Quick update

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Just a quick note to say that while I have been gone, I hope I’ve not been forgotten! I have had a fair share of personal life crises in the last few weeks and even hand (wrist) surgery yesterday for an injury a few months ago, so I need to keep this brief. I just felt bad letting one more day go without at least posting SOMETHING for passers by/feeds/etc to see some activity to know that the blog hasn’t shut down.

Let me get another day or two post-op and I’ll share some of what’s been going on lately. And remember: I’m always posting something on Twitter, so remember you can always follow me there (and read excerpts in the sidebar to the right). More soon!

Inaugural music not so simple a gift

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For whatever reason, I feel compelled to finish this languishing draft in a form different than it began, wanting to publicly consolidate some thoughts on last week’s inauguration while not waxing as far as I originally tried about the future of our nation and a renewed hope in our place in the world. To be sure, I am as excited as I was last week about these things, and I am happy to see that after less 10 days in office, Obama has not only repealed some of the shameful legacies of our last president, but clearly has set an unapologetically new tone from the West Wing to the West Bank.

For the record, I fully expect to be disappointed in some things I really feel strongly about not moving forward the way I thought or that he originally promised. Part of being a good leader is adapting to new situations and information; being a better leader is conveying why things have changed for those who were expecting otherwise. We’ve had enough of this “stay the course” because “I’m the decider” bullshit for a lifetime.  I think everyone on both sides of the aisle should be in a position of compromise on domestic affairs in this time of financial crisis.

Having gotten “current events” out of the way, I want to return and remain on the inauguration itself. I saw it partially live, but since I was caring for my daughter that morning, I was unable to see Obama’s swearing in, speech, and after coverage until later from the DVR. Fortunately, one item I did see live just before having to switch off was when Sen. Feinstein announced the names of Itzhak Perlman, Yo-Yo Ma, Gabriella Montero, and Anthony McGill to play the commissioned inaugural work by John Williams, “Air and Simple Gifts.”  I about fell out of my chair when I heard Perlman and Ma’s names. Mind you, we had just heard Aretha Franklin in the broadcast which was already over the top awesome (not to mention that gem-studded bow hat!), but to have Perlman and Ma on the same stage LIVE as a surprise (I hadn’t done any prior scouting or reading of events) was incredible.  Wind instruments aren’t my thing, so I didn’t know the clarinetist, but Gabriella Montero is a phenomenal pianist and gifted collaborator on several cross-over projects; she’s also certainly Venezuela’s most popular export to the classical music world along with Gustavo Dudamel.

The point is, before the music even began the tremendous surge of pride at how serious music and the arts had been given here was overwhelming.  This was no “filler” cocktail quartet music–this was the unquestionable musical “main event.  It also instantly occurred to me that 3 of the 4 musicians were not originally of this country (Perlman and Ma however are both naturalized citizens), and the fourth was African-American. What incredible symbolism of unification and diversity in just the musicians themselves!

Then the music started.  Once they started playing, the realization hit me like a brick across the head: “OH. MY. GOD. It’s 20-something degrees and Perlman and Ma have their multi-million dollar Stradivarius instruments warping in the cold?!”  Just as my heart recoved from throwing a PVC it then hit me: “Wait…the piano!!!!  How is it being kept in tune?!”  You have to understand–it takes HOURS to tune a piano; there are 88 keys but over 200 strings/pegs to adjust since most keys have more than one string (most have 3)–all of which need to be in unison among themselves and in proper relative pitch with every other key.  I think, “So instrument valuation aside, adjusting the four strings of a cello or violin, or pushing in/pulling out the segments of a clarinet would be comparatively simple, yes, but….”

And suddenly I hear that familiar tune, used so gloriously by Aaron Copland in “Appalachian Spring” that’s become part of the very fabric of  American musical existence.  And then it continued. And continued.  “Aw hell no….” I thought to myself, realizing that this was the focal point for Williams’ work.  I was so disappointed, feeling the event was cheated, wondering how Williams could have not come up with something more personal, more evocative of this special moment in history.

The whole point of a commission is to write something new, not re-work a tune that elementary school children could recognize that was already popularized and made iconic by yet another American composer.  GOOD LORD!

I even tweeted the fact that I thought the composition was less-than-desirable in real-time, so this is not a revisionist point of view, but I did look up what people thought afterwards and I’m comforted to know I’m not alone. In the process, I also discovered what probably everyone now knows about the “live” performance and that what we heard on TV and what was broadcast locally over the speakers was in fact a pre-recorded performance from the previous day for the very technical reasons I was thinking as I was watching.  I didn’t feel bad when I found out, because obviously I know why and also that they were in fact playing in real-time; the honor to the event was still maintained if you could hear any of them acoustically. There were just too many damning technical factors to consider outside the players’ control to do the event justice for everyone while still have them on stage in that weather which Yo-Yo Ma himself described as “wicked cold.”

Regardless though, I’m happy to see that classical music got a prominent moment to shine, even though it was via Williams channeling Aaron Copland cheered on by Wolf Blitzer’s voiceover in the middle of the performance–but I won’t go there lest I get upset all over again… :P

Belated Wellsphere Blowback

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You will be added to the collective.

You will be added to the collective.

Through the power of collective blogging (and Twittering), yet another storm is brewing about Wellsphere in the face of their being bought out by HealthCentral for an undisclosed millions of dollars. HealthCentral currently has over $50 million in VC funding, so this isn’t chump change. Wellsphere claims thousands of medical “experts” in its network and boasts unique page views in the millions per month through its presence among its network “partners” (ie, unwitting bloggers).

Well, it’s more “penetration” than “presence” in the end, because the kicker here is that Wellsphere not only doesn’t pay their partners a damn thing, but worse, outright steals content from bloggers’ own sites and rebrands it as Wellsphere’s own unique content without any attribution whatsoever. Dr. Val exposes all of this quite plainly in a recent post, and many other stories are coming out on Twitter with the search hashtag of “#wellsphere.”

Full disclosure dictates that I reveal that I too was contacted by them last year; however in a moment of what I can only describe as serendipitous procrastination or distraction–whichever–I let the email sit there for a good while. When I took another look, I just didn’t see the point. I never got so far as to read the heinous Terms of Service agreement, because just on its face it seemed like I wasn’t going to get anything except a pretty badge on my sidebar (woowoo!  not.) and a warm glow for knowing I was going to help promote health information to their general online community. And it’s the last point that makes this whole thing stick in my craw–the CEO heading this whole thing may very well have been a complete and utter scumbag, but the request letters came from the Chief Medical Officer person–a physician named Dr. Geoff Rutledge. Through him, the entire modus operandi was predatory, taking advantage of what would be an accurate soft spot of medical bloggers who would of course feel altruistic about disseminating health information and/or being a part of a health network.  It’s the blogging equivalent of a schoolyard bully offering his protection services for lunch money.

If I could turn back the clock knowing what I know now, I’d have signed up gladly. I would have put the little badge on my page, and watched my page hits go–nowhere.  Meanwhile, my content would be sucked and rebranded as Wellsphere’s own. So I’d make posts like “Wellsphere — You’re a Bunch of Thieving Mongrels” and change my “featured blogger” bio to include heinous, non-consensual acts done to me at the hands of Wellsphere’s handlers.

But if you have more to add on this story, all is not lost! Tonight at 9pm EST The Doctor Anonymous Show on Blogtalk Radio will be devoting a part of tonight’s broadcast to this issue, so please tune into follow more and support the cause.

Because resistance is NOT futile.

Live Blogging “Eleventh Hour” on CBS tomorrow

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I’m excited to announce that I will be live-blogging tomorrow’s episode of “Eleventh Hour” on CBS. Airtime is Thursday Dec 22, 10PM EST/9PM CST. I was originally contacted by the show’s PR firm in December to do an episode then but holidays and schedule postponed it to this month. In the interim, I’ve taken advantage of that time to catch up on almost half the season’s 10 episodes and I can honestly recommend the show to anyone who appreciates science, mystery and a touch of the unknown. I can honestly say that this is the first show to have come along in the spirit of The X-Files that does the genre justice (and some of you know about my rather public involvement with that show in the day…hehe)

The setup is that I’m brought in as the science “expert” with another blogger who does this weekly doing the main commentary. In essence, I’ll be the wingman on a two man team providing some scientific backbone in a real-time blogging session that will also take some fan questions along the way. This upcoming episode promises to be a good medically-tilted one about a boy who was seemingly “cured” by drinking some spring water.  I can hardly contain myself if that teaser delivers the medical hoax debunk-fest think it’s going to. :)

The live web cast for the show is here and I assume it will be active around 15-10 minutes before the show actually starts. If you have time and interest, it would be great if you could join us for some multimedia primetime fun!  Hope to see you there!

Small Changes, Big Dividends

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Hello and Happy New Year!  I know I took an unexpected blogging hiatus, and while I did plan on taking a small break through Christmas, the rest was, well, unfortunately not how I thought things would go down. I’ll come to talk about things soon enough, but for now I want to concentrate on getting some “real” content flowing. I refuse for the blog to continue to go stale because of things as mundane as personal problems.

Tuesday is an historic day as we swear in our 44th president, Barack Obama. Personally I’m jealous I don’t live in the DC area anymore (Fairfax County across the river, same difference) because I’d love to be part of a part of a part of something that day. Oh well. But it’s just a day in the end, and much work needs to be done in our nation, one of the most pressing issues being health care reform. I’m neither a practicing physician nor a policy analyst, so I’m not going to embarrass myself with attempts at unoriginality against such smarter people, but I can say what works from a patient’s perspective, especially one who can see both sides of the issue natively. “What do you mean? What do patients have to do with health care reform?”  They’re intimately involved in it! Left out of so many policy discussions, the patient-end of the equation is critical, but more on that later.

This last November I had a silly incident with my wrist and the side of a car that hurt at the time but I blew off, blaming as much my clumsiness as anything else. After weeks of not feeling better and rest/anti-inflammatories not making a difference, I finally got it looked at and wound up at this hand-specializing orthopedic surgeon, MRIs in hand (ha ha) showing a tear (that’s a separate post).  I was very impressed with him and his approach, appreciating his conservative management style. I normally don’t let on I’m a med student for a variety of reasons, but he asked what I studied (chart said “Occupation =  student”) and when I told him, he became even more effusive and engaging. Interestingly enough, we talked mostly about policy issues! (it’s on everyone’s mind right now!)

Regarding my condition, he said he wanted to do a steroid/lidocaine injection into the joint space to give short-term relief, re-evaluate in a month. As many of you know, I’m a classical pianist, and while I don’t play regularly these days, the very idea of a complication that could compromise that aspect of my life mortifies me, so I’m happy with baby steps. He’d be back in a bit and added, “Oh, and I have a letter for you,” as he handed me a piece of paper that for whatever reason I noticed immediately was both hand-signed and on good cotton-fiber paper stock. Still a bit taken aback, I asked, “What’s this about?”  He smiled and said, “I’m an old-fashioned guy, that’s all. I’ll be back in a bit,” and closed the door, instructing the other side for his assistant to begin the prep for the injection.

As I waited, I read this hand signed letter. Here are the relevant excerpts:

A Personal Letter From Your Doctor, MD

Dear Mr. Cantu:

Thank you for coming in today to consult with me regarding your medical care. I appreciate and respect your trust in me as your doctor and orthopedic surgeon. I strongly recommend you share in the responsibility of treating your condition. You can do this by following any medical advice given and keeping scheduled follow-up appointments. Timely follow-up is extremely important as delay in treatment could lead to deterioration or, even worse, permanent dysfunction.

On occasion, delays occur in the office. I ask for your patience as these delays are due to attending patients with complex issues. We will try to keep you informed when such delays occur. I assure you that should your medical problem require extra time, it will be fully provided.

Lastly, it is the policy of this office that all proven conservative (non-surgical) treatment options will be embarked on firstly. Surgical intervention is only offered if conservative treatment fails to alleviate your symptoms.

[closing paragraph, thank you, etc]

Is that awesome or what?  I also noticed in the letterhead the abbreviation FRCS for Fellow of the Royal College of Surgeons in the UK (he’s also an American FACS here, for what it’s worth). He had mentioned training in Canada (his ethnic origin is Caribbean of some kind, didn’t ask) but obviously there is some of that “English gentleman” thing going on here. I know good and well it’s a form letter coming off a laser printer at the last minute before entering the room, but it doesn’t matter. And if doesn’t matter for me, someone who sees what the wizard is doing behind the curtain, imagine how much more it can make a difference to an average patient, particularly older patients, who truly feel that they “connected” with their doctor in a unique and personal way–and on the first visit!

But the story doesn’t end there. After the injection I was waiting for 10 minutes or so to make sure it all got nice and happy in the joint space. Sir Orthopod came in and sat down, and started dictating in front of me. I thought this was a bit odd, though it’s happened on occasion before, but it was always when I was in a physician’s office already or in a hallway; in other words, it seemed like it was just occurring as a matter of course. This was different–he came into my exam room on his own volition, sat down, and started dictating into a digital recorder. He even paused once or twice to make sure he got something right, which he did, my thinking he was taking advantage of my being there out of convenience as I sat and listened patiently.

I thought during this he might just be more at ease because by this time he knew I was a medical student and felt comfortable dictating the technical behind-the-scenes in front of me, but in talking with him later, he said that he does that with all his patients. I was shocked! On the surface, it sounds like no big deal, but there’s a lot that can be said that can be taken the wrong way/misunderstood by someone who can’t parse the terminology/jargon, or feel that the physician “didn’t tell me that,” when in fact s/he did, they just used laymen’s terms in the conversation. But the surgeon said he does that intentionally to further avoid liability and increase transparency. It’s rare and more comes up with worker’s compensation and disability claim-type cases he said, but it’s very hard to claim “I had no idea,” when his standard practice–and that’s the key–is to dictate in front of the patient. The dictation is transcribed to the official record, and if the patient is present, that’s yet another opportunity to both 1) correct the record as it’s being dictated should the physician get something wrong, and 2) provide a legal support structure against false/misleading claims. Add a personal letter signed by hand, encouraging patient cooperation and apologizing in advance for minor inconveniences, etc. and you have a framework for the following:

  • a happy patient who feels listened to and cared for (less likely to sue, far more likely to refer word-of-mouth to friends/family)
  • a physician who knows how to invest, having just spent about $0.02 on a sheet of good paper stock and 1 second signing a letter for literally countless dollars of saved legal headaches, increased referrals, pleasant encounters, etc.
  • a physician who spent ZERO extra time, but by dictating in front of the patient provided extra legal protection, greater fidelity of the medical record, and further fosters a sense of transparency and trust with the patient
  • a patient whose medical expectations are manged from the start, thinking that because they were referred to a surgeon they need/will have surgery
  • a patient whose expectations are managed WRT office wait times not only by telling them it can happen but assuring them their care will not be compromised when its their turn. This also takes the heat off of the front staff, and happy staff makes all the difference too.
  • and perhaps most importantly, a patient who is invited to take an active role in partnership for their own care, hopefully achieving greater compliance for not only better outcomes but lower healthcare costs by avoiding complications, unnecessary procedures, etc.

The small steps taken by this doctor might seem trivial on the surface, but to me they’re genius because they accomplish so many good things in an honest way so effortlessly. The goal here is patient satisfaction and success with the added legal protection a bonus. This is just one relatively medium-sized solo practice in a small-medium south Texas city. Imagine if small changes like these were implemented everywhere, how much morale and rapport could improve, frivolous lawsuits could be avoided (or at least provide further disincentive), and how much the climate could change for the better all-around. I’m not idolizing this guy, I’m thinking beyond him to the bigger picture.

The other thing about his attitude, reflected in his letter, is the participation of the patient in their own care. We keep talking about health policy and reform from a top-down approach, changing insurance policy structures, provider reimbursement schedules, etc. rather than a bottom-up approach. While anyone really involved knows it’s a two-pronged approach, the media, and more importantly, too many patients feel they are mere bystanders in both the discussion and the solution, and I appreciate this physician opening the door to that reality for his patients. More on patient responsiblity in a separate post.

Dr. Manners, I presume?

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Dr Val posted last week about doctors needing to go “finishing school” (original article in the NEJM and “mass marketed” via the New York Times) and said that at a minimum, physicians needed to do basic things that should be automatic, especially with common sense applied to a patient (read: vulnerable) situation. The automatic part would be taught as part of the medical school curriculum, with true compassion and sensitivity coming later. In other words, teach the rote mechanics as one would a physical exam, so a bare minimum of [manufactured] rapport can be established.

Dr. Val said

I don’t think that’s related to their medical school curriculae – it’s the sad result of a broken healthcare system that wears thin our common human decency. Doctors are exhausted by clinical volume, henpecked by bureaucracy, delirious from lack of sleep, and stressed out by the daily grind of bad news, disease progression, and death. When well-groomed adults of sound mind require a checklist in order to smile appropriately, you know something’s terribly wrong.

Let’s remember that this is written by a psychiatrist (this will come up again later). The freedom to think, meta-think, and think again is a luxury (and necessity) that is part and parcel with the specialty. A psychiatrist being “overworked” is quite a different thing than, say, a surgeon, physically and time-wise. It’s no wonder that the more “harried” doctors like surgeons and way over-stretched IM-based specialists would most likely fit a “bad doctor” stereotype needing the bullet list given in the article.

Let’s re-look at the list and find out where, if any, each bullet point can get just a tad unreasonable:

• Ask permission to enter the room; wait for an answer.
The physician is not housekeeping at a hotel, and many patients can’t answer. I am guessing the spirit here is to give the patient some privacy and autonomy, but it’s not always appropriate or practical. You think physicians–multiple ones in the same hall at that–are going to yell through a closed door, “Mr. Sanders? Mr. Sanders? May I come in? Are you decent? *wait* *wait* Mr. Sanders? I just want to talk to you, can I do that?” If you stop to think about how it would play out, it’s just comical.

• Introduce yourself; show your ID badge.
Introducing oneself is a must, I agree. But more important than the name is their specialty or purpose. Doctors, nurses, techs, etc. flow in and out as a matter of course; any one person’s name will NOT be remembered on first meeting usually. “The surgeon” or “the heart doctor” means something to the patient, however.  Showing the ID badge is a bit much, but I agree it should be reasonably visible (not hanging all “cool-like” off the scrub bottom’s cargo pocket) should there be a concern, its absence being the true red flag.

• Shake hands.
In normal conversational etiquitte this goes without saying, but not every patient is in a position to shake hands. Patients might have IVs on the dorsum of one or both hands, or be weak where a handshake (particularly coming up from a bed in a supine position) might be taxing. At the doctor’s discretion, perhaps a small pat on the shoulder from above or the like establishes a “connection.” Some patients may be standoffish or even hostile, and with so much to do and accomplish besides some physical token of greeting on top of the verbal one, just skip it already, it’s not worth the trouble. Psychiatrists live for dancing this dance, reading volumes in the smallest gestures and pondering the meanings; most everyone else uses their time on more practical matters.

• Sit down. Smile if appropriate.
This is where the author really jumped the shark. Sit down?! Where, exactly? Most hospital rooms have ONE chair apart from the bed, and a family member is often sitting in it. A doctor is going to sit in the patient’s bed during the interview? This psychiatrist-centered view is starting to really show its limitations and other-worldly approach. After all, psychiatrists are used to being in rooms where there are more chairs than people, so of course, why not sit down?  And what exactly is considered appropriate to smile or not smile?  I smile naturally almost all the time when meeting someone, like a reflex. Some don’t. I’m not going to second guess all of this now.

• Explain your role on the health care team.
Of all the bullet points so far, this is by far the most useful. If there is one thing that confuses the hell out of the poor patient in today’s overly-specialized/referred environment. No arguments here, solid advice.

• Ask how the patient feels about being in the hospital.
After the previous useful directive, we just had to go back to shrink world–it couldn’t last forever. Asking something like this is fine, if it’s worked into the general conversation and there’s oodles of time on everyone’s hands, but asking directly as written is awkward at best. (“It sucks, what do you think!?”) A far better and more reasonable approach would be “Is there anything else you need, any concerns that we haven’t addressed?” — in other words, be practical. Time is of the essence, and one can make a patient feel listened to and respected beyond their disease without falling into an open-ended, potentially never-ending pit of feelings.

I know that some of what I’ve written above sounds insensitive, but it’s done intentionally and not without a little bit of sardonic wit to balance out the candyland view of the author. It’s ironic that the author’s original purpose was to establish a practical workflow to make patients feel more “listened to,” I suppose, but offered a sample checklist that is, in my opinion, beyond impractical. Perhaps this would have been better tackled by someone in another field who sees [non-psychiatric] inpatients on far greater volume. The author himself wrote about being “good enough,” and I think the smallest common-sense steps can get us there.

I know I kind of beat this to death a little bit, but I do feel strongly about not only good physician-patient interaction having been on both sides of the bed, but also I’ve seen quite a bit of “doctor bashing” in the media lately, and it’s unfair. There are definitely bad doctors who need a serious attitude adjustment to be sure, but there are far more good doctors with good hearts and intentions, twisted into an impossible struggle in a no-win environment.  Knocking before entering a room and waiting outside for a patient to get off the phone to receive an answer like “Come in” shouldn’t even be part of the discussion.  Let me know your thoughts.

Upgrading WordPress with Subversion

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As many of bloggers are no doubt aware, a major update to WordPress was released this week. I  like many others, eagerly upgraded my installation to take advantage of many new long-awaited features (particularly on the admin/management end). However for many, upgrading WP means downloading the latest .zip archive, unpacking on one’s local disk, then uploading the entire contents of the unpacked archive (see the irony here?) through an [S]FTP client, wondering why so many micro-tiny files would take soooo long to transfer (it’s easily explainable, but that’s for another discussion). During this protracted upload, one’s WP installation can become instantly unstable as files are being upgraded in place, creating a real-time oil-and-water mix of two different versions.

So what do I do?  Well, obviously not the above. :) With shell access to my hosting account (for Windows users, think DOS command prompt), up until a few months ago, I would get the new version as usual, only I’d upload the .zip file (or in my case, the .tar.gz “tarball”), unpack it on the server, and replace the installation in a couple of seconds; the time to upload (which would be vastly shorter because it would be a compressed, continuous file) would have no bearing on the “out of sync” problem above, because I’d unpack the files in a few seconds. This is a tried-and-true workflow that nobody could argue with in terms of simplicity and speed.

However, there is an even more elegant method that I started utilizing as soon as I found out WP supported a version control utility called Subversion. Version control is used in the software industry to track changes on various files so one can roll back to a previous version. People do this all the time with, say, a document in Word by saving multiple copies, but imagine 50 developers all making changes simultaneously to a source tree of hundreds of files. You have to be able to track changes so that you can fix what breaks while not discarding what got better.  Anyway, I don’t want to get overly technical, but I wanted to give a slightly better understanding of what Subversion is more than the simple statements in the video. Speaking of which, here it is:

thumbnail of video tutorial

Video of WP Upgrade

Cool, eh?  It’s important to know that the above was recorded in absolute real-time, no edits, and that it was really, truly my live system. Aside from the file and database backups before recording, you saw my real, unadulterated upgrade process (while I wasn’t worried having done this many times, the fact that it was done on a Sunday afternoon when traffic was low wasn’t an accident, either ;) ). Once your svn tree is in place, tracking updates large and small really is that easy. There are no big installation files to download or upload (the `svn’ client gets the individual files it needs, but it’s a fast server-to-server transfer) and unlike dropping a new installation on top of the old one, the old, deprecated files are cleaned away. Note that this is the workflow for an existing subversion WP repository; how to convert a “standard” (ie, uploaded) WP install to a subversion-enabled one is the topic for a future post (if there’s interest).

Anyway, I this helped, or at least inspired you to look into checking with your hosting provider to enable shell access if you have it. Please, please, give me feedback on this because I have lots of ideas on similar videos on WP ginsu outside of the web dashboard, most notably using MySQL queries (the database that powers 99% of WP instances) and the like. I admit command-line management isn’t for everyone, but for those willing to start adding to their toolkit, it opens up a limitless world of possibilities.

P.S. I didn’t make this clear, but this was created mainly for friends and readers in the med blogging world who are not necessarily highly technical. If you stumbled upon here from a search or tech-related link, this was not intended to be 100% comprehensive on anything. Condescending comments by tech trolls about how “retardedly simple” this is have already been removed and will not be tolerated.

Welcome Medscape Readers!

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For all of you who read my pre-rounds interview in the Medscape MedPulse mailing, welcome! In spite of having upgraded to a tag-enabled version of WordPress some time ago, I have not yet gone back and content tagged many of my older posts from last year. I am in the middle of doing that now and will be adding some resources on the sidebars to assist with navigation, for example, all posts dealing with my previous medical school or clinical experiences, etc.

So in addition to a general “welcome,” I wanted to invite you to come back since this blog is always a work in progress.  I hope you had a chance to read last week’s Grand Rounds edition hosted by me and found it an enjoyable read. Make sure you read the current edition at Sharp Brains which will be featured in next week’s Medscape mailing.

Thanks again, and I will be back as a student this coming year–I just can’t say where or as what, exactly. I’ll be blogging soon about some of my future decision points on this topic, so feel free to subscribe to my RSS feed to keep abreast of current posts.  Cheers!

Frustration w/video – help request

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As I blogged on Friday, I wanted to have some stuff up this weekend of a video nature, but my video options are being very, very uncooperative. I have an OLD version of Final Cut on the Mac, but it has since been corrupted and can’t be used right now. Still, it’s a sledgehammer when many times a simple stapler will do.

In this case, I have video of a shell session (like a DOS command line) showing how to use Subversion to upgrade WordPress. I actually I have another unrelated video as well, but they have two things in common: they need their audio replaced with another audio track (recorded on a better mic). Now if it was a straight 1:1 audio swap, that’s trivial. But I do need the help of a video editor w/rudimentary capabilities to stretch out the video on a frame for a few seconds extra, or whatever, to make sure the audio is synced up. Simple stuff that they all can do if the audio/video is muxed together, but not so much if discrete tracks.

iMovie ’07 (I refused to upgrade to ’08, which would have actually put me backwards in this too) can do all this easy, except it MUST convert the video to one of DV (720×480)/DVwide or MP4 (640×480). The captured video is not in a “standard” broadcast dimension, so converting into iMovie ruins it, especially because of the text on the screen, in this case. QTPro can do simple video editing but not replacing sound unless it’s a perfect 1:1 swap.

Anybody have experience with 3rd party video shareware/cheap editors that can do basic editing of this kind while allowing for add’l audio track but play nice with QuickTime and non-std formats too? Yeah, I didn’t think so. But I can be surprised. ;)

“Grand Rounds” Dr.A. Show Wrap-up

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Hello! Above is the video post I did as a wrap-up for last night’s Doctor Anonymous Show in true Dr.A. fashion, except Dr. A. did his before I got to do mine! However, I still did it, because, as Wilford Brimley would say: “It’s the right thing to do.” haha

Thanks again to my star-studded panel: Ramona Bates of Suture for a Living, Mother Jones, RN of Nurse Ratched’s Place, Val Jones of Getting Better with Dr. Val, and Bongi of Other Things Amanzi. I am still in awe that these A-list bloggers all took 90+ minutes out of their Thursday to spend with me.  Awesome.

Also thanks to Vijay of Scanman’s Notes for calling in all the way from India; you made it a cross-contiental event x2!

Whether  you were there or missed the show, go the link above so you can listen to the archive, download it to your computer/music player, whatever you like.

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