According to the Internet phenomenon Wikipedia, blogs (short for Web-logs) are Web sites, usually maintained by an individual, with regular entries of commentaries, descriptions of events, or other materials such as graphics and video. They can serve as online interactive diaries where bloggers pour out ideas, feelings, and opinions, and invite readers to respond with comments of their own that are often equally fascinating and spontaneous.

Technorati, a blog searching service, reports there were 112 million blogs in 2007.

Wikipedia is relegated to a “phenomenon?!” Someone needs to tell these folks at ACEP that they don’t need to qualify what a blog is with enumerated reference; it’s not 2005, and wasting a paragraph on the obvious made me want to stop reading altogether.

Moving on, any person in the blogosphere worth their salt knows the once mighty Technorati has long since lost almost all of its relevance. Nobody uses it for anything useful, its continued existence being somewhat of an anachronism. However, the ACEP authors cite 2007 data from it in July of 2008!!(as referenced in the footnote) WTF?! They aren’t even trying to appear as though they care at this point.

The painfully protracted exposition continues:

[Other blogs] serve largely as public journals, providing authors’ insights and anecdotes without the peer review or editorial vetting that occurs in more traditional journal venues. However, the personal nature of many blogs lends them an intimacy and an immediacy that is often missing from mainstream outlets. Arthur Caplan, a prominent ethicist, compared blogs to an extended form of chatter and conversation.

I noticed here already a condescending tone that would get more and more pervasive throughout the article, that the notion of a peer-reviewed journal is the pinnacle of scholarship and a blog being gossip and nonsense. Wrong and wrong–it’s a comparison of apples and oranges. No one would argue that “big” journals get their gravitas from their editorial boards, but even peer reviewed journals suffer from bias, politics, and other non-scientific factors, and published studies often come under fire after publication for being extensions of corporate/non-scholarly interests. On the flip side, many blogs can honestly stand against some of the giants of the print world in terms of their solid content–far from idle prattle–the “peer review” being the entire world of reading scholars, all free to leave commentary, positive or negative, in an open forum.

It is this point in particular where the “good old boy” stripe of physician is most chafed. There’s a strong sense of “you kids get off my lawn!” as a new medium threatens to tear away the fabric of order and control as seen through the eyes of these authors. The very notion that a patient or layperson has a potential standing of equivalence to published physicians is the fundamental reason behind why this article is being published in 2008 without embarrassment: the ACEP still doesn’t “get it.”

Most of the above is petty quibbling compared to what I’m going to quote here, though:

Dr. Rita Charon, a physician and a leading authority in narrative medicine [whatever the hell that means], believes patients own their stories, and she takes the strong position that physician-writers must have patients approve narratives written about them before publication. Two other writers and experts in literature and medicine – Dr. Jack Coulehan, internist and poet, and Ann Hawkins, Ph.D. – invoke the argument of relational ethics. What will happen if particular patients discover that they were featured in an article, story, or blog? Will they find such attention beneficial, perhaps therapeutic? Or will embarrassment or betrayal boil their blood?

“Patients own their own stories?” Well, yes, in a fundamental ethical way, no one would argue that it would be wrong to publicly share that which is private between doctor and patient. In today’s world, HIPAA guarantees*cough* that their information is kept confidential, and every medical blogger I know goes well out of their way to mask any indentifying features of a story so that any semblance to the original would either be complete coincidence or not specific enough to be unique (“a woman came to the ER last night” would apply to potentially half the emergency patient population, for example, even if it were found to be true). However, the authors aren’t even bringing up confidentiality or legal concerns; they are ridiculously invoking the idea that in a doctor-patient encounter, the patient is the “owner” of the encounter’s narrative.

RUBBISH!

There isn’t ONE story, but TWO stories, at least: one from the point of view of the patient, and one from the POV of the physician. The ACEP doesn’t seem to be concerned with nurses, techs, etc. but the reality is that everyone in, say, a trauma bay (this is the ACEP after all, and ER environments are hardly ever private one-on-one encounters), could feasibly walk away from that encounter and have something to write about and each would be unique representing a distinct POV. You can’t equate or assign ultimate ownership of the experience of any one person, the different jobs being performed, etc. It is the height of arrogance to say that any one person actually “owns” the unique narrative of another. It’s sickening, in fact.

You have to hand it to bioethicists, though. I love that they exist, and like the ACLU, you’re happy they’re there for the “big stuff” that require their unique talents, but like this they’re often involved in issues more for the intellectuo-ethical masturbation debate than for yielding something tangibly better for the patient.

There’s a lot more as the article continues about what kind of “tone” the physician-blogger should strive for, and other paternalistic drivel from authors who have already demonstrated their incompetence on the subject matter. It’s insulting enough as a physician reading this to be told they “should aspire to a voice that is respectful and professional,” much less by these authors who can’t even utilize the very tools they are professing to teach.

Ultimately, however, the relevant question is raised, “What kind of ethical code should be used to protect patients’ confidentiality?” Had this not been the article of two online amateurs, the last section could have served as a wonderful teaching tool. Instead, it turned into yet another demonstration of hubris demonstrating, “Look how I’ve offered a solution to this problem!”

The solution for a “code of ethics” had already been actively addressed, voluntarily, in the medical blogging world, without the need of paternalistic mandates from out-of-touch organization chairpersons. The Heathcare Blogger Code of Ethics (HBCE, also knowns as “Medblogger Code”) was created by communal referendum with each blog’s participation vetted beforehand. Nowhere in the HBCE will you find paternalistic directives like “Wait one week before posting [clinical encounter] material to your blog.” We (and I say ‘we’ because I’m an active member in this community) assume that bloggers who care enough to announce due diligence with the HBCE badge don’t need to be micromanaged about their own posting habits, timing, or frankly judgment on any subject.

In fairness, I’d love to see what these two ACEP bioethicists would make of the HBCE and even the sibling patient-focused community, the Patient Blogger Code of Ethics (on the same site above). Perhaps that can be the subject of a future article, once the authors get this whole “blogging” thing down.

I’ve been robbed–ROBBED–I say! Celeste, a long time commenter and reader of this blog, pointed out to me that National Public Radio (NPR) has taken one of my old posts and stolen it, without reference, without a “hat tip,” without anything, in their feature entitled “Playing Five Beats To The Measure.”  My post entitled “5/4″ obviously is the victim of an NPR five-finger discount. Now it stands to reason with NPR you’re going to get a much more polished product than with lil’ ol’ me, but the spirit of my post clearly comes through, and with the added literary/dramatic touch of a second, autobiographical voice feeling an “odd” kinship with this asymmetric time signature.

I invite you to read mine first, then see the NPR feature. Afterwards, tell me whether or not mine gives those thieves a run for their money!  heh

Something worthy of mention: Brooke Shields is actually one of the models in the girl’s clothing picture! And for those of you who think (correctly) that the fashion industry nowadays sends the wrong message to girls to be unreasonably thin, check out that same picture which advertises “also chubby sizes.” (!!!) That’s one step away from me regressing to a 10-year-old being bought Sears Toughskins “husky” sized jeans. AAAH!!! Not the “X” stitched on the back pocket! Nooooo!!!

There’s also another page of PG-13 items, like “water pipes.” (Hash sold separately)

(via BoingBoing)

What’s wrong with this? There’s no cool Independence Day graphic! I was at the real google.com, not google.com.mx, where I’d see this:

(by the way, this is hilarious because the button for “I’m feeling lucky” has been translated to “Voy a tener suerte,” which literally says, “I will have luck,” or as one would colloquially read it, “I’m gonna get lucky.” I don’t think Google has that much control over everyone quite yet…hehe)

Then I thought, “I wonder if I’m not seeing it because it knows my IP is in Mexico?” I then VPN into UH (becoming a local node on the campus network via a secure connection, so although physically here, I’m virtually “in Houston”), and voila:

How’s about them apples? Google intentionally doesn’t display the cool art for anything other than people in the USA, even if they go to the USA Google address. Party poopers.

(More on the background of Google’s artwork here)

A 43-year-old man with no significant medical history presents to his primary care provider (PCP) complaining of a “wound that won’t get better” on the left side of his neck. He states that the wound has been slowly growing over the past 2 years after it first appeared as a small pimple. In his efforts to heal the wound, he has used a variety of over-the-counter topical remedies such as hydrogen peroxide and triple antibiotic ointment; however, the wound has continued to spread and worsen. He was finally encouraged to visit his PCP when his brother noticed the now several-centimeters-long lesion (Images to follow). The patient denies having weight loss, fevers, or chills. He has not traveled during the past 5 years.

On physical examination, the patient is somewhat overweight. His vital signs are normal except for a blood pressure of 165/93 mm Hg. The patient has a 10-cm ulcer at the collar line on the left side of his neck. A homemade dressing that the patient had placed on this lesion contains a small amount of serosanguineous fluid. No lymphadenopathy and no masses are noted around the neck or in the armpits.The rest of the physical examination findings are unremarkable, except for numerous small hyperpigmented macules on the patient’s chest and back.

What is the most likely diagnosis, and what is the diagnostic test of choice?

Now go here to see the images and the dx (warning: wound images for the non-medical readers).

His brother says, “Dude, I think you need to see a doctor about that.” Gee, ya think?!? How can this guy go two years with that thing on his neck? Remember, this thing started as a “small pimple.” At what point, packing it with 4×4s, does one finally say, “You know, this pimple might not just go away.”??? You’d think the 75L of hydrogen peroxide he’d bought over two years would have at least kept it from getting, you know, “icky.” At least the triple antibiotic ointment kept the granulated tissue nice and moist.

These are the kind of patients that walk out of the room saying stupid shit like, “You see?! That’s why I don’t go to doctors; they don’t give you nuthin’ but bad news. They just want your money. Plastic surgeon, my ass! Although a boob lift might make me look younger…hmmmm…”

I think 90% of what my personalized report says is very much on the mark. I don’t post all the little web quizzes you see everywhere because most of them are trash, but this one was very innovative using graphical response techniques, so I thought it should get special mention. It allows for a literal sliding scale to the answers, making the response process more natural and intuitive, which in the end, makes the test more reliable because the person taking it has less of a chance to “overthink” the answer.

Check it out!

But seriously, I have enjoyed YouTube ever since it came out, but like most people, only to watch little ditties people forward me and get a good laugh. I had no idea that there were soap operas and all sorts of things broadcast via people’s webcams–like I care about the dating life of some chick who’s known only as “T1f4nny.” Please. However, I discovered a phenomenal thing that has been sucking up all my time recently–vintage classical music videos and other rare performances. (yes, this is where you guffaw mercilessly at my geekiness) I’m talking rare footage from the 50s or 60s of Sviatoslav Richter, Emil Gilels, or David Oistrakh not previously seen outside the (then) Soviet Union or, on the other side of the spectrum, pristine (as much as YouTube can handle) footage from a live concert in Japan last year of Arcadi Volodos from someone’s camcorder. 99% of you have no idea who these people are, and that’s OK–trust me when I tell you that these are giants of their respective instruments (and yes, they are all Russian, but that’s usually the way I roll, musically).

To see what I mean, go here to watch a clip of Volodos from somebody’s frickin’ living room for crying out loud, playing Mendelssohn’s “Wedding March” from A Midsummer Nights’ Dream (arranged by Vladimir Horowitz and Volodos). All those words will mean nothing once you hear the first few notes, but please keep watching at least past 1:20 because that’s when the fireworks start. Now what kind of chance would I ever have had to see Arcadi Volodos in the first place much less be privvy to a private performance?! Thank you Internet, thank you YouTube.

As for MySpace, up until a few weeks ago, all I knew of it was “where the kids hang out online” and that it was always associated with various pedophile scandals since, obviously, that’s where the “kids” hang out. After hearing enough comments from some people in class about what they read, I finally logged in expecting to see nothing but teenage crap. Oh. My. God. 1/4 of the planet has a profile on MySpace, and now I do too (which is pretty irrelevant considering I never go there, but you need to create one to see much of anything). I think perhaps HALF of my medical school class actively maintain their MySpace profile, and within a week of signing up, I got a random email from a person who went to my high school asking if I remembered him (I didn’t). I had no idea so many “older” folks actively frequent MySpace. I have enough problems keeping up with blogging and emailing, so I’ll leave the MySpace to others, but from what time I did spend on there, it was obvious it had complete “black hole” status, following so-and-so’s friends, comments, etc. It’s similar to blogging in a kind of LiveJournal or Blogger way in it is a pre-built community, but SOOO much deeper and bigger. And far more hideous. I swear people’s MySpace profiles look like a scary glimpse into a schizophrenic mind.

As much as finding/following profiles of pathetic pop star wannabes on MySpace is loads of fun, I’ll stick with YouTube.

Bling H2O [note the inconsistency of the logotype presentation] is the inspiration of Kevin G. Boyd, Hollywood writer-producer. While working on various studio lots where image is of the utmost importance he noticed that you could tell a lot about a person by the bottled water they carried. [I suppose my Kirkland H₂O would label be as a janitor.]

[Bling's] mission was to offer a product with an exquisite face to match exquisite taste. The product is strategically positioned to target the expanding super-luxury consumer market. Initially introduced to hand-selected athletes and actors, Bling H2O is now excitedly expanding it’s availability… Bling h₂O is pop-culture in a bottle. But it’s not for everyone, just those that Bling.

Bling H2O comes in Limited Edition, corked, 750ml, recyclable frosted glass bottles, exquisitely handcrafted with Swarovski Crystals.

This stuff costs $35 a bottle, $420 for a case of 12 (no savings for you!). For water. The same stuff that falls freely from the sky.

I am imagining the genius of Mr. Boyd, as his little minimum wage army armed with glue guns, dab cheap-ass Swarovski knock-off crystals onto these frosted bottles before filling them with water from the hose outside his LA house. Apparently Paris Hilton uses these to give to her dog, Tinkerbell. That’s about all you need to know.

You see, this kind of ridiculous excess is why people from impoverished, oppresed 3rd-world nations see the United States and hate us so much. But it’s ok: we have good will messengers like Madonna, who will adopt/steal their children one at a time.

(what does this have to do with medicine and/or Mexico? absof-inglutely nothing. I’m just procrastinating studying for a pharmacology exam. )

But perhaps even more important is that medical student blogs are useful for students themselves. It’s therapeutic to record your feelings, to vent frustrations, and to register difficult experiences. This is the kind of activity that makes for a sensitive and caring doctor — probably the kind of doctor that most beginning students expect to be but forget about somewhere along the line. Blogging can help students remember. It’s also instructive because it allows us to chart our progress through the years. On those bleak days of surgery clerkship, it may be encouraging to look back and see how far you’ve come since the first squeamish posts about anatomy lab.

Finally, blogging can create opportunities and open up frontiers. Beyond the simple scenarios that have helped me — such as getting the inside scoop on hospitals during residency interview season — getting involved with the nascent medical blogosphere can help you sift through the Web’s educational resources (such as a collection of clinical cases and archived school lectures). It also can inspire student activism or show you what life is like in foreign med schools. Blogging might even open up doors into research.

That “foreign med schools” pseudo-link you see there would have had you arrive here, but it’s live on the real article, so thanks Dr. Nick for the link! Also, thanks for a great article. The “therapeutic” value of blogging is pretty obvious, especially for med students, professionals, or anyone else in a demanding, stressful field, but the more insightful commentary is about the connections one makes. Speaking personally, I have joined a community of medbloggers that I truly feel give far more to me than I give to them, and through them I learn about so many things every day. As students, it’s important to put down the textbooks for a while and soak in knowledge and experience directly at face value, not as merely the sum of a collection of finite, discrete processes. The sum of the parts is sometimes less than the whole. Every blogger represented in my sidebar and many others I have yet to discover has his/her own unique story to tell, and through them, I am enriched beyond my own experiences.

The First Baptist Church dismissed Mary Lambert on August 9 with a letter explaining that the church had adopted an interpretation that prohibits women from teaching men. She had taught there for 54 years.

The letter quoted the first epistle to Timothy: “I do not permit a woman to teach or to have authority over a man; she must be silent.”

In a rare show of egalitarian sensitivity, Rev. LaBouf did concede that a woman can fulfill whatever responsibility she desires, but “outside the church.” Perhaps he said these things because, irony of ironies, the good reverend’s boss in the city government is a woman.

Every city council meeting, Rev. Neanderthal must be wishing he could say things like “Fie thee, Whore of Babylon! Speak not with thy forked tongue, lest the wrath of the Almighty smite thee asunder!” but he probably slinks back in his chair like the sad, cowardly man that he is when he’s not behind the pulpit.

However, I found this odd:

In general, the study found, mothers who scored above this threshold reported less interaction with their babies — reading to them or playing games less often than non-depressed mothers did. [...] Depressed fathers reported less play with their infants as well. And women whose husbands were depressed read to their baby less often than other mothers did — pointing to the potential effects a spouse’s depression can have on the other parent.

Ok, I’m convinced my child’s mental capacity will exceed mine; she’s already showing certain development well outpacing where she should be on paper at the moment. But even my daughter’s preparation for world domination does not include the ability to comprehend or otherwise benefit from story reading at 11 weeks. I play and talk to her all the time, but break out a children’s book and read? I think that’s a bit much, but then again, what do I know…peds sure isn’t my area.

To see this and then think of all the stir and controversy and conspiracy theories about Landis’ alleged testosterone doping makes one feel even more cheated. This is what sport, what courage, what heart is all about. I’ll pay to see these two race if they’re the last ones to come in before I’d give a nickel for most athletes out there. Inspiring.

Does a company really need to advertise in such a way? I’m reading about laser-assisted local anesthesia–trés cool, cutting edge–so the intrusion of a gaping venous stasis ulcer (in a banner ad, no less) is not quite what I was prepared for. Oh well. At least there weren’t any maggots…