disclaimer: The only payment I received was the copy of the book. 

Standardized patient: Over the course of three days, I had 23 head-to-toe physicals from 23 medical students

From Slate:

"I was the first person these would-be doctors had ever fully examined on their own. Some were shaking so violently when they approached me with their otoscopes—the pointed device for looking in the ear—that I feared an imminent lobotomy.

A "standardized patient" is a trained person who is paid $15 an hour to be poked and prodded by inexperienced fingers, so that med students can learn communication and examination skills before they are sicced on actual sick people.

Now there are standardized patients trained for genital duty (they're called GUTAs, for genitourinary teaching associates).

Dr. N wasted the first eight minutes of the exam trying repeatedly to get a blood pressure reading. The panic in his eyes seemed to say, "She appears to be alive, yet she has no vital signs."

Comments:

Lakshman Swamy - Don't forget that some of them were capable! I have to say, in my experience as an MS2 at Wright State, our standardized patients are amazing teachers. It is much easier to learn physical exam skills and even interviewing when the patient can give you precise feedback. The author is right on with the characters that patients can portray... it is shocking when they break character to give feedback! Just recently I learned how to do the male exam with two standardized patients ("GUTA" -- never heard of that term before). I was definitely feeling a little ... awkward before the session began-- this was by far the most invasive thing I had ever done to another person. But the standardized patients were amazing about the whole process, even acting out the different hesitations that we might encounter in patients, emphasizing the importance of the exam, etc. Without being too graphic, I can't emphasize how much I learned about how to do those exams and what I was actually supposed to be finding. It was a totally different experience than I expected, and after it, I feel really confident about the whole process.

I can't even IMAGINE what it would be like to do that with my classmates-- and how much less I would have understood. Wow.

References:

Oh, no! I'm the first patient these 23 medical students have ever examined. Slate, 2010.

http://www.slate.com/id/2169480/pagenum/all

Image source: OpenClipArt.org, public domain.

Pancakes, Pizza, & Protein Bars

Since I am graduating soon, the subject of "what's next?" keeps coming up. Everyone wants to know, "what's your plan?" and "what are you going to do with this degree?" In the past, I have been the gal keeping herself awake all night worrying with a million questions and stories in her head. I have never been the person to trust the universe and allow its process to unfold before me.

However, I am happy to report I am now learning to be more present in the moment. Of course, that's not to say I haven't thought about what's next. I'm just not letting the ambiguity weigh me down anymore. Instead, I'm enjoying my life in the right here and right now and trusting that following my passions will guide me in the right direction.

At the moment, the only thing I can be sure of is that the next phase of my life is going to involve some darn good food. So, I'm putting my energy and focus into that. After all, what you focus on expands. My summer is going to be delicious. :)

Until then, a little help from some vegan restaurants will have to do. I have mentioned Pizza Pi before and I will mention them again because they are just that good. They are completely vegan and have a wide-range of pizzas and toppings. I tried their gluten-free pizza crust over the weekend and it was fabulous. Their pizzas and desserts are fabulous enough that I've heard people say, "I can't believe this is vegan!" Yep, vegan food is that good.

Before my class on Saturday morning, Ash and I carved out just enough time in our busy lives to sit down to breakfast. Portage Bay Cafe was the perfect place for this. Their philosophy is sustainable, local, organic food and they have plenty of vegetarian and vegan options for breakfast. You have to get there early enough (7 or 7:30 am) to avoid the line, but it is worth it!


And finally, if you're in need of some vegan, gluten-free protein on the go, Bumble Bars are delicious. This was in my bag of goodies from VegFest that I got for renewing my Vegetarians of Washington membership. The main ingredients are sesame and flax seeds and they are also much lower in sugar than traditional protein bars. Yum!

Equal Pay Day 2010: Wage gap in science and engineering

Today is Blog for Equal Pay Day! 


This post isn't meant to be lazy, but I realized that the idea I had for today I already did over at Girl w/Pen. Yes, I've finally gotten to the point in my writing where I have forgotten what I've written about. It took a web search to remind me. Oh, so pathetic...but back to today's post....

One reason why I am passionate about piquing girls' interest in science and engineering as a career path is the money. Even in this recession, starting salaries for computer-related and engineering careers are on the rise. They are also usually higher than any other field. This can be quite a carrot for sticking out a second semester of Calculus or even organic chemistry.

But I also tell my students that there is a wage gap for scientists and engineers. Back in 1999, the National Science Foundation found that the wage gap for engineers was only 13 cents. Not bad. Overall for science, engineering and math, it looks like the wage gap in 2001 for starting salaries was 24 cents.

Some have theorized that the difference in the wage gap between science and engineering can be attributed to the market. Since there are less women in engineering, they can usually negotiate a better salary since they are more in demand. Some have also theorized that the biological sciences are facing dropping salaries since more women are entering...This is yet to be proven...salary wise anyway.

Bottom-line is that the wage gap impacts all women. Even in uber-women dominated careers like nursing, men out earn women.

And of course the gap widens for women of color as seen in these lovely graphics that the Feminist Looking Glass posted from NPR. Although considering the serious lack of people of color in science and engineering, I'd love to look at that wage gap.

Other Equal Pay Day links of note:

• On Equal Pay Day, Reform Movement Calls for Wage Equity
• National Women's Law Center Action
• Sen. Dodd's statement and NWLC's blog

AskaPatient.com - Medication Ratings and Health Care Opinions

This website "reports patient ratings and rankings of pharmaceuticals and prescription drug side effects. Database includes FDA-approved pharmaceuticals."

http://www.askapatient.com

You can Search by Drug Name:

http://www.askapatient.com/rateyourmedicine.htm

You can add ratings for the medications you take or look at ratings and comments from other patients.

For example:

cetirizine
http://www.askapatient.com/viewrating.asp?drug=19835&name=ZYRTEC

simvastatin (scores rather low)
http://www.askapatient.com/viewrating.asp?drug=19766&name=ZOCOR

Please note that I am not sure how useful the site is, and obviously, this post is not an endorsement or recommendation.

Related readings:

How reliable are those patient driven rating sites? Notes from Dr. RW, 2010.
Analysis of 4,999 Online Physician Ratings: most patients gave positive reviews (2011 study) http://goo.gl/LgG5L - It begs the question: couldn't researchers add 1 more for a round number 5,000?

Image source: AskaPatient.com.

Different types of kidney transplantation - Mayo Clinic video

"Dr. Raymond Heilman, Medical Director of the Kidney Transplant Program of Mayo Clinic in Arizona, gives an overview on the different types of kidney transplantation, including living donor and paired donor exchanges, and explains what kidney donors can expect."

The false idea that only the “top journals” publish the important stuff

From the former Editor-in-Chief of BMJ:

The naïve concept that the “top journals” publish the important stuff and the lesser journals the unimportant is simply false. People who do systematic reviews know this well. Anybody reading only the “top journals” receives a distorted view of the world. Unfortunately many people, including most journalists, do pay most attention to the “top journals.”

References:

Richard Smith: Scrap peer review and beware of “top journals”. BMJ Blogs.

Google ranks the top 100 journals and NEJM is no more the "top dog" according to G Scholar Metrics for Publications http://goo.gl/unTjs

Comments from Google Buzz (March 22, 2010):

Heidi Allen - Love the fact that the BMJ have put out so bold a statement

Neil Mehta - Very provocative. Agree that Peer review is mostly a joke and a lottery. Unfortunately we still live in a world of publish or perish. We need to have something like a YouTube of papers. As more people read these and rate them, the cream will rise to the top. The raters should also be rated and that should also count towards academic promotion.

Lakshman Swamy - Neil-- I agree, but it should be a closed system. Anyone can read, but not anyone can rate-- have to have credentials of some sort. Can't risk creating another place for opinions to become stronger than data.

Ves Dimov, M.D. - On a more basic level, this is also a simple appeal to all physicians to read more than the top 5 journals. Wait... Most physician don't even read the top 5 journals.. :)

Social networks help in some way though - I tend to have a closer look at articles linked by the people I follow.

Vamsi Balakrishnan - @Neil Mehta A friend and myself actually shared that same idea about science, about publishing and its current state. We had a grandiose goal of starting a publishing site that would be more about sharing ideas than anything else (www.sciencetrader.com/).

When I think about publishing in famous journals being important, I think about the famous "cloner" who published in Nature (http://en.wikipedia.org/wiki/Hwang_Woo-Suk); if peer-review was successful, I doubt that he'd have been published his fabricated data. But, once you're successful and thus renowned, no one would have the courage to question you.

Kind of a similar situation is found with Einstein back in the day. When he was working on TOE (theory of everything; a unified grand scheme for how the universe works) he denied the possibility that quantum mechanics could rule the microcosm simply because of his belief that regardless of the evidence, "God does not play dice with the universe" (or something close to that). The macrocosm followed his rules exactly as he predicted, so the microcosm should do the same. No one questioned him since...it's Einstein. He's probably right. (He wasn't); I think Dr. Feynman said in his book (Surely You're Joking Dr. Feynman) it took another ~10 years before Einstein admitted he might be wrong...

Anyway, I diverge.

A last example that's more healthcare-related would be the scientist who developed valproic acid as a treatment for seizures. This scientist, Eymarde, made 30-40 drugs...every drug he made was GOLD, meaning they ALL worked. No one had as much success as he did in creating seizure medications. He could have said anything he wanted about seizures medications since he was the expert, and it was taken as the truth. Unlike most scientists out there though, he knew he was willing to admit that he's not perfect and that no one could make this many drugs work so well. So, he developed controlled studies...testing every component of the medication, only to find that the vector he used to dissolve his "drugs" in was the actual active component with anti-convulsive properties. A modern scientist...would not do anything. Publish or perish. If you just retracted every paper you've written for the last x amount of years...it'd be pretty hard to get future funding, even if you were being honest. This Eymarde did however respect his trade and his peers, so he retracted every one of his papers. After this bit of honest science, he was forgotten to the world and ridiculed.

In a completely circuitous way through three different example, I'm trying to say that I agree with you that peer review, and generally the scientific process now due to peer review is broken. Changes are needed.

Neil Mehta - Vamsi,
thanks for those examples. I was not familiar with the Einstein or the Eymarde examples - I want to publish my case series that suggests famous scientists with last names starting with E tend to make errors that they own up to several years later. Do you think that I should submit to top tier journals? Suggest Vamsi for peer review? Just kidding. Enjoyed reading your comments.
Look forward to more conversations

Vamsi Balakrishnan - Oh, wow, I didn't even notice the common endings. I went searching for a third "E" named person...but couldn't find one that is...on par with the Woo-Suk one.

If I write a book, it's going to be a collection of stories about famous scientists and the things that they...endured and the follies they've made.

It will be entitles, "Famous Scientists: The Things They Endured, and the Follies They've Made."

Aidan Finley - http://www.nature.com/nature/history/timeline_1950s.html The Krebs Cycle paper was rejected by Nature for not being impactful.

http://www2.uah.es/jmc/ai56.pdf (article reviewing other major rejected discoveries, including the MRI). Nature editorial: http://www2.uah.es/jmc/

Ves Dimov, M.D. - "The Krebs Cycle paper was rejected by Nature for not being impactful."

Isn't this just amazing? Reality is truly stranger than fiction.... :)

Aidan Finley - To be fair, I think everyone recognizes it was a mistake.

Related reading:

Nature rejected/declined Krebs cycle paper in 1937 - there were too many submissions - but few remember them now... http://goo.gl/mcxPd

The grossest failures of peer review (PDF) http://goo.gl/3ovkn

Image source: 2009 cover of the journal BMJ, low resolution, fair use.

Couscous & Veggie Bowl

Have you ever had one of those nights where you literally forget to eat? I'm sure that must sound weird. A food blogger forgetting to eat. With all my classes this week, my mind has been off in a million directions and forgotten about my stomach. Until now.

Couscous has definitely become my new fave this year. Quick, easy, and tasty. There also seems to be a million different things you can do with it. It cooks up in 5 minutes and by adding a few yummy veggies, within 10 minutes you too can feed your forgotten appetite.

Boil 1 1/4 cups water. When water is ready, add water to 1 cup whole wheat couscous and stir. Cover for 5 minutes. Fluff with a fork. While couscous is sitting, rummage through your fridge for leftover vegetables or anything you'd like to top off your couscous. Here are some of my favorites: carrots, green onions, spinach, red bell peppers, broccoli (lightly steamed), sunflower seeds, and baked tofu. Finish with a dollop of tahini, a squeeze of fresh lemon, and a few slices of avocado.

Mobile Medicine via iPod/iPhone/iPad Apps

NatureVideoChannel — March 31, 2010 — "You might not realize it, but with an iPhone, you also have a stethoscope and a CPR trainer within reach. These are just a few of the more than 2,000 medical applications available on the iPhone, and here we've rounded up ten for you to check out. Whether you're a researcher, doctor, or patient, get ready for your medicine to go mobile."

Smartphones and portable devices for medical education

I use an iPhone Touch to listen to lectures and watch presentations (PDF and video). Amazon Kindle works for the same purpose (PDF only, no video).

However, the external speaker of the iPhone Touch leaves much to be desired in terms of sound quality and volume, and recently, I started downloading the lectures directly to my cell phone (HTC Touch Pro2). The HTC Touch Pro interface is not as polished as the one on the iPod Touch but the device itself is not tied to iTunes and I can easily download audio files from the mobile sites of Google Reader, Bloglines and Google Docs.

Comments from Twitter:

@DrVes: Why are some doctors and nurses giving back their iPads? http://j.mp/Hq15aD - Easy: iPad works great for pt education, NOT for data entry. Only 10% of doctors currently use an iPad at work http://j.mp/Hq15aD - I use iPad daily to discuss these diagrams: http://j.mp/Hq1k5v

iPad is a great teaching tool @CraigCCRNCEN was able to explain to Vietnamese family AFib and clots by showing them animation from YouTube.

Brian S. McGowan PhD @BrianSMcGowan: so is the best option for docs still a touch screen laptop? teach w/ touch screen, work w/ full keyboard? #hcsm

@DrVes: iPad works well for discussing DDx, Tx options with pts. Much more portable than laptop. Full-keyboard COWs best for typing.

Jeff Bray @jeffkbray: I have been scanning all my medical reference books and store them on my iPad for quick use and no weight - great tool and mobile

Related:

Book Review: Karma by Nancy Deville

I didn't read the entire book...I couldn't. Karma by Nancy Deville is a detailed fictional account of an American doctor who is kidnapped and forced into sexual slavery. I was able to read thru Dr. Meredith Fitzgerald's breaking and transfer from Istanbul to Mumbai and then I had to skip chapters to see if Meredith was saved. When I saw detailed, I mean detailed.

Human trafficking is not a topic that I feel knowledgeable enough to speak about, but then again, I'm fairly certain I know more than the average person about the shear magnitude of the problem. And thus I think that added to my overwhelming feeling while reading the book. Perhaps someone unfamiliar with the problem might continue to read while thinking "I don't believe this." I kept reading thinking, "I know this, why am I reading this?"

The storytelling was great and too real for me.

My only qualm with the book is that I felt that it was stereotypical to set a story like this in Turkey and India. Human trafficking happens everywhere, including here in Chicago. Why not elsewhere? Deville addresses this at the conclusion of the book by telling readers that the story could happen anywhere. Was that enough for me? I'm still not sure.

But I can't say that I wasn't sucked into this book. I carried it around one weekend so much that my husband made a comment. Now, I read a lot and he rarely comments on how engulfed I am with a book.

If you do decide to pick it up, I ask you to do so at an indie bookstore or Powells.com.

The book will break your heart, but it also will be memorable. But I really hope it also moves you to learn more about human trafficking.

Disclaimer: The only payment I received was the copy of the book.

Better Sleep, Better Learning? Obstructive sleep apnea can reduce a child’s IQ by 10 points

From Science Life Blog at the University of Chicago:

Pediatric obstructive sleep apnea, or OSA, can have long-term, detrimental effects on a child’s cardiovascular and respiratory health. But it can also create neurocognitive effects, such as a reduced ability to learn and retain information.

OSA can reduce a child’s IQ by as many as 10 points, while treatment in children with OSA can improve grades.

References:

Better Sleep, Better Learning? « Science Life Blog « University of Chicago.
http://sciencelife.uchospitals.edu/2010/02/15/better-sleep-better-learning

Sleep duration is shorter in obese children http://goo.gl/z5JFs
Sleepiness and sleep-disordered breathing may be found in 19-29% of children with positive allergy test (http://goo.gl/AfCWZ).

Taking charge of your toddler's vaccination record is the best way to ensure they don't miss any shots

From Reuters:

"In our country, we think the doctor should have all the medical records," said Dr. James McElligott, a pediatrician at the Medical University of South Carolina who worked on the study. "I like the idea of putting the ownership back in Mom's hands and empowering her a little bit."

When parents kept a so-called shot card, their child's odds of being up-to-date on vaccinations rose by more than half.

40 percent of the toddlers had a shot card, and 84 percent of these had up-to-date vaccinations. By contrast, only 79 percent of the children without a card had all their shots.

Use the card: it doesn't have a downside and it's cheap."

References:

Want kids' vaccinations up to date? Keep the record | Reuters, 2010.
http://www.reuters.com/article/idUSTRE61E37I20100215

The College of American Pathologists unveils a new patient website MyBiopsy.org

The site is easy to navigate, well-organized and it looks helpful. Check the navigation menu in the left sidebar.

MyBiopsy.org redirects to:
http://www.cap.org/apps/docs/reference/myBiopsy/index2.html

RSS feed is also available: http://feeds2.feedburner.com/MybiopsyFeeds

This is the "fan page" on Facebook: http://www.facebook.com/MyBiopsy.org

(link via @Berci)

Lentil & Tomato Curry

Today was the first session of a 3-day coaching series I am taking. Just to clear up any confusion, coaching is not about sports (well, maybe the sport of life), but is about working with a client to deepen their learning and help them move forward in their actions.

We had an interesting conversation about bodies and body language. Our bodies don't lie. (Unlike our minds which make up stories all day long!) What do you notice when you tune into your body? What is your body telling you?

Tonight my body, particularly my stomach, was telling me that it was time for some real food. The last few nights have been extra busy, crammed with homework and late workouts, so dinner has been a vegetable & protein shake. Fine, tummy, you win. Curry it is!

This recipe is simple and relatively quick. Most of the ingredients are things probably already in your kitchen, making it even more convenient. You can also play around with a lot of different substitutions.

1 large yellow onion, diced
2 cloves garlic, minced
1 cup brown lentils
1 cup water
1 russet potato, diced
1/2 cup frozen peas
1 can diced tomatoes
small handful of cilantro, chopped
1 tsp olive oil
1 tsp freshly grated ginger
2 tsp curry powder
2 tsp cumin
salt and pepper to taste

Simmer lentils, water, potatoes, peas, and can of tomatoes (with juices).

Heat oil in pan and add in onions and garlic. Saute for a few minutes and then stir in the spices. Mix with the lentils and continue to simmer until lentils are soft. Serve over brown rice and garnish with cilantro.

Gluten-free, soy-free

Vitamin D deficiency occurs frequently in COPD and correlates with severity

Vitamin D is a steroid hormone and a component of a complex endocrine pathway sometimes called 'vitamin D endocrine system' (Medscape, 2012).  1 in 4 individuals will develop COPD during their lifetime (Lancet, 2011).

Serum 25-hydroxyvitamin D (25-OHD) levels were measured in 414 (ex)-smokers older than 50 years and the link between vitamin D status and presence of COPD was assessed. The rs7041 and rs4588 variants in the vitamin D-binding gene (GC) were genotyped and their effects on 25-OHD levels were tested.

In patients with COPD, 25-OHD levels correlated significantly with forced expiratory volume in 1 s (FEV1).

Compared with 31% of the smokers with normal lung function, as many as 60% and 77% of patients with GOLD (Global Initiative for Obstructive Lung Disease) stage 3 and 4 exhibited deficient 25-OHD levels lower than 20 ng/ml.

25-OHD levels were reduced by 25% in homozygous carriers of the rs7041 at-risk allele.

76% and 100% of patients with GOLD stage 3 and 4 homozygous for the rs7041 allele exhibited 25-OHD levels lower than 20 ng/ml.

Vitamin D deficiency occurs frequently in COPD and correlates with severity of COPD. The data warrant vitamin D supplementation in patients with severe COPD, especially in those carrying at-risk rs7041 variants.

Despite this circumstantial evidence, a recent trial of vitamin D replacement in patients with COPD did not show a reduction in exacerbations unless the patients had a severe vitamin D deficiency.

References:

Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene. Thorax 2010;65:215-220 doi:10.1136/thx.2009.120659.

http://thorax.bmj.com/content/65/3/215.short
A vitamin D3 dosage of 800 IU/d increased serum 25-(OH)D levels to greater than 50 nmol/L in 97.5% of women http://bit.ly/GzBCcA 

Image source: Lungs, Wikipedia, public domain.

Tools for Your Food Revolution - Wolfram|Alpha Lets You Compare Chicken to Corn Dog, Apple to Orange

Compare: chicken breast to corn dog

Compare: 1 apple to 1 orange

Imagine if students had the opportunity to compare the nutritional values of lunch options and make informed decisions before ever hitting the cafeteria. For example, students can go online to Wolfram|Alpha and compare grilled chicken breast to a corn dog. Wolfram|Alpha provides them with a nutrition label for each item, and shows a side-by-side comparison of nutritional values such as fats, proteins, and vitamins in each food option.

More comparisons:

Compare egg to cod
http://www.wolframalpha.com/input/?i=compare+egg+to+cod

Compare shrimp to cod
http://www.wolframalpha.com/input/?i=compare+shrimp+to+cod

References:

Wolfram|Alpha Blog : Tools for Your Food Revolution

http://blog.wolframalpha.com/2010/03/23/tools-for-your-food-revolution

The Personal Analytics of My Life - Stephen Wolfram Blog http://goo.gl/iwHRo

Comments from Google Buzz:

Dr Mike Cadogan - Some nice tools...
I also like the simplicity of fealth
http://www.fealth.com/nutrition

Ves Dimov, M.D. - Looks interesting... I was not aware of Fealth... http://www.fealth.com/nutrition

Dr Mike Cadogan - Original post was here:
http://lifeinthefastlane.com/2008/09/physician-feed-thyself/
I think I will repost...

Ves Dimov, M.D. - Isn't it nice - the way a blog serves as a personal archive... I have not read the post either. Will have a look. Thank you for taking the time to review the service back in 2008.

Image source: Wikipedia, public domain.

Nonsurgical Weight Loss with a Liquid Meal Program - Mayo Clinic Video

"Surgery may be an option for some people, but for those who don't want surgery or can't have it for medical reasons, there is another option. Doctors at Mayo Clinic developed a liquid meal program geared toward people who need to lose a lot of weight."

Facebook Friend Request - A young doctor gets a message from a dying patient

From the NYTimes:

"Last winter, in the middle of my intern year, I became Facebook friends with a young man who was dying in the intensive-care unit. An investment banker in his mid-20s, he thought he was healthy until a fluttering in his chest and swollen ankles took him to a doctor. Now he was in the I.C.U. with a rare cardiac condition and the vague possibility of a transplant.

“Are you on Facebook?” he asked me. “I’ll friend you, and you can see the pictures.”

He’d been sending upbeat status updates from the I.C.U.; to read them, you’d never know he was so sick, but to me they were missives from a dying man."

Comments from Google Buzz:

Mark Hawker - Just before I do comment, I'd like to say that I do not have a clinical background so I cannot comment or empathise on the writer's clinical content or her situation. However, I can comment on my personal feelings about the story.

My reaction to this story was one of shock. A testosterone-filled medical student who got herself into a preventable situation. The lines that made me most uncomfortable were:

- "This boy on Facebook was, well, hot."
- "I didn’t think there was an ethical principle about following a patient on Facebook, and I didn’t worry that he’d see a picture of me in a bikini on my page."

It's not the fact that she didn't reply to this patient's message but the fact that she got herself into that situation in the first place. Would a doctor take a patient's telephone number to "see how they were" or go out bowling with them? Her emotions got the better of her and this led to more stress/turmoil in the future stages of the case. Does she feel this way to all her patients, or just the good-looking ones?

Secondly, "I signed on to our medical-records system and followed the notes that led — inevitably now — to his death." What now? In my opinion she had no right at all to do this. Her access was not about clinical care at all, nothing shy of being nosey. Does she also look up the medical notes of her ex-boyfriends etc.?

i just can't see how this would be OK? Maybe I'm missing the point... 10:51 am

Ves Dimov, M.D. - I see your point and I think it's a valid one. We already know that some physicians have hard time looking at patients only from a professional point of view, and I agree with you that this is a problem. It has little to do with Facebook though since this mind set can be propagated through any communication channel. Facebook provides some misunderstood "privacy", if not anonymity. 11:04 am

Mark Hawker - Yes, that's right. Facebook is merely a "medium" much like telephone, an address, papyrus, etc.

I can't come to imagine how hard it must be to separate from a patient but can you be too human which can lead to enormous emotional stress in the long-term? Maybe this encounter led the writer to feel lonely about her own situation? Would she have reacted the same if she found that he was not single? Though, this is information she should never really have found out about...

Can this type of separation be taught, or is it embedded within us and cannot be taught? 11:11 am

Ves Dimov, M.D. - "Can you be too human?"

Yes. There are two rather simplistic schools of thought for professionals: cold and technical but gets the job done vs. warm and fuzzy, bubbly and compassionate... "When you have appendicitis, you want a surgeon, not a poet holding you hand for comfort."

"Can this type of separation be taught?"

I think so. It's part of the professionalism - one of the 6 core competencies of a physician training:

http://casesblog.blogspot.com/2008/03/remembering-acgme-6-core-competencies. 11:18 am

Anne Marie Cunningham - I think I did read this around the time that it was first posted on NYT... in fact I'm sure I did. At the time I was struck by how this doctor communicated her confusion over many things... not being able to help this patient... realising that he had a life before being a patient... struggling with his death. It didn't strike me that she had been unprofessional. She engaged in small talk with the patient and he invited her to be a friend on Facebook to see the photos of his trip. She could have said "No, I'm not on Facebook" or "No, I don't think it is appropriate to be friends with a patient on Facebook", but she didn't. Instead she allowed him to invite her to see those photos. We don't know how public his profile page was. Perhaps it was public. Maybe she shouldn't have looked again. But she did. With regards to following up his medical story through his notes... well I don't think this is inappropriate either. Looking at what happens to patients after you have looked after then is how you learn. It's what we encourage students to do and it absolutely the best way to learn when you are a doctor too. Should she have written this account? Well, through it... and I presume she has changed enough so that we couldn't figure out who the patient is.... we are given something to think about. We are able to think about what she should have done. We are able to think about what we would do if we are patients. This is a generous act because she is sure to know that some people will be critical. Most of the comments criticise her for not responding to this direct message and it is what she criticises herself for. Should she have gotter herself into this situation? Who knows. Would she do it again? Only she knows. I commented on twitter, that I don't think that her behaviour was unprofessional. That doesn't mean that I think it was professional. I think that she is struggling with a professional identity. That's not surprising because she is a very young doctor.

I'm not sure from reading this if she ever actually did become his friend on Facebook. Responding to a message allows people to see more of your profile, and it sounds as if that is why she made the remarks about the possibility or not of him seeing her in a bikini. Perhaps it wasn't something to worry about because there are no photos of her like that on Facebook. With regards to seeing him as 'hot', I take that she sees that in contrast to his lack of hotness in a hospital bed. She gets to see him as the well person he was before being a patient. It probably made the tragedy of his story, and the sadness of his situation even more real to her.

Should she not have known any of this? Some would say, as a few commenters do, that the sadness is that she only came to know about him as a whole person through Facebook. The nature of medicine is that we mostly only ever get to see our patients on our turf. Seeing and knowing about their whole lives, if they are happy for us to, is not wrong or innapropriate.

Medicine is not just about information. It is about caring and that is what this story tells us about. 7:08 pm

Anne Marie Cunningham - PS For a critique of 'professional distance' as professionalism I suggest this paper by Joanna Shapiro http://www.peh-med.com/content/3/1/10

No one ever said that being a doctor was easy! 7:14 pm

From Twitter:

@markhawker

http://twitter.com/markhawker

Read this account... http://nyti.ms/dcM271 Do you think this is funny or very, very worrying? Do people think this article about a medical student and Facebook is funny? http://nyti.ms/bc80tC Maybe I'm getting too old for this...

Anyone care to count the number of ethical breaches that she abused in the story and, worryingly, admitted to. Would that happen in the UK?!

I'm still torn as to how "human" a doctor should be whilst working. Well, maybe one not driven entirely by testosterone. Yes, does require a lot of thought! I was just taken aback by the article & how the world seems to think these things are OK.

Confidentiality, looking up medical records unauthorised, wishing to respond to a "casual online message". Qualities of a Dr? Nothing catches your eye about testosterone-crazed medical students let loose to breach confidentiality regulations and ethics? You don't think that this student maybe got herself in too deep because of a hot-blooded crush which affected her clinical judgment? Would she give him a phone number etc.? Has the ICU been mistaken for a bar?! Is there a difference between being human and emotional?

It's not the fact she didn't communicate, it's the fact she got herself into that position in the 1st place.

"This well-intentioned resident naively violated HIPAA by accessing records for no purpose other than her own personal interest." Thank you.

There are many factors that contribute to this: personal, age, experience etc. I think her "issue" was preventable.

Interested in learning about the psychological effects of these interactions and skeptical about the altruism of the writer.

Interested to hear your thoughts. I think the article is wrong in many ways... Will watch out for your analysis.

I wonder if she removed him as a Facebook friend... If not, I could find his name, right? Not too anonymous.

Note:

If you see your comment here and you would like to have it removed, please let me know via comment or email and I will comply with your request within the same business day.

References:
Lives - Friend Request - NYTimes.com.

Scaring physicians aways from using social media

Image source: Wikipedia.