FreeMD.com’s Free Medical Horoscope

Dr. Val Jones at Revolution Health yesterday wrote a scathing review of freeMD.com, a site that offers to triage a person (for free!) and determine if they need to see a doctor. Our conversation actually started on Twitter where I read that last part to mean, “alerts you to seek medical attention.” I had reviewed a site like freeMD.com about 6 months ago and thought I’d already seen it (I can’t find the URL for the site I thought it was, but it was vastly different, focusing more on disease education than decision-making). I played devil’s advocate for Dr. Val’s test case, a female with abdominal pain (read her post for details), by saying that using a tool like freeMD could very well be a good thing, causing someone to seek medical attention for a condition they’d not thought of (ectopic pregnancy) that could very well warrant medical attention. She has since made some more comments, all extremely critical, and I thought I should finally go and see what the hubbub was about.

The first thing that struck me (apart from the realization that it was a different website than I thought) was the founder of the site, Dr. Schueler, in a video stating, “I’ll help you decide if you need to see a doctor and why.” Already, my alarm bells are blaring. We’re not even talking about a physician encounter via IM, email or other faceless medium–we’re actually talking about a disembodied algorithm given the look and feel of a doctor “there for you.” The whole thing makes every attempt, down to the good doctor reading the text questions in a video (marketed as “Breakthrough technology”) to give you the false security that a real doctor is guiding your care. To make matters more slimy, the footer of the website has the following disclaimer:

freeMD is provided for information purposes only and should not be used as a substitute for evaluation and treatment by a physician. Please review our terms of use.

Why doesn’t Dr. Schueler speak THOSE words just as clearly as “I’ll help you decide…?” Perhaps because the whole incongruous nature of the site, the entire clashing dichotomy is that FreeMD markets itself to be a unique service in healthcare yet disavows itself of the veracity of its own advice.

The Happy Hospitalist did his own mock patient for this site, and it was a doozy. Happy and others are intelligent, experienced physicians who can come up with all sorts of clever zebras to outwit the system. I’m just a med student unable to draw from a well of complicated experiences; nevertheless, I find this approach pointless. Happy’s mock 70-year-old pt in ARF is unlikely to be at home clicking on a website, as would anybody worthy of being in an ICU, volume depleted, electrolyte deranged, in respiratory distress, etc. FreeMD is obviously for 1) a younger, presumably ambulatory crowd, 2) people who would already go to the Internet to research their problem in the first place. I fit that bill, so I put it through its paces. My findings after a few rounds:

• Questions are often “yes” or “no” with no ability to say “I don’t know” when that lack of knowledge is significant. Asking a woman “are you pregnant” or “did you miss your last period” when they are irregular in the first place (and without asking if they are regular) is such an example.
• Questions such as “Do you use cocaine (yes/no)” can be replied “no” when the person uses meth or any other number of stimulant drugs that would elicit similar results.
• As in the above, questions don’t go from general to specific as a normal H&P would proceed but pulled out heuristically from a database of questions at random levels of specificity. Had I been asked if I used illicit drugs first, I could then be asked which ones, or “no” would skip the whole hierarchy.
• Most egregiously, in no example was I ever asked about prescribed, pharmaceutical drugs. How can this thing triage anybody without taking to account the medications they are on? Give me a break. This is a dealbreaker in the first degree.
• A severe headache that’s described as the “worst I’ve experienced” is immediately shortcut to the end of the interview with a possible subarachnoid hemorrhage. Whoah! While I applaud the good doc for not letting a serious one like this fall through the cracks, no question of hypertension, trauma, or other medical history had been made yet. I even said the headache did not come on suddenly (and how “sudden” is that? one day? one hour?). And shockingly, no attempt to quantify pain (“worst experienced”) seems to be a real oversight for an EM physician where pain control is at the forefront of almost any triage.

OK, like I said, I’m just a med student. I’m not trying to outwit the system, yet even I can see how this thing needs serious work. It smacks of a tool that could do some good someday (yes, I see the “beta” in the upper right corner) but is a hammer looking for a nail at best, and irresponsible at worst. While writing this, I saw that Dr. Schueler responded on Dr. Val’s site and said that this tool is not attempting to arrive at a true diagnosis and while far from being perfect, it’s much better than an uncontrolled search of the internet at large. I say that for a large portion of the population, this is probably true. But again, one of the biggest offenses this site makes is an unmistakeable intent to make the patient feel like they were evaluated more thoroughly because a doctor in a white coat is “talking” to them. Take away the touchy-feely schtick and my respect for a tool being transparent about what it offers jumps up several notches. Add to that the glaring holes in logic–clinical and heuristic–that even I can see on first blush, and I’d ratchet back the “breakthrough” rhetoric in a serious way.

I haven’t been as fire-breathing as Dr. Val mostly because I want a site like this to have a place–a proper place–in the ability of patients to have an informed choice. Too many people use the Interwebs and find tripe from the likes of Kevin Trudeau, Reiki shamans, and other snake-oil scammers. At least this is based on some real protocols/algorithms used in medicine. The difference is that those same algorithms in a real clinical setting are never removed from the human element wielding them with clinical judgment. The marketed need of a physician connection is something that needs to be filled by primary care. They should be the ones an unsure patient calls, receiving the expertise of a “live” doctor that knows their history and medications to say, “Come in right away,” “Go to the ER,” or “Come see me about this in the next few days.” I’m sure I’m being naive about this point as a student not able to take into account all the financial issues of this, but Dr. Schueler sure isn’t doing this for complete altruism, so I can’t be completely wrong. Leave a comment telling me what you think.

(P.S. I commented on Happy’s post above wondering if Dr. Schueler would trust his system to triage his wife/mother or other loved ones exclusively. That certainly would cut to the meat of the marketing matter.)

Testing Flickr from ecto

Went out to a park the other day to shoot some wildlife. Uploaded a pic to Flickr, and now I’m seeing how it embeds in the blog. Heeeeere goes:

I could delete this if it works, but I should probably leave it up just ’cause. There aren’t any other pics in my photostream yet, but that will change soon.

Ok, onto the next post…

(Update: Ugh…how do I get the text NOT to float on the right? Small potatoes for now…how do I get the pic to specifically link to the “Large” version on Flickr? Perhaps that’s a blogging software limitation. I’ll try it by hand. And why am I typing “out loud” for testing purposes? Probably to show that even though I may not post every week day, I still think about it. )

EM Blogger “Hate”: Nature or Nurture?

Sid Schwab posted an entry the other day about EM blogs (I’m including nurses in what I write here) and their penchant for not only being right-of-center politically, but “vitriolic.” I want to say off the bat that I’m not here to defend his remarks point-by-point, but what he said about his post not being directed at any one blogger in particular and specifically that it was written months ago is absolutely true. In fact, he shared the draft with me in November of last year. The draft then is very close to the post of the other day, down to the same witty ending. In that sense, what is written really is representative of how he feels, not some knee-jerk rant.

But why did he share the draft in the first place? Because I said that I was going to post about that very topic because I had come to many of the same conclusions independently. I’m unapologetically liberal on most issues, but I keep an open mind and try not to let the occasional offhand remark about “lefties” keep me away from an otherwise informative or entertaining blog. Unfortunately, there are some sites that I just can’t read because of in-your-face right-wing screed brought up with no provocation, or commentary that is so ill-informed, it begs the question if the poster has MPD to also be a healthcare provider with [assumedly] a necessary component of humility and compassion. When I took stock of the sites that fit that category as I was trimming my newsreader’s feeds, I came to an inescapable conclusion: almost all of them were EM blogs.

EM has been corrupted by being made into the PCP of the disenfranchised and uneducated, as well as the pressure valve for inpatient floor inefficiency as admitted patients crowd the ED, further straining things. I get it. I was a volunteer at Ben Taub Hospital in Houston for over a year, primarily acting as an unofficial Spanish translator. Ben Taub is a model of your classic, inner-city urban hospital. Analogies would be Parkland in Dallas or King in LA. Houston, being the 4th largest city in the US and given its demographic, the ER population was primarily Black and Latino, both seemingly unable to speak decent English. I’m not going to pretend that my experience means a damn by comparison, but I wanted to make clear that I’m not talking out of my ass here.

I give the benefit of the doubt to any blogger of any kind when ranting that this the blowing off of steam is not representative of the patient care, that the “dumbass welfare mother” did not get treated at 30% of the care as the “private insurance patient.” But when blowing off steam or generalizing various patient populations is a near-daily occurrence (so much so in one example of a nurse blogger that ™ed the phrase “Medicaid Mentality,” as if it took much mental muscle to come up with it), ultimately I see it as a sad state of the person that wrote it. Just as it’s the height of stupidity to tell a cop, “My tax dollars pay your salary…” it’s just as stupid and self-important to say, “My tax dollars paid for that Mexican’s CT scan.” You don’t make enough to make a difference in anybody’s hospital bill as you aren’t that important. Abuses will occur in any system, and to the best of the ability of those responsible, it should be reported and dealt with. But the cost of tracking down every thug who has some drug money stashed away who might just be on Medicaid is ridiculous (watch your tax dollars go away even faster with the new Medicaid Police Enforcement Unit!). The fact that they come into your ER wearing far more jewelry than you’ve deemed appropriate for your label of what their economic/Medicaid status should be is irrelevant at best, pompously arrogant at worst.

On the subject of labels, “liberal” is used as a mild pejorative by those on the right, with “pinko,” “tree hugger,” “moonbat,” “terrorist sympathizer,” and many other colorful words to use for stronger effect. What words are used to describe those on the right? “Conservative” is simply a proper term (except this administration is anything but; real conservatives despise the “neocons” just as much as we do). “Fascist,” perhaps, but there’s a lot in between. You see, therein lies a big difference: there isn’t nearly the same screedy list to choose from because collectively, we try not to be that way. Everyone is guilty of generalizing to a degree as a necessary evil, but profane name-calling and deriding those who are “too stupid to go to their PCP/OBGYN” is not a staple of most any medical blogs outside of the EM ones. For the blogs that are offenders here, the tone of “I’m better than you” (you = patient/family, boss, administration, co-workers) is unmistakeable.

There are very polarizing issues in health care, such as is healthcare seen fundamentally as a right or a privilege? How much should the economics of medicine be market based vs. government regulated? There are no easy answers to these questions, yet too many simply state their simplistic opinion and accept no other. I don’t care if someone’s on the wrong side on an issue from my POV, but a well-stated argument–however ill-informed I think it to be–deserves respect. Too many right-wing bloggers don’t even bother…not they they owe me or anyone else an explanation, but at the same time some of these are the same that jump on others’ sites sniping their tired rhetoric there as well.

When I saw the comments to Sid’s post both on his site and others, it struck me how some didn’t even read it properly; the answer to their question was right in front of them had they simply turned off their prepackaged assumptions. Worse still, some clearly read it by quoting and commenting and STILL overlooked the obvious. It occured to me at that point that Sid’s post acted sort of like a political Rorschach test–in reading it, one would see what one wants, perhaps a reflection of oneself.

Lastly, a modest request to the right-wing EM bloggers that can’t help but make commentary on sociopolitical issues of their less fortunate patients: when there is a positive story (and there are, don’t lie), share it and don’t ruin it with a caustic comment about this or that. Write about a surprisingly positive encounter for what it is. It’s not right to have a situation where your assumptions were turned upside down, proved dead wrong, only to mentally chalk it up as an anomaly. No one here is so naive as to think that there isn’t a definite pattern among certain patient populations, but the exceptions are far more interesting than the rule. Share them.

(Update 6/26/08: The SCOTUS just ruled the DC handgun ban unconstitutional. Believe it or not, I agree with the majority and Scalia’s written opinion that any complete ban that prevents law-abiding citizens from protecting their home is against the spirit of the 2nd amendment. I’m from Texas, after all. Just another example of how none of us are 100% anything politically)

Updates, Bags, and Social Networks

Blog Updates:
I’m happy to report all is well. The blog software is updated, making room for all the “current” plug-ins, themes, etc. and most importantly, the security fixes applied so that I don’t get h4×0r5 hijacking the site to something hideous and embarrassing like an online yarn shop. I’d never live that one down. Regarding the slick black theme: yes, it’s understated, and surprisingly, yes, it’s pretty much done. I downloaded it of course, because I can’t create much of anything, but I can always edit and tweak. (which I need to do because I want my links underlined and my blogroll subcategorized) However, I really like the minimal, clean look. Maybe in a month or two I’ll think to add a graphic here and there, but the day you see a flash ad at the top (for yarn and fabric!) is the day you know for sure I’ve been abducted. Thanks Vijay and TinyShrink MD (heh) for the shout outs.

Bags:
As I wrote on Twitter the other day, I have a serious thing for bags. I am, in fact, completely indistinguishable from a woman shopping for purses with the level of scrutiny that I investigate pockets, seams, zippers and compartments. However, the presence of my Y chromosome does mean that I must depart somewhat from my inner female in that looks and it matching anything else I have are nearly irrelevant. I don’t care if the bag looks like a freak accident that escaped the Coach genetic testing labs–I care about function,form, and feel, ONLY and in that order.

So my brother was here last week, and I saw a bag he had that I don’t recall his having this last Christmas. I asked what it was, and he said “Weren’t you the one that told me about this?” Disgustedly, I gave a look like, “You fool! Do you think I’d forget something like this?!?” as I pawed The Precious.

Here is the object of my desire. It’s different from my brother’s, but our gear needs are different. Yes I know the orange isn’t the most aesthetically pleasing color, but just look at that removable DSLR camera bag attachment. Yes, I know the whole “snake” theme is a bit odd, but that’s some sexy stuff. YeSSSSS!

Obviously, I’m not getting this anytime soon, but my current eBags laptop backback is not doing too well (in fact, it’s nearly unrecognizable from the online pictures). It’s also surprisingly heavy all by itself–something I found recently as I emptied it to have it be managed by Claudia when I was last in the hospital. “Honey, I need this because, like, you know, the next time I might be in the the hospital–what? yes, I know the doctor said all would be fine, but you never know…ok!–I’m just saying, the next time, if I have this, it won’t be as heavy for you when you have to manage it,” just isn’t very convincing. I’ll work on it.

Social Networking:
In my previous life, I was a senior-level IT person/consultant. It should come as no surprise, then, that when faced with a “SIGN UP NOW” email from a relative, friend, or annoying co-worker–it matters not–in order to see their pictures or whatever online with some proprietary service, I normally would hit “delete” without a second thought (and might even be annoyed that thanks to them, they at least have my email address). Why on earth would I want to give away my information to a business that I have nothing to do with who, upon trying to make ends meet, will be like so many others and whore their user data to the highest bidder, maybe even sinking so low as to start putting up yarn ads. (If you got that reference, you’ve read this all the way through and I thank you from the bottom of my ad-less heart)

Maybe it’s the sweltering Texas summer heat, maybe it’s having some burnable time on my hands, but I seem to be trying out new services sites like it’s going out of style. Normally meticulously recorded in SplashID on my Blackberry (encrypted of course), I have yet to keep up with all the usernames/sites I’m registering. It’s like I have Daddy’s credit card and going on a registration/shopping spree and don’t care about amounts or receipts, wadding them up and throwing them on the floor as I search the next target. There’s a ton of redundancy and overlap in these things, and I think I’ve reached the limit of what I’m willing to try. I think with each useful service, there is a “best of breed” product; that’s the one I’ll sign up with.

And what it is with the lack of vowels in these names? Flickr. Stumblr. Feedlr. Tumblr. Mastrbatr. I gotta pull back before some 21-year-old CIO in the Bay Area tweets to his other entrepreneur buddies and with all their collective information figures out the exact position of all the constellations at the time of my birth. On their iPhones.

(Medical stuff–personal and news/commentary–coming in a jiffy, I promise!)

Blog updates

Tonight I plan to upgrade this site to Wordpress 2.5.x. I’ll also be applying a new theme, though I’m not 100% sure which one it will be. I can say, however, that it will NOT be a completed task anytime soon. I’m not a web designer and I don’t want to waste time making things purty. I care more about functionality and such and will be adding a few new plugins as well. So, if there are a few glitches y’all notice over the next 24-48h or so, please PLEASE let me know. Letting me know what you think of the new semi-temporary look and feel as well would make me verrry happy.

I may yet continue as a Mexican medical student at another school, so I haven’t given up the domain yet, but it’s time for some serious housecleaning around here. If your blog is not on my sidebar and we’ve commented/emailed in the past, let me know–it’s just on oversight on my part. OK, time for me to start scrubbin’!

Pendejos at Pemex

I just saw what is perhaps the stupidest thing I’ve read in a long time. Apparently, many people from SoCal are driving to Tijuana to fill up their vehicles because of the cheaper, Mexican-government-subsidized Pemex (Petróleos Mexicanos) gasoline. Since the government controls the gasoline, Mexicans do not feel the week-to-week spikes driven by speculators and doomsayers (that also conveniently coincide with things like Memorial Day weekend) and enjoy a more stable price that’s based on longer-term, “reality-based” data.

The problem is that although it’s cheaper, Pemex gas sucks. It’s dirty and is, in my experience, at least a third less efficient than American gasoline (measured by mileage on what a fillup gets me on either side). It deposits more gunk in the engine, requiring more oil changes (which comes from, you know, OIL) and filter swaps (plastic = OIL) to make things run comparably. Additives like STP gas treatment to help boost fuel efficiency by raising the volatility of the gasoline in the combustion chamber (organic liquid = OIL) are often added by locals at fill-up at additional cost, negating savings. Since it’s less refined, the combustion of Pemex gas is also horrible for the environment, as any traveler who’s experienced the pollution in Mexico’s large cities can attest.

Away from the pump, you’re going to spend upwards of $2-3 each way crossing the border in tolls, and then you’ll have the random-ass inspection coming in on the Mexican side, combined with the all-too-familiar US Customs agent with a hard-on for being the one to catch an al-Qaeda operative coming in as a roofer (who, by the way, is in my trunk as we speak). I guess these people’s time isn’t worth anything.

I think the only way this could POSSIBLY make a difference is if one was filling up a very large tank or several portable tanks to make the crossing/time factor worthwhile, even with the 33% lowering in efficiency if one is saving at least 33% on the cost of the gas. Perhaps for some, like those that drive around town all day looking for that one filling station that has the gas at $3.87 instead of everyone else’s $3.89, it’s all about the satisfaction of proving …. something.

As pump attendants [in Mexico, you don't pump your own gas by law] struggled to keep up with dozens of vehicles lining up for fuel, U.S. and Mexican drivers traded insults. A few even brawled as they waited for hours in searing heat this week in the rough border city of Tijuana.

“I am not budging until I get to the pump. I don’t care what anyone says, I’ve been waiting for two hours,” said Jaime Rosales from Southern California, at a gas station where buses, trucks and cars all vied to get to the pumps.

Talk about asking for an ass-kicking. The article talks about border town violence like it’s everywhere–it’s not. But don’t think for one second you just might be pissing off the wrong person. In Mexico, the American is the foreigner, and too many cross over and think just because the USA is a few miles away that “someone has their back.” Um, no. I hope the gas was worth it for them, because the time it took for the average vehicle owner to go, wait, brawl, wait, fill up, wait and come back, I actually got something done without wasting any gas.

High Definition

One of the things I love to do in my free time is photography and video. I don’t claim to have any special talent for either, but given enough time and footage, I can make something pretty cool video-wise. For our IRS “stimulus check,” (which, thanks to my working last year for those months I earned one) we did our patriotic duty to help piss in the ocean invigorate the economy and bought a high-def camcorder. Given our financial situation, this was a rather extravagant purchase (and I bought it for way cheap as a refurb, so I think I did pretty well) but our 5-year-old camcorder was ailing so badly, I’d rarely break it out; consequently, I missed filming many moments of our little one.

Here’s the funny part: there is no HDTV in any of our family members to be found. Oh sure, the computer monitor can serve that purpose, but who wants to watch a movie on a 20″ monitor? After the firesale we had in Mexico to move back, the only TV we have is this bargain basement 21″ Magnavox which does a shitty job of showing standard definition without problems much less HD. So why bother with HD at all? Simple: futureproofing. I have yet to see my daughter’s 2nd birthday last month in its full HD video glory, but it’s on digital tape (HDV format) whenever that time comes…

…which leads me to another quandary: this whole process has underscored how much I need to upgrade my computer system. Handling HD video is seriously CPU/GPU intensive. The raw video (1920×1080) doesn’t even fit on the computer screen. The disk space requirements are enormous as well: going from HDV->Apple Intermediate Codec will cost almost 75gigs/hr of hard drive space. Ouch. Now I need a RAID array as well, because I sure as hell ain’t going to trust a single drive to be slammed with that much I/O, project after project, and survive for long.

But what a cool camera. In truth, I can record in HD and export in downsampled SD DV like any other tape-based consumer camcorder. The difference is that 1) I have the original footage in HDV format on tape for future re-import, and 2) the image quality is STILL a product of a superior CMOS image sensor and all the functionality the camera provides leveraged to make a much better video product. I’m still learning everything, and I’m scared that the more I learn, the more I discover things like “if I had this kit to use a 35mm lens adapter, imagine what depth of field control I could have!”

I am not a filmmaker, and I have no plans to change careers to become a cinematographer or movie editor. I think I am drawn to this new (and inevitably expensive) hobby because it channels the dormant parts of myself that are creative, that do yearn to create something brand new, or at the very least, transform the ordinary into something special. Just as a picture can be worth a thousand words, a visual story can be worth a thousand pictures.

This should be fun.

Hospitalia: Bowel Run

So at long last, this series continues. We left off with a negative EGD and an extremely low Hgb/HCT that was dropping even within these 48 hours. Well, what’s an eager GI doc to do if an EGD is negative? Of course: the colonoscopy. Aside from the unpleasant idea of having a metal snake going against traffic, I was pretty calm, knowing enough from recent experiences that I wouldn’t know any better.

Even though I’ve never had one, I know a few who have, and I knew that a “bowel prep” was involved. This is a nice term that means being forced to take some substance(s) that make you go to the bathroom so much that nothing is left. Literally. As long as you haven’t eaten recently, the upper GI is empty after a few hours unless you have a problem (eg, stricture), so this prep is unique to the lower GI where visualization would obviously be a problem without it.

I already spoke of the less-than-optimal bedside manner of my GI doc, but he outdid himself this day. The sadistic asshole ordered–and I shit thee not:

• 4 doculace (Colace): This is a mild laxative/stool softener. Harmless enough, but why 4?
• 1 bottle (~10oz) magnesium citrate: This is some nasty stuff. It’s fizzy salt water with a metallic-limestone aftertaste. Alone, this would make most people regret they drank it. Cramps and disomfort are par for the course here.
• 10mg x 3 lactulose: OK, here’s where Dr. Fecophilia has just jumped the shark. This order alone would have at least resulted in some violent events. The problem with lactulose is that gas/cramping is massive. Oh, and I was supposed to have already had mag citrate above. When my dad was in end-stage liver failure before his transplant they’d use this stuff for hepatic encephalopathy; it’s a different mechanism for why but the end result GI-wise is the same. I saw what ONE would do to him; I don’t want to imagine 3. Ah, but the best is yet to come…
• 1 gallon Golytely: Perhaps the most ridiculously inappopriately-named product in medicine, one does not “go lightly” at all. No, one does not go gentle–one rages, rages against the power of the ‘lyte. This stuff also has a relative called “NuLitely,” probably because one says, “Nooo! Nooo!” after knowing what it is. It’s not enough you are drinking a laxative in the first place; you are essentially chasing it with a gallon of water. Oh, and you can’t nurse this stuff over hours since the water would be gradually absorbed in the small intestine, enter circulation, and would eventually be peed out instead. No, this stuff has to be imbibed as if one were a pledge at a frat party, slamming one small glass after the other without mercy. This is often used all by itself for surgical bowel preps. What I did to this sadistic bastard to make him use this in concert with the others in his terrible arse-anal is beyond me.

To make this long story short, I refused the Doculace and the lactulose. I had been on a combination of clear liquids and NPO for over 48 hours; this was overkill on a normal day, much less when lime Jell-O was the closest thing to solid food I’d had. The next morning in the GI lab, the doctor came by and asked why I “refused his orders.” I said I thought it was overkill and that I promised I was adequately prepped on what I took. He then lectured me patronizingly on the need to follow directions but stopped short of cancelling the study (as if I’d let that happen w/o a fight).

The actual in-room experience was even more pleasant this time than the EGD: no foul throat spray, no mouthpiece/bridle (to keep from biting the scope) being fitted, just lying on my side when all of a sudden I was sleepy, then I was in the recovery area. That propofol is some dreamy stuff.

[Un]fortunately, the colonoscopy was negative, no signs of bleeding, polyps, erosions, or anything suspicious. Now what?!

Well, that’s for the next post.

Like last time, here are some more tidbits to share:

• I wanted to know all the values of my bloodwork, so I asked to see my chart rather than nickel-and-diming the nurses for individual values (which is all they’d be willing to do). I had to sign a release form authorizing myself to view my chart. My signature had to be witnessed that it was indeed me signing it. For me. And I had to fill in exactly what I would “allow” myself to access (labs only, h/p, etc.) Does this not strike anyone as the height of the absurd? I’d understand if I had to sign something putting a request in writing to appease the hypermeticulous records people, but an authorization?
• Said chart review had to take place with a chaperone. I can understand this–not everyone has a “big picture” view of this document’s importance, and some malcontent nutzoid could have bad intentions. I had 30 minutes with which I could view what I wanted (or what I “allowed” myself earlier, heh), and while I knew someone from cubicle-land would be there, I didn’t expect the Eye of Mordor watching me, just standing there, making sure I didn’t harm The Precious. Never a word, always watching. I would have liked to have browsed more at leisure, but I think it was the whole point was to be made to feel like a voyeur to your own data.
• Nurse: “So they tell me you’re studying to be a doctor.” Me: “Yes, that’s true.” Nurse: “So what’s your major?”
• What’s with medical staff of all varieties barging into the room while knocking?! If you’re going to invade my room space, as is the right of you to do since this is a hospital and not a hotel, don’t make it seem like you’re “respecting” my privacy when you’re fully in the room, door wide open to the hall on the second knock as I’m walking from the bathroom with my gown open. Knock, wait a second or so (at least don’t open the door fully to the hallway), or don’t bother.
• If techs want to wear white coats and stethoscopes (which, as in respiratory techs can be totally part of the job), receptionists want to wear scrubs when they see no patients, and doctors can wear whatever they want, please don’t blame the poor patient not knowing who is who. I made the mistake of thinking my new, un-introduced nurse was a radiology tech and you think I called her mother a slut. (“Did you hear what he said?!”) Hospitals need to impose some basic standards to avoid confusion, and common sense dictates that unless you work in a peds clinic, My Little Pony scrubs will not foster respect or that one is in good hands by any adult patient still conscious.

Next installment: the even longer metal snakes these GI docs have waiting in black suitcases, [un]informed consent, and the past that comes back to haunt you.

Ping

Just a ping (“One ping please, Vasili?”) to let everyone know that I’m clawing my way back into the blogosphere. I just fired up my newsreader and counted the thousands of posts since I last ran it over a month ago. SHOCKING! Most friends had 20-30 posts, and not a small few had quite a few more than that. I am so ashamed.

So, given the above, I’m sorry to admit to my peeps that even though I’d like to, I almost certainly won’t get to read all of your posts. If your magnum opus was much before last week or so, chances are I won’t see it unless you tell me.

As for me, well, I’m doing better in some ways and worse in others, all to be shared soon. I know, you’ve heard that before, but this time, I’m motivated by something coming up in my ongoing personal medical drama in a couple of weeks for which I’d like the site to be current. That aside, I genuinely am motivated to write again for its own sake. I think I had to step away for a bit (part voluntary, part forced) to appreciate what I have here, namely, the friends and associations I’ve made online and the support I’ve received publicly and privately.

Lastly, after having been egged on somewhat by Dr. A. and Vijay, I am trying to get over myself to start audio and/or video blogging. I’m 100% ready to go, except every time I record something, and especially for video, I see it, I shy away and trash it instead of posting it. So why the conflict? Well, put simply, “blogging” in this way is SOOOOO much easier. A long post that is edited, re-edited, etc. can be simply dictated/filmed naturally. Sometimes typing is a chore, and I can’t seem to shut off the “edit” filter with the written word; since we’re not talking Hollywood special effects here, I just don’t feel the need to over-edit for A/V media. So if this seems even remotely interesting to you, please leave me a comment telling me what you think so I can stop second-guessing myself and put it out there once and for all. If tomatoes get thrown my way, I’ll just make a marinara.

P.S. You can also follow me on Twitter (when it’s up–don’t get me started on that…), since of course it’s far easier to update goings-on there.