tags: medicine
2000
November
- 2000 Nov 6
- Medicine and Open Source Software
Geek M.D.
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2001
September
- 2001 Sep 19
- The Oath
Why I feel the way I feel, right or wrong.
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2003
August
- 2003 Aug 26
- med school fear of blood desensitize
This Google query leads to an old blog entry. Despite dealing with bleeding literally almost every single day, I’m still not immune from syncopizing from a vasovagal reaction at the sight of my own blood.
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2006
September
- 2006 Sep 23
- coding, practicing medicine, and a brief word on blogorrhea
I stumbled upon this blog post about how most of the time spent developing code is actually spent rewriting rather than actually writing, which actually fits the aphorism about how most of writing in general is rewriting. But the thing that he discusses is that this is a function of the fact that most developers can’t immediately grok what code is supposed to do just by reading it, and a lot of them end up trying to rewrite what has already been written, which, in my estimation, is a glorious waste of time.
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November
- 2006 Nov 7
- human nature
It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation. — Rudolf Virchow
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December
- 2006 Dec 1
- the first of the last (to sleep, perchance to dream)
(The track that is currently playing is "The Perfect Kiss" by New Order)
· Read more… - 2006 Dec 19
- fatness and the tragedy of efficiency
Being a Person of Greater Mass™ myself, I understand the discrimination against fat people. (I think the epidemic of anorexia nervosa and body dysmorphic disorder among women is another thing entirely, and very bizarre and disturbing, but that is another tale in the telling. Seriously, though, there are way too many women who are either healthy or dangerously underweight who continue to claim that they’re too fat, and sometimes I have to repress the urge to send them all to the inpatient psych ward on the grounds that they are a danger to themselves.)
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2007
April
- 2007 Apr 1
- the slow diffusion of information across fields
Joanne brings up a disturbing story concerning [May Yuen]1, a Chinese American who joined the Army, who ended up killing herself.
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- 2007 Apr 7
- erratum or mere sophistry
Randomly, I saw this diagram of a serotenergic neuron. Rageboy wonders about the similarities between LSD and SSRIs.
· Read more… - 2007 Apr 7
- we don't need no stinkin' crash cart
Uh, can you really be a hospital if you can’t perform a resuscitation? Or at least attempt one?
· Read more… - 2007 Apr 17
- april is the cruelest month
I worry that my capacity to empathize with sadness and tragedy has been destroyed. Most the time at work, I’m forced to put on a mien of detachment and objectivity. If I took everything bad that happens at work to heart, I’m pretty sure I would’ve quit a long time ago. Or I’d have committed suicide.
· Read more… - 2007 Apr 21
- weariness
It’s been a long while since I’ve had to work seven days in a row. In of itself, that kind of schedule makes me cranky. Add to it the fact that this included two overnight calls, and that’s approximately 120 hours of work. Fun times.
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May
- 2007 May 16
- phil collins “take me home”
Maybe I’m just being morbid. Maybe it’s because I just finished working in the ICU and watched plenty of people die and signed plenty of death certificates. Maybe it’s because I had dinner with (among others) someone who works for the medical examiner. Nothing like talking about people who died in sudden, unexpected, and often gruesome ways while having Japanese food. Maybe it’s because the track before this one was “Mad World” by Tears for Fears, which has the classic line “the dreams in which I’m dying are the best I’ve ever had,” a song that was resurrected by Gary Jules and the movie “Donnie Darko.”
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June
- 2007 Jun 22
- full circle
It’s 5 a.m. and I’m actually at work, where I am allowed to sleep. Unfortunately, I’m all keyed-up and can’t seem to sit still. Hurry up and wait, indeed.
· Read more… - 2007 Jun 23
- by the pricking of my thumbs
So I thought about the story of Snow White, how her mom pricks her finger on a sewing needle, and when she sees a drop of blood upon the white cloth she is sewing, she thinks of naming a daughter Snow White. So she gives birth, and then dies.
· Read more… - 2007 Jun 25
- trolling the board
A few small gems that made me laugh out loud that I found while looking for potential admits on tonight’s emergency department board:
· Read more… - 2007 Jun 26
- at least i'm not that guy
Wow. This sounds bad.
· Read more… - 2007 Jun 29
- the etymology of "gorked" and its cognates
Gorked is a word we like to throw around the emergency department and the hospital wards from time to time. In our general usage of the term, it basically means someone who is non-responsive, generally comatose (as opposed to mere altered mental status/delirium.) In some ways, it has an iatrogenic connotation to it, as it is sometimes used to describe patients who are inadvertantly rendered unresponsive due to excessive dosing of medication (although the more common terminology for this condition is snowed) or unresponsive because of a bad clinical outcome, such as massive stroke, brain hemorrhage, post-code brain (so called because this is what tends to happen when they call a code blue [cardiac and/or respiratory arrest emergency] and it takes more than 8 minutes to get you back, meaning that there is bigtime hypoxic-ischemic brain injury—no oxygen or bloodflow to the brain), or post-bypass brain (which is usually a lot more subtle, and usually has psychiatric qualities to it, but occasionally, someone who gets a coronary artery bypass graft—abbreviated as CABG and affectionately pronounced like “cabbage”—gets gorked.)
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August
- 2007 Aug 12
- fatherhood
Odd, the synchronicity of this post from someone who is going to be a father. (P.S., the asking of highly detailed, extremely specific questions is not a sign that someone is going to be a good father. In fact, it is extremely annoying to the average health care provider, whether midwife, nurse, or physician, and for some reason, the information they have never seems to comport with either the reasonable guidelines suggested by the American Academy of Pediatrics, or the reasonable guidelines afforded by what is traditionally called “common sense.” One could even go as far to say that such nit-picking and attention to often irrelevant detail is a sign that things may go very badly, and that this individual may very well stifle all things that are good about being a child. The specific details of feeding regimens—except in regards to what will allow your baby not to choke to death from aspirating milk—are pretty pointless, since the correct answer to the question of “When should I feed my baby?” is “When he/she is hungry” and believe me, they’ll tell you when they’re hungry, and the correct answer to “What should I feed my baby?” is “Milk” for the first six months of life. There is a raging debate as to whether you should use breast milk or formula, and the data has a lot of good things to say about breast milk, but if, for whatever reason, this is not going to be an option, I would not let your baby starve to death because someone tells you that formula is evil. Bottom line: you’re doing fine, in my opinion.1
· Read more… - 2007 Aug 12
- atm (against the mainstream)
In an [article in the Chicago Sun-Times][1], Steven Pinker brings up some ideas that are often met with knee-jerk reactions. (The terms “sexist,” “racist,” and “fascist” seem to pop up in the brain for some reason.)
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September
- 2007 Sep 10
- basic concepts in wound healing
One of the things we learn as children about wounds is that you should never pick at your scabs. This is guaranteed to prevent healing of the wound, and can actually promote scarring to the point of disfigurement.
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October
- 2007 Oct 4
- desperate housewives derides philippine medical degrees
Not sure if you’ve come across the latest outrage du jour. Apparently, Teri Hatcher’s character in ”Desperate Housewives” thinks her gynecologist is a quack because he just diagnosed her with being perimenopausal, and she demands to know whether or not he graduated from a medical school in the Philippines.
· Read more… - 2007 Oct 9
- rehab (even amy winehouse had to go)
OK, I’m not talking about my drug problems. I’m talking about the terrible shape my body is in.
· Read more… - 2007 Oct 14
- hypochondriosis
You would think that being a trained medical professional would make me immune to supratentorial disorders.
· Read more… - 2007 Oct 27
- priestly duties
It has been about six months since the last time I had to give The Talk™. It’s not something I’m particularly good at, although I’m better than I used to be. In the end, it’s about getting to the point: your loved one is dying, and everything we’re doing to her/him is only prolonging suffering. Will you give us permission to stop these things, and focus on making her/him comfortable?
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December
- 2007 Dec 22
- misunderstanding modern medicine
I have finally found a synonym for my embryonic philosophy tha I've been calling "The Art of Not Wanting." Akin to Hindu and Buddhist ideals (where desire brings about suffering),voluntary simplicity is a lifestyle that eschews the excesses of the modern and post-modern era. It has significant bearing on the contemporary environmentalist movement as well as with its intersection with Neomarxism.
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2008
February
- 2008 Feb 17
- cerebral malaria
Erythropoietin protects children from the cerebrovascular ischemic effects of cerebral malaria.
· Read more… - 2008 Feb 24
- random walking through pubmed
I'm a sucker for cross-disciplinary, cross-age demographic topics, and Grand Rounds today was given by Martina Brueckner, M.D., a pediatric cardiologist and scientist from Yale.
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March
- 2008 Mar 3
- profession: astrophysicist/neurosurgeon
I'm sure you've heard the phrase "it's not rocket science" to describe something that should be easy. So Raymond Chen asks what actual rocket scientists say when they want to describe something easy. The common answer seems to be "it's not brain surgery."
· Read more… - 2008 Mar 8
- one man's slack as another man's creative meditation
There is a meme floating around on the blogosphere, promulgated by Duncan Riley's spin on a post by Jason Calcanis of Mahalo fame, and seconded by technophiliac Robert Scoble. The idea is that startup companies cannot afford slackers, so anyone who is not a work-a-holic needs to be fired. (Note that Calcanis has eased off on this statement.)
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April
- 2008 Apr 4
- hoping against
I have this fantasy that if I hold my breath and Valsalva real hard, that nothing will come in through the emergency department that they'll call me about.
· Read more… - 2008 Apr 5
- a song in my head
As I finish off my residency, I realize that no matter how awful some of the remaining hours and the minutes can be, this experience is finite and bounded. My senior resident on my very first in-patient intern month took a sardonic aphorism from the seminal medical novel "The House of God" and added a hopeful corollary which has become something of an unspoken mantra. "They can always hurt you more, but they can't stop the clock."
· Read more… - 2008 Apr 9
- ever heard of opportunity cost?
This article in the Washington Post tries to argue that prevention is more expensive than intervention. The only problem is that they deliberately ignore two preventative measures that have clearly been demonstrated to decrease costs: immunizations, and colon cancer screening.
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May
- 2008 May 2
- difficulties with obtaining a full physical exam
A man was seen by his doctor.
· Read more… - 2008 May 11
- the intersection of pop music and medicine
There are two units in the hospital that tend to get a particular song stuck in my head.
· Read more… - 2008 May 18
- bullshit diversity/code triage/first against the wall
Wow. Just, wow.
· Read more… - 2008 May 20
- the public is unmerciful/origin of the health care crisis
I learned about the sordid history of health care and health insurance while writing a paper in college for a two unit class that was pass/not-pass (and therefore useless to my GPA.) It forever opened my eyes to the lunacy that we loosely term health care in America.
· Read more… - 2008 May 20
- bad patient registry
The idea of being able to review your primary care physician and leave a comment online is a little unnerving for me. I know for a fact that not everyone can like me, and many patients will just be put off by my approach no matter what I do. But you gotta be true to yourself, and you can't please everyone all the time.
· Read more… - 2008 May 21
- why end-stage liver disease patients should not take viagra
Found on my iGoogle page, with elaborations:
· Read more… - 2008 May 25
- chart abbreviation or not?
June
- 2008 Jun 4
- small triumphs/on the other hand
Given all that tripe, I did have a decent day today. I managed to get in an arterial line after three tries. The attending that I'm working with—who has a reputation for making interns cry—thinks that I'm probably no dumber than a box of rocks. (Which, believe me, is a complement.)
· Read more… - 2008 Jun 8
- more multivalent medical jargon
- 2008 Jun 15
- i'm not here, this isn't happening
An incredibly haunting piano and vocal re-interpretation of Radiohead, entitled "How to Disappear Completely", found on Kid A
· Read more… - 2008 Jun 21
- post-mortem while the body's still warm
Wow. Just, wow. Good thing I'm a little drunk.
· Read more… - 2008 Jun 22
- set adrift on memory bliss
The Dragonfly Initiative suddenly took me back to those halcyon days of yore, when I could just sit for hours studying things that I find are of little-to-no clinical relevance. Chronic renal failure? Obsolete. It's Chronic Kidney Disease. Congestive Heart Failure? Obsolete. It's just Heart Failure, or Decompensated Heart Failure, now. There is no such thing as Non-Insulin-Dependent Diabetes Mellitus, either. It's either DM type I or type II. Beta-blockers are standard of care in Decompensated Heart Failure. Digoxin is almost useless, except as a way to achieve rate-control in atrial fibrillation. The difference between Q-wave Myocardial Infarctions and non-Q-wave Myocardial Infarctions are academic and don't make a difference in terms of treatment. What we care about are ST-elevations: STEMIs vs NSTEMIs/unstable angina. And it's all called Acute Coronary Syndrome now.
· Read more… - 2008 Jun 29
- clinical medicine
That is most of it, being a physician—listening and seeing. The rest is technique.
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September
- 2008 Sep 6
- reviewing the fat man's rules from the house of god
The House of God is a satirical novel written in the mid 1970's by a physician who goes by the pseudonym Samuel Shem. The book is about the experience of an intern physician trying to survive the rigors of the residency program associated with the mythical Best Medical School (a thinly veiled reference to Harvard.) The Fat Man is one of the senior residents in this residency program, and he came up with a set of rules that I find terrifyingly useful.
· Read more… - 2008 Sep 23
- when all you've got is a hammer
It's odd, but I'm starting to look at the disaster that has befallen Wall Street like something akin to a person having a stroke or a heart attack. Sure, the symptoms are most dramatic during the acute phase, and it's the acute phase that's probably going to kill you, but it's important to recognize that what a stroke or heart attack means is that this person has been sick for quite a while. Coronary artery disease and cerebrovascular disease don't just develop over the course of a week. It takes years of unhealthy living to get you to the point where you are vulnerable to having a heart attack or stroke.
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2009
April
- 2009 Apr 1
- house is a neonatologist, too?
I always get hooked by the opening song, "Teardrop" by Massive Attack, which is like one of my favorite songs. So the episode I'm watching right now has House seeing babies. Crazy.
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2010
January
- 2010 Jan 8
- that's probably pretty low on the differential
So I've got this pain in my right foot that's been bugging me for the past couple of days. It's not terrible pain, it's just annoying. Over the years, it's come and gone, and it's never really lasted long enough that I've thought much of it. What it probably is is just run-of-the-mill plantar fasciitis. I should probably just take some NSAIDs and do some calf stretching exercises.
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2015
June
- 2015 Jun 9
- The Erosion of the Doctor-Patient Relationship in the U.S. health care system
There are some deep cultural problems that underlie the brokenness of the health care system in the U.S.
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July
- 2015 Jul 10
- Alternative Medicine and Conspiracy Theories
I got sucked into following this story about three seemingly unrelated health care providers who incorporated alternative medicine into their practice who were all murdered within a short period of time. I even have Google Alerts for their names.
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October
- 2015 Oct 23
- Pyrimethamine and the Treatment of Toxoplasmosis
I will admit, I haven't really been looking too closely at the antics of Martin Shkreli, founder and CEO of Turing Pharmaceuticals, who is famous for buying the rights to the drug Daraprim (generic: pyrimethamine, used for the treatment of toxoplasmosis in patients with AIDS) and jacking up the price from $13.50/pill to $750/pill.
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November
- 2015 Nov 5
- Bras Don't Cause Breast Cancer
In case you were worried, bras don't appear to cause breast cancer.
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2016
January
- 2016 Jan 8
- Uber for Doctor House Calls
I remember reading about Jay Parkinson, M.D. back in 2007 and it did seem like a perfect convergence of popular technology and medicine.
· Read more… - 2016 Jan 16
- Curing Cancer and Shooting for the Moon
The POTUS likens curing cancer to the moonshot. The thing is, cancer isn't a single disease, it's a collection of heterogenous, vaguely-related diseases that have multiple causative effects, widely varying pathophysiology, and widely different prognoses.
· Read more… - 2016 Jan 29
- Dermatology
If it's dry, moisten it. If it's moist, dry it. If you're not on steroids, start using them. If you are on steroids, stop taking them. — almost everything I learned about dermatology, taught to me by a general surgeon
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February
- 2016 Feb 2
- Exercise Related Transient Abdominal Pain
So I finally figured out the technical term for a side stitch: exercise-related transient abdominal pain. Now to find the ICD-10 code….1
· Read more… - 2016 Feb 19
- Organic Food
It's well known that conclusions from scientific papers can be confusing and misleading, especially when filtered through the popular press.
· Read more… - 2016 Feb 19
- Hair Grooming Syncope
I am almost certain that this is the reason why one of my patients recently syncopized.
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August
- 2016 Aug 4
- Anarchocapitalism and Medicine
Prior to Medicare and Medicaid and before employee-provided health insurance, health care was a luxury only the wealthy could afford, and most diseases and all cases of severe trauma were completely untreatable. I'm not sure why people think the era before the advent of antibiotics, modern emergency rooms, and positive-pressure ventilation was all that great.
· Read more… - 2016 Aug 6
- Meta-Analyses
Aside from the overhyped and clickbaity headlines, one of the basic problems of popular medical journalism is that they generally elevate meta-analyses over randomized controlled trials.1
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