Grand Rounds 3:38

Jacob M Gershberg . Images from the NLM History of Medicine Webpage

Grand Rounds is up over at Dr Val’s Blog. It’s a nice edition – succinct and well-organized, with a short and long version. Plus, she included a post of mine that I hadn’t even submitted! Thanks , Dr Val! My favorites from the lot:

Kerri meets a sympathetic Barista:

Damn you, Starbucks. Just when I’ve thought I’m beyond your caffeinated claws, you reach back out and gently bring me back in.

Type-B Premed captures a slice of life in the ER that will tear your heart out.

“You’re sure?” Upon hearing the news, a perfectly manicured hand raised to her mouth to hide her trembling lip…

Dr Rob explains the genetic difference between men and women. Hilarious!

Many scientists believe that the feeling by many women that jeans make them look fat comes from the fact that there are more genes in a women’s body, and this is actually a cry for help from the chromosomal level.

Now head on over for the weekly best of the medical blogosphere!

Grand Rounds 3:38

Jacob M Gershberg . Images from the NLM History of Medicine Webpage

Grand Rounds is up over at Dr Val’s Blog. It’s a nice edition – succinct and well-organized, with a short and long version. Plus, she included a post of mine that I hadn’t even submitted! Thanks , Dr Val! My favorites from the lot:

Kerri meets a sympathetic Barista:

Damn you, Starbucks. Just when I’ve thought I’m beyond your caffeinated claws, you reach back out and gently bring me back in.

Type-B Premed captures a slice of life in the ER that will tear your heart out.

“You’re sure?” Upon hearing the news, a perfectly manicured hand raised to her mouth to hide her trembling lip…

Dr Rob explains the genetic difference between men and women. Hilarious!

Many scientists believe that the feeling by many women that jeans make them look fat comes from the fact that there are more genes in a women’s body, and this is actually a cry for help from the chromosomal level.

Now head on over for the weekly best of the medical blogosphere!

The Knife Sharpening Guy

This is fifth in a TBTAM special series called I Get it on the Streets. Links to the next post in the series are at the end of each post. Enjoy!

On any given Sunday, if you live in New York City and have your windows open, you may hear a clanging noise coming from the street below. If you do, drop whatever you are doing, run to your kitchen, grab your knives and head downstairs as fast as you can. Because Mike the knife sharpening guy will be there with his truck ready to give your steel a new edge.

That’s right – A mobile cutlery grinding service. A time-honored tradition that still exists in some US cities , unchanged from what I imagine it was years ago, when aproned housewives and the cooks of the rich listened for the clanging bell and headed downstairs, gathering around the truck to grab a few minute’s gossip with their neighbors as the cutlery man sharpened their knives.

Mike’s been sharpening New Yorker’s knives and scissors in this truck for years, having learned the trade from his father, who outfitted the truck before Mike was born. Mike remembers riding with Dad when he was as young as 5 years old. Now Dad is gone and Mike works fulltime in the DA’s office and has a grown son of his own. But he and his son still take the family truck out on weekends, driving from their home in Brooklyn over to Manhattan to sharpen knives, mostly on the Upper West Side. Word on the street is that they provide great service at a low price.

Today was the third time I’d seen Mike’s truck, but unfortunately I’ve never been able to get my knives to him. Once he was even in front of my building, but I was late for something or other and could not take the time to run upstairs for the knives.

I suggested that perhaps getting a web site and publishing a schedule would help folks like me to get him our business. But Mike didn’t seem interested in changing a thing. After all, he’s not in this business for the money. It’s really just an excuse for he and his son to spend some time together and keep the family tradition alive. But they did promise to head over to my neighborhood sometime soon.

I’ll put my doorman on the lookout for the truck, and ask him to buzz me next time Mike comes by. Hopefully, I’ll be home.

Or maybe I should just start carrying my knives around with me….

Hash Browns

Mr TBTAM makes a mean batch o’ hash browns. Some people call them home fries. I call them delicious. They’re great with fried eggs for breakfast, or cooked up with some roast beef for dinner (we call that hash). To make it healthier, use olive or canola oil.

The best way to be sure you have will be able to make home fries is to serve baked potatoes for dinner. Cook a few more than you’ll need, and you’ll have the makings of a great breakfast tomorrow.

Mr TBTAM’s Hash Browns

3 baked potatoes, skins on, diced
1/4 cup diced onions
1-2 tbsp vegetable oil
Salt and pepper

Ketchup and/or hot sauce

Heat a frying pan till nice and hot. Add enough vegetable oil to coat the bottom well and heat.

Add potatoes and lower heat to med high. Let sit about 3 minutes or so till bottoms of potatoes are browned. Add onion. Toss. Cook, watching carefully and turning only when the bottoms are browned, about every 3 minutes or so. After most of it is browned, you can toss a bit more frequently to prevent the onions from burning. The trick is not to turn too often and to let the potatoes brown before turning them, otherwise you end up with mashed potatoes.

Season with salt and pepper, remove from heat when perfect and serve immediately with ketchup and/or hot sauce.

Operation Garden Storm

The Aphids are back, and the annual struggle for control of my garden has begun.

I thought I’d gotten them all last year. But the evil-doers re-grouped and set up winter training camps in the soil of my containers, where they indoctrinated a whole new crop of young fighters. This spring they attacked with a vengeance, spreading their evil venom throughout my pristine garden, curling up my honeysuckle flowers and causing their leaves to drop, even threatening to swarm the day lilies before the first bud had even opened.

To make matters worse, the bastards have enrolled their allies in the axis of garden evil, the wooly adelgids, to infect my evergreens.

Wisconsin Department of Natural Resouces Website
These insurgents hid in the old growth of my evergreens, beneath the bright green canopy of spring’s eruption. So that it was not until I trimmed the bushes back last week that I saw the tell-tale white cottony honeydew and dropping yellow leaves. It made me sick, I tell you. Sick.

But if these terrorists think that they can take control of my garden, they are wrong. Dead wrong. Because I’m taking them on with everything I’ve got. This, my friends, is war.

Phase 1 – Targeted Strikes

First, I bring out the garden hose. Nothing like a good strong spray to knock those buggers off the plant and onto the ground. Although this picture makes it look random, I actually use precision targeting, getting in close and hitting every infected flower or leaf I find. If there are too many aphids on a limb, I take the whole limb out. Sure, I’ll sustain some collateral damage, but it’s necessary for the survival of the entire plant. Then it’s on to…

Phase 2 – Organic Weapons of Mass Destruction

That’s right, I bring out the Neem Oil and insecticidal soap. These oils are safe to use yet highly effective, basically smothering the soft bodied aphids. The soap emulsifies the oils, making them more effective.

Of course, if I had gotten off my winter couch-potato ass in February, I could have sprayed a dormant oil then and I wouldn’t have this problem now. Sort of like if the FBI had gotten their act together a little earlier we wouldn’t be in this mess now…

Phase 3 – Take out the Collaborators

Then it’s time to get the ants. Ants, you see, farm the aphids for the honeydew and proteins that the aphids secrete. In return, the ants protect the aphids against other bug predators. (Sort of like the Taliban and Saadam…)

I take a mutipronged approach to the ants. First, I use landmines – Diotomaceous Earth (DE). DE is the fossilized remains of the shells of one-celled plants called diatoms that inhabited the earth’s oceans millions of years ago. Large deposits of DE can be found all around the world in areas where oceans once existed. DE looks like a fine white powder. But look more closely, and you’ll see that it’s like microscopic scrap metal, whose shards cut and break the ant’s limbs as they move past them.

Photo credit: Univ of California Dept of Paleontology Website

DE is safe to use, but I wear a mask that I fashioned out of paper towels as I spread DE around the base of my plants on a hot, windless afternoon. Die, you bastards, die!

Next, just in case the ants make it past the DE, I wrap my tree trunks with tanglefoot, a sticky substance that both repels and traps the ants and keeps them off the trees.

Finally, I plant deterrents at the base of the at-risk plants. From what I have read, ants hate spearmint.

Phase 4 – Special Ops

After I have done all I can do, after I have been covered in water from hosing and smell of neem oil, after I have scrubbed the tanglefoot off my hands, after the DE has had a few days to do it’s nasty work, and after enough time has passed to lull any remaining aphids into complacency, than, and only then, do I call in the Special Ops Unit.


(Double click on the arrow to view video)

That’s right, the labybugs. These babies have been training their entire life for this mission. One adult ladybug will devour up to 1000 aphids a day!

I purchase one bag of 500 ladybugs at my new favorite Garden Center, Hicks, out on Long Island. Then, under cover of night, I creep outside, and after hosing down the leaves of the plants, open the mesh bag of ladybugs and sprinkle the brave fighters over the honeysuckle bushes, the day lilies, the apple trees and the evevergreen boughs.

Of course, the biggest question is, will they stay? They did! Next day, they’re still there on my evergreens chomping away at the adelgids. I declare victory – for now.

Phase 5 – Post War Strategy

I may have won this battle, but this administration isn’t resting on its laurels. The insurgents are still out there, and I’m going to weed them out with weekly Neem spraying. And next February, come what may, I’m doing a dormant spraying.

This is one occupying force that’s not leaving.

Welcome to My Blogroll!

A much belated welcome to my blogroll to the following blogs that I have been reading for some time now.

Midwife with a Knife – A blog by an energetic fellow in Maternal Fetal Medicine. Brings back so many memories (good and bad) from my training days. And she’s a fellow foodie and chef! Commenter Hillary, an aspiring gynecologist and foodie, suggests that we all open a birthing center and B&B. Not a bad idea…..

Sugar and Ink – A pediatrician who, like me, started her blog as a food blog. She just recently began to reveal her medical self to the world.

Suddenly… Sudan: A riveting blog by a Canadian doc with medicins sans frontieres stationed in Sudan. Written in lower case, in a style that somehow reminds me of Camus.

today a boy came from “far away” to the hospital, accompanied by his father. his leg was full of holes from an infection that had festered for two weeks. he was thin from it, all angles. I lifted his leg off the bed to look at the other side, and it came apart at the knee.

last year, I went camping with my friend jehan. we paddled for hours to find our own lake. we set up camp, and the next day, in my hammock, after a cup of strong coffee, I ate a plum for half an hour.

Surgeon’s Blog: I re-discovered Dr Sid Schwab’s blog when I hosted Grand Rounds recently. He just finished publishing a nine-part series called “Operation: Deconstructed”, where he takes you through every step of a colectomy, from preop to dictation. If you’re a patient, you’ll come away with an understanding of How Doctors Think as good as any recently published book will give you, and we physician readers will learn something new in every post.

Dr Smak: Just discovered this rural family physician via a well-written comment to a recent post of mine. She’s a fellow gardener and has a nice bookshelf over there at her site. Stop on by….

Come See Me

My general feeling on phone medicine is this –

If it’s important enough to call me for treatment, then it’s usually important enough for you to take the time to come in so that I can diagnose you properly.

That goes whether it’s a vaginal infection, irregular menstrual bleeding or what you think is menopausal symptoms. I have found after years of experience that a phone call is a poor substitute for a good old fashioned in-person history and physical.

Although most patients are grateful to be offered an appointment, not every patient likes to hear this. These are generally those whose calls start out something like this – “I need you to call in….”. For such patients, any attempt from me to get even a little history is treated like an annoyance. This in turn really annoys me, and I have to count to 10 before explaining patiently that I need to hear a little bit about what is going on with them so that I can prescribe properly, and that in some cases it may be necessary for them to come in. Thankfully, all but a few patients understand this once I explain it to them.

The Exceptions

One notable exception to my rule is the patient calling with an uncomplicated UTI. Research has shown that phone diagnosis and treatment is both timely and effective, and most guidelines allow for phone treatment if the diagnosis is clear and there are no other complicating factors. Not to mention that the symptoms can worsen rapidly over several hours, so that timely treatment is important. But I always offer an immediate appointment, and find that many women are grateful for the chance to see me or my nurse personally for the problem.

Notable for not being an exception are calls for yeast infections. That’s because by the time they call me for this problem, most patients will have already tried an over the counter regimen themselves. And self-diagnosis of vaginal yeast infections is notoriously inaccurate.

What about contraceptive problems? Well, I’ll play around with your pills over the phone for problems like nausea or moodiness or acne, and am more than willing to call in whatever brand your new plan covers. Irregular bleeding can be a tougher problem – sometimes it’s from missed pills, or an expected side effect of the method a patient is on (such as Depo Provera or the IUD). That’s where a few more questions can be helpful. Hopefully you are in a place where you can talk about private matters – not the coffee shop or your cubicle at work. If not, then you’re better off calling me back later or coming in so we can talk personally.

Menstrual irregularities? Well, I generally let everyone have one off-cycle a year provided they have a negative pregnancy test and there are no red flags like very heavy flow or severe pain. But honestly, if your cycle was different enough for you to pick up the phone and call me, it’s probably worth coming in, don’t you think? Because I’d really prefer to see you in person. And if there is any chance that you are pregnant, there’s no way we’re handling anything over the phone. So come on in. Today.

What about Money?

I like to think my view on phone treatment is not affected by reimbursement. But I can’t honestly say that if I worked in a high-volume managed-care practice, I might not be more willing to treat more over the phone.

Not surprisingly, money often affects the patient’s decision to come in or not. It’s not unusual to get a call from a patient asking for phone treatment because I am not in her plan and she does not want to have to pay for a visit. In these cases, I will do what I can for her over the phone provided I can do so safely, but encourage her to change to an in-plan doc so that finances don’t affect her healthcare decisions.

The Future

It’s interesting to hypothesize how tele-medicine might change my practice someday. Or reimbursement for phone calls. But somehow I can’t quite imagine that I’ll ever be able to do a pelvic exam over the phone, so I wouldn’t predict my practice to change much…

Make a Date with a Date (& make some cous cous)

I’ve just discovered how much I love this marvelous fruit. It’s sweet, moist, and full of fiber. Although dried dates do contain sugars, they are very satisfying and one dried date contains about 24 calories – not bad if you’re using it as part of a larger recipe. Dates are a good source of vitamin A, B1 and B2, are high in potassium, calcium and iron and are also a decent source of magnesium.

What can you do with dates besides eat them whole? Well, I like to add a couple of cut up dates to my morning oatmeal. No need for brown sugar when you do that.

And here’s a great recipe for Sweet Moroccan Couscous that I served last week at my Choral Group’s Annual Party. Its not a genuine couscous in a couscouserie recipe, but everyone seemed to enjoy it, and I promised Sally I’d post it. Enjoy!

SweetCouscous
Recipe modified from the Lowfat Jewish Vegetarian Cookbook

1 1/2 cups liquid (I used 3/4 cup orange juice and 3/4 cup water.
1 cup couscous
1/4 cup pitted dates, finely chopped
1/4 cup raisins
1/4 cup dried apricots, chopped
1/4 cup slivered almonds
1 tsp cinammon
a few tbsp water

Toast almonds in small pan on stove over medium heat, stirring often until light brown. Let cool.
Bring liquid to boil in a medium size saucepan. Remove from heat, add couscous, cover and let sit for 15 minutes.

Meanwhile, in a separate pan, cook dates, raisins, almonds and cinnamon in as little water as necessary to heat and soften them a bit. Add to cooked couscous. Sprinkle almonds on top. Serve warm.

The Next Generation of Abortion Providers

An insighful article by Stephanie Simon in the LA times explores the reasons why some young doctors are gravitating to the field of family planning. It’s a career choice driven by passion, politics and a committment to choice.

I found that the sentiments of one young doctor interviewed in the article echo those that I felt years ago when I first decided to enter the field of Ob-Gyn….

…young doctors-in-training have found their own motivation to enter a field that they know will put them at risk of isolation, harassment and hatred. For them, doing abortions is an act of defiance — a way of pushing back against mounting restrictions on a right they’ve taken for granted all their lives.”It’s like when your big brother says you can’t do something,” Lederer said. “That just makes you want to do it even more.”

Most of these students are members of Medical Students For Choice, a group who’s motto is “Without providers, there is no choice”. How true.

Simon states in her article that there is no straight path to becoming an abortion provider. Actually, there is – a family planning fellowship. These comprehensive programs are at some of the best medical schools in the country, and combine family planning and abortion training with clinical and epidemiologic research and a master’s degree in public health. The fellowships are an important bridge between the provision of family planning services and the public health aspects of the field.

The intimidation of physicians being perpetrated by this government appears to be serving as a catalyst for some young men and women to enter a field that can only get tougher. They deserve our gratitude and support.

Manhattanhenge 2007

Manhattanhendge is that magical moment when the setting sun aligns perfectly with the east-west streets of New York City, shining gloriously through the canyons created by our stone monuments to the urban gods. It happens twice each year, in May and July.

The term Manhattanhenge was coined by astrophysicist and Hayden Planetarium director Neil Degrasse Tyson in 2002. Here’s Tyson explaining this unique New York moment –

One of these days I will plan and get a great photo from a prime spot, instead of my usual quick snapshot taken from wherever I happened to be at sunset. I get another shot this year on July 11th…

Addendum – Hmm…A bit of debate as to this year’s date for Manhattanhenge. I thought it was May 29th, AM NY says May 30, but apparently it’s May 31st this year! Dr Tyson – it’s time for an offical Manhattanhenge website to keep us all straight…

Addendum #2 – OKAY, Here’s the offical word from Dr Tyson (I emailed him and he replied!).

Manhattanhenge begins at 8:10 p.m. (May 30), and at 8:20 p.m. (July 13), at a cross-street near you.

Doctor’s Bad Handwriting

Learning the Palmer Method

Dinosaur Doc is complaining that we docs are unfairly stereotyped as bad handwriters. Apparently #1 Dinosaur was once a calligrapher and has a gorgeous penmanship.

My handwriting is not just legible; it is lovely. Patients are often in awe of my prescriptions, instructions and Return to Work notes, usually accompanied by some crack about doctors and their handwriting…I know for a fact that I am not the only doctor with legible handwriting, and I am sick of listening to assumptions about my penmanship based on the letters MD after my name.

Well, #1, you may have been a calligrapher, but I was masterfully trained in the Palmer Method of handwriting by the nuns at my grade school. As testimony to the success of the Palmer method, my sisters, girlfriends and I all had beautiful Catholic girl handwriting, which usually looks something like this –

Interestingly, the boys did not seem to take as well to the Palmer method – I don’t recall my brothers’ handwriting ever being as “Palmerized”. It must be a girl thing.

My friend T. still has handwriting that would make the nuns proud. But, I am ashamed to say, my handwriting has completely deteriorated.

Was it medical school or leaving the church that caused the decline? I can’t say.

What I do know is that the situation is even worse when one considers my signature, which was so long in grade school that I had to hyphenate it across the page. That same signature has now shrunk to a mere squiggle which resembles the letter y in the word “try” up there.

So bad is my John Hancock that my daughter’s teacher did not believe it was real, and accused the poor kid of forging my signature on her report card. I had to send in a note to explain that I am a doctor who signs her name hundreds of times a day, and that indeed, this was what my signature had become. (Not to mention it was a great report card – what would my daughter’s incentive be to have hidden it from me and then forged my signature?)

All of which is a long way of saying that I beg to differ with you, #1 Dinosaur. I think most of us docs have pretty bad handwriting.

And you are clearly an exception to the rule.

Fighting Malaria – The Time is Now

World Malaria Map

This week’s issue of JAMA is devoted to malaria – a disease that affects over 300 million people each year and takes one million lives annually, most of them small children in Africa. In pregnant women, malarial infection can lead to preterm delivery, low birthweight and anemia.

The combination of increased attention, new drugs and new approaches to this serious global problem has created a window of opportunity that must be grasped now if we are to eradicate malaria from the earth. But it will take a concerted effort from governments, industry and the private sector if it is to work

Weapons in the Fight Against Malaria

  • Treatment: Artemisinin-based combination therapy (ACT) is the treatment of choice. Artemesin is a derivative of the plant artemisia annua, a Chinese herb that has been used for many years to treat fever. As is the case with many herbs, its mode of action isn’t entirely understood and it is non-patented. Research is ongoing to find new combinations and delivery systems for ACT’s. Both Novartis and Sanofi-Aventis sell ACT to endemic countries at a reduced, no-profit cost, but cost remains high in many areas and counterfeiting of unregulated product is an increasing problem. There is also increasing concern that resistance will develop.

  • Insecticide-Treated Nets (ITN’s): This is one of the easiest and cheapest strategies for preventing malaria. Sleeping under an ITN can reduce the risk of malaria by almost 50% and dramatically reduce perinatal disease and child mortality. A single bed net costs between 4 and 6 US dollars, family nets about $10.

  • Indoor Residual Spraying (IRS): Insecticide use remains one of the more controversial but highly effective approaches to eradicating malaria. Opponents are concerned about the environmental and health effects of insecticides. Proponents argue that in malaria endemic areas, until better alternatives are available, the benefits far outweigh the risks. I side with the proponents.

  • Prophylaxis in Pregnancy: In endemic areas where prenatal care exists, giving pregnant women sulfadoxine-pyrimethamine (SP) in the latter part of pregnancy can reduce anemia-related deaths and low birthweight.

What Works Best?

That’s a subject of much debate. Probably a combination of all of the above.

What Our Government is Doing

George Bush launched the President’s Malaria Fighting Initiative in 2005, possibly one of the few positive legacies of his presidency. He pledged to increase U.S. malaria funding by more than $1.2 billion over five years and challenged other donor countries, private foundations, and corporations to match his pledge. Of course, if even one quarter of the Iraq war budget were spent on malaria….

What Bill Gates is Doing

A little bit of everything, really, but one interesting thing is investing in One World Health , a non-profit pharmaceutical company that seeks to discover, develop and distribute drugs against malaria (and other diseases in the third world). He’s also donating to Medicines for Malaria, a public/private partnership between existing pharmaceutical companies and the public sector, which seeks to do the same thing.

What You Can Do

You can join the fight against malaria by donating to any one of the causes listed at the end of this blog post. Or just Google “malaria”. In an amazing show of how the internet can be a power for good, this will find you over a dozen organizations that are helping the cause.

I’m sending my dollars to Veto the Squito, a campaign launched by the Love, Hallie Foundation to buy ITN’s for kids in Africa.

Why Love, Hallie? Well, I have a bit of a personal connection. Love, Hallie was founded by my friend Sofia and her husband Ted in memory of their amazing daughter Hallie. Raising money to buy ITN’s is exactly what Hallie would have done, so that’s what I and my girls are going to do.

You do what seems right for you. But do something. Because the time is now.
_________________________________________________________________
Organizations that are Leading the Fight Against Malaria

Malaria Foundation International – $ 5 per net, 100% of your donation buys nets. Or set up a fundraiser. Or raise money via your website.

Veto the Squito: Kids helping other kids

CDC – Bed Nets for Children

Malaria No More – If you’re a soccer fan, this is your organization. Beckam is their spokesperson. His motto? “We need nets”. This is where American Idol gave part of their Give Back donations.

Nothing But Nets – Buy a net. Save a life.

AMREF (African Medical & Research Foundation) – They have projects in Tanzania, Ethiopia, Kenya and Uganda.

Sweat for Nets – Children helping children in partnership with the CDC.

Grand Rounds 3: 35

ImpactEDnurse is hosting this week.

Bloggers were asked to submit a post they are particularly proud of. It’s a smaller selection that usual (only 26 posts), but each is a gem. Truly the best of the best.

Head on over.

Thoughts on Medical Blogging

In this week that has seen the departure of three of my favorite medical bloggers from the public blogosphere (Fat Doctor, Flea, and now today, Dr Dork), it’s reassuring to learn DB’s Medical Rants is five years old today. (via Kevin, MD.) What’s even more reassuring to me is that Dr Bob is not anonymous and that his blog seems not to have led to any problems with his job as an academic physician.

Which leads me to comment on the doomsaying going around the medical blogosphere. I for one do not think that the medical blog is an endangered species. Sure, we’ve had a rough week. But we’re just getting started, folks. Because we are so new (except, it seems, Dr Bob), we’re having some growing pains. Painful as they may be, this is what it feels like to be on the forefront of something new.

And so we are all learning as we go. Because of the nature of what we are doing, the entire learning process is public. Which is not so good for the bloggers who’ve been hurt, but good for the rest of us.

Here are just some of the things I’ve learned these past few months from my fellow blogger’s experiences.

Employee Blogging

Blogging about one’s workplace or one’s colleagues is risky business, whether we are doctors, Google employees or bookstore clerks. Just because we are doctors does not mean we are immune to censure by our employers. I’ve thought a lot about this.

I do think, however, that being doctors gives us more protection than most employees from being fired for our blogs, don’t you?

Patient Privacy

Concerns about patient privacy are very, very real. And the disclaimers we put on our blogs may not be enough to reassure the public that they will not see themselves discussed on a blog someday. I don’t know the answer to this one, except that I find I am uncomfortable blogging about a specific patient without asking her permission. I’ve talked about this before, too.

Self-editing

Because we do not have editors, we must rely on ourselves to self-edit. Remember the old adage “count to ten”? Perhaps we need something similar. Like “Save it as a draft for 24 hours, and if you still feel the same tomorrow, post it.”

Maybe we should take advantage of our relationships with one another and ask for a little peer review once in awhile. If you’re worried something may be over the line, send it on to a fellow blogger you respect and ask their opinion before you post it. I for one would be happy to peer-review anything you’all want to send me, if only for the joy of getting to read it before everyone else does…

Shop talk

We are also learning that our rants can be interpreted by some as disrespectful to patients. And that “shop talk” commonly heard in the doctor’s lounge may not be appropriate when blasted throughout the blogosphere.

This is where private blogs may provide the “doctors only” locker room forum that we all need occasionally. Therefore I am hoping to get an invitation from Dr Dork to read his private blog and to visit Fat Doctor at her new invitation-only blog whenever she decides to re-enter the blogosphere…

The sad thing is that these private blogs will deprive the rest of the world of the opportunity to get to know these incredible individuals. And that is a damned shame.

Mean commenters

Some people out there who choose to comment in our blogs can be mean-spirited, foul mouthed and cruel. Just take a peek at the comments section over at Dr Wes’s blog after I asked him a simple question about a new test that my brother has been asking me if he should have. (I’m sorry, Dr Wes, to have stirred up so much annoyance for you…) This sort of cruelty led Dr A to take a blogging hiatus recently, although I am pleased that he is back. And now Neonatal Doc is on a blog-break for similar reasons.

I don’t have an answer for this one except to say “Neonatal Doc – come on back already!”

Anonymous or not?

This, of course, is the question that plagues me the most. Anonymity brings a certain freedom, doesn’t it? But I am beginning to believe that freedom is really just a false sense of security. After all, it is not freedom to say whatever we want without repercussions. It is not freedom to talk about others in public without them ever finding out. It is not freedom to say the first thing that comes to our heads without stopping to ask ourselves “Will I be sorry for this later?”

I’m beginning to side with Dr Rob that we should be willing to name ourselves. (His recent post “I am a blogger. I am a doctor” is a must-read for any new medical blogger.)

Revealing my identity makes it harder for me to fall into the “chat room” mentality that uses anonymity as a springboard for behavior that would never happen if my name was known. What I say, I stand behind. If I say something offensive, they have the right to challenge me. If I am wrong, I will say so and make the correction and/or apologize.

My partners know I blog. My staff knows I blog. My wife and my Mom know I blog. If my patients ask, I give them the URL of my blog. I am me on my blog – faults and all. Some people out there seem to think that medical professionals aren’t just normal people. Thanks to the “professionally offended,” we are losing voices of real people doing hard jobs.

 

I have been “outing” myself almost daily these days to patients who want to know more about what I may think on a certain issue. I’ve been holding back from telling colleagues, more so because most are not as into the internet as I am and probably don’t even know (or care) what a blog is.

To be honest, the main reason I haven’t made my blog public is that I hate my photo on our medical center’s website, and figure that if I reveal who I am, someone will google me and see that horrible picture…

Are there any Agreed Upon Standards for Medical blogs?

Thanks to Walter at Highlight Health for pointing out the existence of the Health on the Net Foundations “Code of Conduct” for medical websites. Bloggers that meet HON’s standards can apply for their accreditation. (Anonymity runs counter to the code).

Final thoughts

I want to personally thank Barbados Butterfly, Fat Doctor, Flea, Dr Dork and Neonatal Doc for the opportunity to read their amazing blogs. Their departure has left a gaping hole in the fabric of our blogging community. I hope that together we can re-weave it, but this time with threads that are strengthened from their experiences.

I also hope those who have chosen to leave the blogosphere will consider returning after they have had time to recover and reassess. Because we need their voice.