Is Physical Examination Useless?

There has been a lot of discussion in the medical blogs recently about the usefulness (or lack) of physical examination.

I personally think that physical exam is very important but when "the HMOs force physicians to care for a maximum number of patients, in a minimum number of minutes for the lowest number of dollars" something has to give...

One of the comments on KevinMD says that clearly: "Why do I have the feeling this guy never had to see 40 patients a day at 15-minutes per encounter... I bet his physical exams would leave a lot to be desired at that rate."

Anyway, if you want to refresh your skills, you can review this large collection of free physical examination videos organized by body system.

Update 3/23/2007:

Dr. Wes comments on "Procedural Darwinism":

Take the stethoscope, for instance. It is rapidly succumbing to Procedural Darwinism. If it weren’t for the stethoscopes ability to hear breath sounds, it would have been extinct long ago. The echocardiogram is far superior to “hear” heart sounds, and adds procedural survival protection by providing additional size, structure, and functional information regarding the heart with little pain or toxicity to the patient. The echo also reimburses well.

Further reading:

Hyposkillia. Deficiency of Clinical Skills. Herbert L. Fred, MD, MACP. Tex Heart Inst J. 2005; 32(3): 255–257.
Comments about deficiency of clinical skills. Retired doc's thoughts.
Declining clinical skills. Notes from Dr. RW.
An old-timer bemoans the demise of the physical exam, or hyposkillia. KevinMD.
The Danger of Being "Too Fast"
In defense of clinical skills. Notes from Dr. RW.
What does the evidence say about clinical skills? Notes from Dr. RW.
Time, Now, to Recover the Fun in the Physical Examination Rather Than Abandon It. Arch Intern Med. 2006;166:603-604.
Imagine: Physical Exam Can Save Lives. Dr. Wes, 08/2007.
The Physical Exam Can Be Pretty Important, Part 2. Dr. Val and The Voice of Reason, 03/2008.
Mourning the loss of basic clinical skills. Notes from Dr. RW, 2009.

Updated: 09/09/2009

"Super Glue" Can Be Used Instead of Sutures

Dermabond is a Medical "Super Glue"

Dermabond® is the only FDA-approved and commercially available adhesive for wound repair in the US.

The American Family Physician has a good review on Using Tissue Adhesive for Wound Repair: A Practical Guide to Dermabond (3/2000).

The commercial website for Dermabond has patient information but not much on, for example, how you can remove the glue.

Medgadget writes that many people still do not know about the super-glue: "Dermabond is not new. It's been around for a decade. And it makes sutures so 19-th century."

For a professional review of indications and contraindications to Dermabond, please read the American Family Physician article above (free full text).


Over-the-counter Super Glue

Band-Aid® Liquid Bandage is an over-the-counter product based on the same glue (cyanoacrylate) that is in Dermabond. If you have an wound which needs stiches or Dermabond, you have to go to ER. By contrast, Liquid Bandage, which works fine for small wounds and cuts, is available at Walmart.


How is Liquid Bandage different from Dermabond?

Liquid Bandage has lower tensile strength than Dermabond. "If you place the material between your thumb and finger and hold it for 2 minutes you will still be able to pull your fingers apart. This is not possible with Dermabond." (Source: BandAid.com)


References:

Using Tissue Adhesive for Wound Repair: A Practical Guide to Dermabond. AFP 3/2000.
Liquid Bandage
Cyanoacrylate from Wikipedia, the free encyclopedia

In the News

iPod Will Limit Volume to Protect Ears

New iPod software lets you limit volume reports USA Today. Parents can set a limit on their child's iPod and lock it with a code.

This doesn't help at all Microsoft CEO Steve Ballmer -- his children do not use Google and do not have iPods. "I brainwashed them", he admits. Is this the way?...


Neurontin Helps Hot Flashes

A Chance Find, and Voilà ! Goodbye, Hot Flashes. Hello, Sleep. NYTimes.


Image source: OpenClipArt.com

Six Tips for Happiness by a Harvard Teacher

6 Tips for Happiness

Tal Ben-Shahar teaches Positive Psychology (PSY1504) or "how to get happy" at Harvard University. He claims that you can be a "learned optimist" too. Just simplify. These are Ben-Shahar's 6 Tips for Happiness:

1. Give yourself permission to be human
2. Happiness lies at the intersection between pleasure and meaning
3. Keep in mind that happiness is mostly dependent on our state of mind, not on our status or the state of our bank account
4. Simplify
5. Remember the mind-body connection
6. Express gratitude

Nothing new. Just remember to simplify -- this is the most important thing -- keep your eyes on the big picture. See the lecture videos on the Positive Psychology website. The PowerPoint files are also available.

MOTORS of Your Life

Studies describe a set of wellbeing practices that are correlated with the feeling of happiness (BMJ, WJM). I tried to summarize them in the mnemonic MOTORS because the pursuit of happiness, in its altruistic sense, can be the motor of your life.

“MOTORS” stands for:

Meaning --> find a meaning in what you do for a living but don't forget to set limits around it
Outlook --> have a positive outlook on life. Be philosophical but also focused on success
Time --> spend quality time with F&F (Family & Friends)
Out of of yuppie values --> don't focus on chasing money or prestige
Religious / spiritual practices
Self care practices, like sports or meditation

All these 6 features are correlated with feeling happier, and some of them even with living longer.

References:
Finding Happiness in a Harvard Classroom. NPR.
Harvard's crowded course to happiness. 'Positive psychology' draws students in droves. The Boston Globe.
How to get happy. Lifehacker.com.
Four Happiness Tips From Tal Ben-Shahar. FoxNews.
Thinking About Medicine - Your Inner Peace
Radical optimist Rob Brezsny talks about overcoming our cultural addiction to gloom and doom on WPR.org. Download mp3.
You don't have to be happy to do your job well, writes Joe who is the 'world's most popular blogging anesthesiologist'
20 Ways to Get and Stay Happy. Time, 2007.
Image source: OpenClipArt.org, public domain.

Related:
Finding Happiness in PubMed, and Life. Open Medicine Blog, 09/2007.
Happiness. DB’s Medical Rants, 03/2008.

Experienced happiness is largely set by personality, it will temporarily respond to changing circumstances. The Lancet, 2010. http://goo.gl/ot3Kx

We Blog Cartoons: Free Cartoons for Your Blog

Dave Walker is the author of We Blog Cartoons: "You can freely re-use them in your blog. Simply copy and paste the code.

Why are you letting us use your cartoons for free?
The more people that enjoy my work the better and life is generally too short not to give things away."



For better results, subscribe to the RSS feed of We Blog Cartoons.

Medical Blog Closed Down by Request of Employer

Rich Churcher is a pediatric ICU nurse in New Zealand and his blog GeekNurse was telling "the truth about nurses and nursing, for people who thought they knew."

Not anymore, it seems.

"Owing to concerns raised by staff and management, GeekNurse's archive has been removed from public display."

Just a few weeks ago, the blog hosted Grand Rounds (a weekly summary of the best posts in the medical blogosphere) and was featured on Medscape.

This development is unfortunate, to say the least.

In today's world, it makes sense for all employers to have a blogging policy which clearly states what the employees can and cannot write on blogs.

IBM's blogging guidelines are a good start and can be adapted to fit the specific needs of different employers.

KraftyLibrarian questioned recently if any hospitals had blogging policy.

I am not aware of any official blogging policy by a health organization but given the fact that a blog is created every minute, it is about time all hospitals had one.

There is already an example of a doctor who blogs against the hospital he works for. This is aside from the "natural-born ranters", as GruntDocs calls them -- the blog he found is well-written but I'm not sure how the name Fingers And Tubes In Every Orifice sounds to the prospective patients...


Bottom line:

Blogging is good but it would be nice to have some ground rules in this game which is still very new.


Update 3/28/06:

Enoch Choi points out that Geek Nurse's blog is still available in Google cache - "once on the web, always on the web" - at least until the new update of the cache.

For archiving purposes, the 2:25 edition of Grand Rounds is saved on Writely.


References:
Simply Fired - How NOT to Blog About Your Job. Especially If You Are a Doctor
Farewell, Geek Nurse
Doctor's blog takes on Indiana medical establishment. The Courier-Journal, March 6, 2006. Link via KevinMD.
Image source: GrundDoc.com

Interesting Posts in Medical Blogs

How I Spent Last Weekend

Doctor Herbert tells us how he found his medical diploma in his hurricane-ruined New Orleans home.


There are no perfect physicians just as there are no perfect humans

"The word "diagnosis" is simply a fancy word for "opinion.", via Kevin, M.D.


Always believe the patient

BookOfJoe explains why he's glad Jim Balsillie (Chairman of RIM) is not his anesthesiologist. "DON'T BE DEAD RIGHT. Believe the patient." And he gives just one more example of why, in the end, the machines will always let you down.


Creative Suicide Attempt

KidneyNotes describes a patient who injected himself with rattlesnake venom in attempt to kill himself. Source: Southern Medical Journal.


This doctor successfully uses the power of placebo: The Doctor's View: Magic in the ER (Time.com).

Link via Kevin, M.D.


Coding Level-IV Visits Without Fear, Family Practice Management, February 2006.

Link via Kevin, M.D.


Foreign Body in the Bladder

A patient self-inserted an electric wire in his urethra which then became entangled in the bladder. At that point the only way out was through surgery.


10 Best Walking Cities in the U.S.

BookOfJoe has the list and the winner is Portland, Oregon.

AltaVista Founder Dies of a Heart Attack at 42

Heart disease does not affect only middle-aged and elderly people, just review the latest news and you will be convinced:

Paul Flaherty, AltaVista online search engine creator, dies at 42.
The Mercury News, Mar. 24, 2006.

Digg.com has the responses of the fans of the now defunct search engine AltaVista. Do you remember that before Google was launched, AltaVista was the best?

A 38-year old man died of ST-elevation MI.
The Massachusetts Medical Law Report.

There are 20 comments on this case at KevinMD.com/blog.

"Young Women Don't Have Heart Attacks." So Wrong.

Dr Helen survived a heart attack at the age of 37. She discusses her experience and what can be done to prevent coronary artery disease with experts in a Heart Health Podcast.

Young age does not "rule out" coronary artery disease. There may be a genetic predisposition (proven in the case of the famous Russian skater Grinkov, 1996) and we all need to be aware that some young people are at risk.

Further reading:
A Heart-to-Heart with GigaOM Readers: Popular IT blogger Om Malik survived a heart attack at age 41. GigaOM, 01/2008.
Photo of Paul Flaherty, source: Labnol.blogspot.com
Image source: Gray's Anatomy, 1918, public domain.

Related:

Dangers of unrecognized heart disease: Husband dies while giving wife CPR (both found dead, age 60, 59) http://goo.gl/LZ39U

Cocaine FOR Chest Pain

A patient with a history of cocaine abuse, cardiomyopathy with EF 15%, DVT and PE, and noncompliance with Coumadin, is admitted with chest pain and INR 1.0.

Urine toxic screen is positive for cocaine.

Doctor:
"Mr. So-and-so your urine is positive for cocaine."

Patient:
"You know doctor, my chest was hurting so bad that I took some cocaine to help it."

Doctor:
"This cocaine could have killed you. It's really bad for you..."

Patient:
"You know, when they discharged me last week, they gave me some of those Coumadin pills in the Lovenox box. Coumadin... Cocaine... may be I got confused..."

Cocaine FOR chest pain? No comments.

References:
Cocaine chest pain. Emerg Med Clin North Am. 1994 May;12(2):391-6.
Cocaine-associated Chest Pain. How Common Is Myocardial Infarction? Academic Emergency Medicine Volume 7, Number 8 873-877.
Cocaine-Induced CP with High CK - MI or Rhabdomyolysis?
Cocaine from Wikipedia, the free encyclopedia
Note: the story characters may be fictional.

Related:
Pulling Teeth. Fat Doctor, 01/2008.
Hugo Chavez: "I chew coca every day." Gadling, 01/2008.

Updated: 01/26/2008

Google Health in the Works?

Google and Medicine

A ZDNet blog reports the rumor that Google is working on a project called Google Health. Adam Bosworth, a vice president of engineering, is supposedly leading the team to create G-products for the healthcare industry.

It looks like Google folks read Dean Giustini's editorial about Google Medicine in BMJ and decided to give it a try...


Increase the Speed of Innovation

Google Finance was launched today.

Google Health will be be available... this summer?

Eric Schmidt, Google CEO, says the pace of innovation will increase which will lead to the release of many new products this year. I just wish that all new products were as polished as Gmail when it launched... Some of the new Google services, like the RSS Reader, look half-baked.


The Alternative: Windows Everything?

Windows Vista release is postponed once again (until 2007) and this gives Google some breathing room before Microsoft starts another attempt at conquering the information world. Make no mistake about it, the Redmond giant is in the best position to unify all your digital data across all platforms: desktop, PDA, game box and internet. Too bad they somehow don't get this Web 2.0 thing...

References:
Google Health, what is it? Googling Google. ZDNet.
Adam Bosworth from Wikipedia, the free encyclopedia.
Windows: the experience. Torres Talking (Mike Torres is a project manage for MS blog platform, MSN Spaces).
Wikis, blogs and podcasts: a new generation of web-based tools for virtual collaborative clinical practice and education. Boulos MNK, Maramba I, Wheeler S. BMC Med Educ 2006;6:41.

Clinical Skills Videos. A Summary of Free Online Resources

Online Physical Exam Teaching Assistant by the University of Florida College of Medicine
You can watch the videos online or download them to your hard drive.

Physical Exam/Interviewing Modules & Videos by the University of Virginia
The website features streaming videos in QuickTime format.

The UCLA Physical Exam Project
Standard physical exam videos plus tutorials on how to perform a pelvic exam, Pap smear and GC/Chlamydia cultures. Videos cannot be downloaded.

Connecticut Tutorials Physical Examination by the UConn Health Center
Similar to the websites above.

Clinical Skills Online by the St. George's University of London
Videos can also be seen on Palm or Windows Mobile (Pocket PC).

Common Currency Videos by the Dalhousie University
Videos teach procedure skills, called "common currency": peripheral venous access, arterial blood gas sampling, phlebotomy/venous blood sampling, and urinary catheterization. More to be added soon.

There are more useful links for online medical education at the Clinical Skills Education Center of the Queen's University, Belfast. Our website ClinicalCases.org is also listed there.

Update 4/11/2007:
The most updated list is available here: Physical Examination Videos.

Further reading:
Imagine: Physical Exam Can Save Lives. Dr. Wes, 08/2007.
Image source: OpenClipArt.org, public domain.

Updated: 08/07/2007

Medscape Features Interesting Cases - A Case Series for Medical Students

This new case series is presented by Robert Centor, MD, the president-elect of the Society of General Internal Medicine, and the author of the popular blog DB's Medical Rants.

A new case is featured every 2 weeks and medical students are invited to discuss and solve several clinical questions. The series is written by Dr. Centor and medical students or residents at the University of Alabama at Birmingham School of Medicine.

At the end of 2004, we launched the website Clinical Cases and Images - An Online Case-based Curriculum of Clinical Medicine, which received more than quarter million page-views last year. Contributors to the website are physicians and residents at the Cleveland Clinic and the Case Western Reserve University-St. Vincent/St. Lukes residency program.

Congratulations to Medscape on starting their project, which just like ours, aims at bridging the gap between theory and practice. There is often a big difference between what we read in the books and what we see in our clinical practice every day. Somehow, the patients are different from their "standard" disease description in the textbooks. An experienced physician used to say: "his CHF did not read the book..." Case descriptions have a great educational value for medical students, residents, and even for practicing physicians.

Image source:
Hampton Hump in Pulmonary Embolism

Clinical Case: "I swallowed a pen"

24 year old female presents to the ER c/o swallowing a pen two days ago. She has had vomiting and epigastric pain since then. The patient has a long history of similar behavior in the past.


KUB: Overlying the stomach or perhaps within the stomach is a linear lucency measuring approximately 12.5 cm. It has a metal tip.

Another case:


Gastric foreign body (toothbrush) seen on endoscopy.
Image source: Wikipedia, public domain.

Continue reading on ClinicalCases.org.

Statins in Business News

Business journalists monitor very closely the Annual Scientific Session of the American College of Cardiology. Just today, there are 3 reports about new studies claiming that a particular statin is more effective than its rivals:

Pfizer's Lipitor aids kidney in heart disease patients. MarketWatch.

Lipitor at a dose of 80 mg po daily "improved kidney function" in patients with CAD. This is better than Crestor which at its higher dose can adversely affect kidneys.

New use for AstraZeneca cholesterol drug. CNN Money.

In the Asteroid trial, Crestor used at a dose of 40 mg po daily reversed plaque build-up in the arteries of patients with CAD, "the first time a statin has demonstrated regression of atherosclerosis in a major clinical study." Can you REALLY reverse CAD?

Study: Vytorin better than Lipitor. MarketWatch.

In the Vyva study, Vytorin was more effective than Lipitor in lowering LDL levels. No wonder Pfizer's shares are down.

More blog coverage of ACC meeting:

Lipitor Demonstrates Improvement in Kidney Function in Patients With Coronary Heart Disease. KidneyNotes.com.

Plavix, they now say, not only doesn't prevent heart attacks, it might cause them. Medpundit.

Treat CHF with mechanical filter that bypasses the kidneys. Medpundit.

Related:
Health: Nothing but a number: Lifestyle changes to control cholesterol. Dr. Sidney Gottlieb, Cleveland Clinic Canada, National Post, 01/2008.
Image source: Cholesterol. Wikipedia (public domain).

The Podcast of the American College of Cardiology

The American College of Cardiology launched a video podcast called ACC Conversations with Experts, the web address is:

Conversations.ACC.org

"Dr. Adolph Hutter asks the tough questions in these 20 minute topical discussions. Each Conversation is a fast-paced discussion between leading experts in cardiology and is focused on topics that are important to you. "

You can watch the program directly on the ACC website or subscribe on iTunes and take it wherever you go with your iPod.

The ACC podcast is definitely on the top 5 medical podcast list that UBC Google Scholar Blog has assembled:

1. New England Journal of Medicine

2. Nature

3. Journal clubs for specialists - Cardiology, Ophthalmology and Critical Care.

4. Johns Hopkins Medicine

5. Patient Podcasts - Cleveland Clinic's HealthEdge and Medicine.Net


References:
Top Five (5) Podcast Websites in Medicine. UBC Google Scholar Blog.
Medical Podcasts - Direct Links to Subscribe on iTunes
Medical Podcasts: A Complete List
Image source: sxc.hu

Pediatric Grand Rounds

Grand Rounds: Volume 1, Issue 24

Clinical Case: Kasabach-Merritt Syndrome

An one-year old boy presented to the hospital with right upper arm swelling since birth (click to enlarge the picture) and a low platelet count of 1,500.


Hemangioma of right upper arm

Continue reading on ClinicalCases.org.

Clinical Case: Bilateral Hemianopsia Due to Pituitary Adenoma

61 year old male had problems with his vision while driving and was bothered by the light. These complaints started gradually several months ago.

He saw a local eye doctor who found abnormal visual fields and referred him to endocrinology. An MRI was done.

Read more on ClinicalCases.org...

Image source: Wikipedia

MDCalc is a Useful Online Clinical Calculator

Grahamzon.com has launched a brand new online clinical calculator at MDCalc.com. It looks good although a bit green... (go to the website to see what I am talking about). The calculator is free and you can download the beta version to a PocketPC.

MDCalc includes many useful formulas and scores, including but not limited to:
- FENa
- CrCl
- Water deficit
- PORT Score in Community-Acquired Pneumonia

Graham is a medical student and an author of the popular medical blog Over!My!Med!Body! He is something of a "serial IT entrepreneur" in the medical blogging world. MDCalc is his second website aimed at making the life easier for physicians and patients. Last year, Graham launched MedsList.org, a website to help patients keep track of the multiple medications they are taking.

It looks like Ajax is Graham's native language. Kudos to him for starting these promising projects.

References:
A Medical Student Writes About Different Clinical Clerkships
Image source: MDCalc

Clinical Case: Asbestosis in a Retired Pipe Fitter

78 yo CM complains of SOB after 3-4 flights of stairs.

He is a former smoker and a retired pipe fitter who had asbestos exposure.


CXR in early asbestosis shows plaques above the left and right hemidiaphragms and early basilar fibrosis.

Read more on ClinicalCases.org....

What's Your Favorite Muscle?

Brad Wright has been a full-time anatomy lecturer for 5 years and he is soon to be a medical student. Obviously, Brad knows a lot about the muscles of the human body and he explains why his favorite one is sartorius in My favorite muscle.

More posts from his Anatomy Notes blog:

- Nasal irrigation to fight common cold

- My uvula trick. Caution: This is not for the faint-hearted.


Image source: Openclipart.org

Doping using habits of a baseball legend

Barry Bonds's 2002 season "was fueled by meticulous three-week cycles in which he injected growth hormone every other day, took the Cream and the Clear in the days in between, and capped the cycle with Clomid." Source: Game of Shadows, a book written by two San Francisco Chronicle reporters.

Bonds was reportedly using multiple drugs: two designer steroids referred to as the Cream and the Clear, insulin, human growth hormone, testosterone and trenbolone.

People at the Bay Area Laboratory Co-operative (BALCO), a sports nutrition center, were tracking Bonds's complicated doping regimen with calendars and folders.

Using drugs is such manner is detrimental to health.

References:
Bonds exposed. Shadows details superstar slugger's steroid use. Sports Illustrated
Barry Bonds from Wikipedia, the free encyclopedia
Image source: OpenClipart, public domain

The Journal of Hospital Medicine Is Launched Online

The Hospitalist Journal

The Journal of Hospital Medicine is the official journal of the Society of Hospital Medicine. Here is Volume 1, Number 1.

Dr. Qadeer (a member of the hospitalist group at the Cleveland Clinic) and Dr. Brotman (a former member) have an article in the inaugural issue of the journal.


Society of Hospital Medicine Annual Meeting

Registration is Open for SHM's 2006 Annual Meeting in Washington, DC. I submitted a case report from this website: Pneumoperitoneum Due to Sexual Activity, which was accepted for poster presentation.


Link via Notes from Dr. RW.
Image source: cover of Journal of Hospital Medicine

Poor man's copyright. How to prove that you had the idea first?

Scenario:

You made a scientific discovery and you want to prove that you were the first who made it. Your publication is months (or years) away. What to do?


Solution:

Send yourself a certified letter containing the details of your discovery and do not open it. This way the date of your contribution is certified by the Federal Government and in the future dispute over rights of scientific discovery (or copyright), you have a proof of it. Reportedly, this is the method Hollywood screenplay writers use as so-called "poor man's copyrights."

Does anybody know if this holds in court?


Update:

It looks like the "poor man's copyright" concept does not work. References are provided in the comments below. On of the great things about blogging is the self-correction: if your write something incorrect, somebody will point it out. Thank you.


Idea by: Navin Kedia, DO (publication permitted)
Image source: OpenClipArt.com (public domain)

Chronic stress at work can make you sick

More than 10 000 people employed in 20 London civil service departments (aged 35-55) were followed up for 14 years in a prospective study published in BMJ.

According to the authors, "a dose-response relation was found between exposure to work stressors over 14 years and risk of the metabolic syndrome. Employees with chronic work stress were more than twice as likely to have the syndrome.

The study provides evidence for the biological plausibility of the link between psychosocial stressors from everyday life and heart disease."

How the CEOs Work and Relax

Bill Gross, Chief Investment Officer, Pimco: "After about 45 minutes of riding the exercise bike and maybe ten or 15 minutes of yoga, all of a sudden some significant light bulbs seem to turn on. I look at that hour and a half as the most valuable time of the day." Source: CNN Money.

According to a study reviewed by Science Blog, daily brisk exercise reportedly decreases the risk of pemature death by 70%. The study found that “highly fit” men had half the risk of death compared to “low fit” men. For every 1-MET increase in exercise capacity, the risk for death from all causes was 13% lower.

References:
Chronic stress at work and the metabolic syndrome: prospective study. BMJ 2006;332:521-525 (4 March)
Secrets of greatness: How I work. CNN Money/Furtune.
Image source: openclipart.org, public domain.

Related:
Work stress and coronary heart disease: what are the mechanisms? European Heart Journal, doi:10.1093/eurheartj/ehm584, 01/2008.

Updated: 01/29/2008

It's Brilliant: Continuous search engine queries for public health

Continuous search query means that you set up a search on GYM (Google, Yahoo, MSN) and subscribe to the RSS feed of it. The search engines perform the search continuously (every 20 minutes) and whenever they find something new, you get notified via RSS. Google and Yahoo offer the continuous search for their news section and MSN makes it available for everything, including plain search.

I use the continuous search queries to gather information whenever something new is published about the Cleveland Clinic or any other topic that interests me (from disease conditions to stock market). The IT department liked the idea so much that they now feature the RSS feeds for the Cleveland Clinic in the News on the front page: RSS Feeds for the Cleveland Clinic

Information is power. Dr. Brilliant is the newly appointed CEO of Google.org, the philanthropic arm of Google, and he is planning to harness some of this power to improve public health. He is reportedly working on a new Google spider which will continuously search the web for news stories that may signal an emerging epidemic. This is how the Global Public Health Intelligence Network found the first cases of bird flu last year.


TED Talks: Larry Brilliant: The case for informed optimism.

References:
Brilliant Google Exec to Use Internet to Prevent Disease. Medicalinformaticsinsider.com.
RSS Feeds for the Cleveland Clinic
Google Alerts Tutorial To Help You Stay Ahead of the Curve. DigitalInspiration.
Image source: Wikipedia

Further reading:
Q&A: Larry Brilliant. Nature News, 01/2008.

Updated: 07/26/2008

Cleveland Clinic Health Edge on Google Video

The Cleveland Clinic produces a weekly video called Health Edge which features new health care developments and research projects. You can subscribe to Health Edge on iTunes or you can watch the videos directly on Google, just search for "Cleveland Clinic".



Google Video is gradually becoming an important distribution channel because it eliminates the cost for the producer (what is better than free?) and it is easy to use.


Suggestion:

Now you can post your hospital's Grand Rounds videos online to share with the world.

"Just look for the 'Put on site' link on the video's playback page. It's free, it's fast, and users don't have to download anything to enjoy video right from your site." (A look inside Google AdSense).


References:
Video Podcasts by The Cleveland Clinic
Use Google Video to showcase your products. Inside AdWords.
So a video's worth ... 10,000 words? A look inside Google AdSense.

Johnny Cash - 'Hurt" - On Google Video

The Man in Black was the Man in Pain.



"This poignant performance of Nine Inch Nail’s, "Hurt" is almost haunting, as it was recorded just prior to Cash’s untimely death. Whether or not a Johnny Cash fan, this performance is powerful and deep with emotion." Source: FastFocus.TV

Johnny Cash knew pain like few other people, he spent his whole life with it after his jaw was broken during dental surgery and reportedly never healed completely after 34 operations.

When asked about the jaw pain, he used to answer: "It’s pretty severe, almost all the time. Except when I’m onstage. I pray for that, and it works. It doesn’t alter or hinder my performance. I don’t take painkillers."

Strangely enough for our litigious society, Johnny Cash never sued the surgeon despite everybody's advice.

References:
Johnny Cash: A Law Unto Himself. Barney Hoskyns, Mojo 36, December 1996.
Johnny Cash from Wikipedia, the free encyclopedia

Updated: 01/04/2008

Teach Online with Nuvvo

Nuvvo is a Web 2.0 application which helps create online courses.

The service may be useful as a central hub for your students. The websites address is example.learnhub.com. "Example" is the name chosen by you.

See the Nuvvo video tour showing how you can use the application.

You can offer the online course for free, or charge for it, in which case Nuvvo collects 8% of the earnings.

References:
Teach and learn with Nuvvo. Lifehacker.com.
Image source: Nuvvo.com

Residency Program Blogs

The Early Days

I think the first residency program blog was Bedside.org launched by a faculty member at the University of Cincinnati in March 2003. It looks like Dr. Carl Gandola is still the sole contributor to the website.

For the Residents, By the Residents

My former residency program at Case Western Reserve University (St Vincent/St Luke) followed in 2004, and as far as I know, that was the first blog created for the residents by the residents (correct me if I am wrong). Actually, the website was not a blog in the exact sense of the word but it just used the newly redesigned (at that time) Blogger.com to make a regular website supported by the residents who contributed clinical cases, EKGs, CXRs and medical procedures info. This website grew quite popular within the residency program and spun off several projects, including the blog you are currently reading.

One thing that is very important for any website is to have a prominent "About Us" page which shows who is responsible for the writing. We had this from the beginning. How can you trust the content if you do not know who wrote it?

New Players Joining the Crowd

VCU MCV Hospitals Emergency Department Residency blog, started in January 2006, is the newest residency program blog I am aware of. It features interesting patient cases and other information. The "About Us" page is not complete but otherwise the blog is certainly worth-checking out.

Osler.wordpress.com seems to be the first blog by a residency program director. David Theige, MD is the program director of the University of North Dakota Internal Medicine Residency Program. Somehow, I think that we should not name our blogs Osler, Hippocrates or Cushing... but who am I to judge others?

Harbor-UCLA Family Medicine Residency Blog is a group effort -- several residents and faculty members at an LA county hospital and clinic write posts.

Clinical Correlations, an NYU Department of Medicine educational web site, hosted by the Internal Medicine Residency Program.

Ground Rules: HIPAA and Blog Guidelines

Medical blogging is a great educational endeavor, especially for residents, but certain rules have to be observed:

- Strict protection of patient confidentiality as detailed by HIPAA

- Compliance with institutional blogging guidelines, if available

Whatever you write, remember that your patients, your boss and Big Brother May Be Reading Your Blog (Businessweek.com).

Blog away and enjoy the two-way street that the Web 2.0 is all about: Read <----> Write.

References:
Simply Fired - How NOT to Blog About Your Job. Especially If You Are a Doctor
Case Reports and HIPAA Rules
Do's and don'ts of corporate blogging. CNN Money, Fortune.com.
Wikis, blogs and podcasts: a new generation of web-based tools for virtual collaborative clinical practice and education. Boulos MNK, Maramba I, Wheeler S. BMC Med Educ 2006;6:41.
Feature: 5 Reasons to Use WordPress as CMS. BloggingPro, 2007.
Image source: VCU MCV Hospitals Emergency Department Residency blog

Updated: 11/27/2007