You’ve probably heard about the outbreak of swine flu in various parts of the U.S. and Mexico recently. We even received a page via the UrgiCare service that one mother believed that her daughter had swine flu today! Talk about mass panic.  Interestingly enough, the swine flu is of a similar in subtype to the flu that caused the 1918 Spanish influenza outbreak (H1N1).  Google has set up a tracker to follow all of the suspected swine cases in North America:

View H1N1 Swine Flu in a larger map

medicine humor, medicine

As I specialize further in my career, I increasingly wonder how much my time is worth. In the hospital, we often see a strict division of labor. Physicians seldom perform phlebotomy or vital signs–this is the job of lab techs and nurses.  Our time is valuable and should be spent on tasks that require our many years of specialized training.

Does this division of labor exist outside of the hospital? Numerous medical residents have told me that they hire housekeepers to maintain their homes or apartments simply because “it’s not worth my time”. Other chores that I’ve heard residents renounce include: 1) mowing the lawn 2) cooking 3) washing dishes [including putting dishes into the dishwasher].

I’ve renounced cutting/logging trees ever since I entered medical school, mostly because I find that operating a chainsaw may prematurely end my career as a physician before it even begins. I don’t particularly care for logging trees either. But what about other tasks? What tasks can you refuse to do before being labeled a pampered snob? Read more…

medicine, misc food, life

I’m at the point in my internship that taking overnight call on the inpatient floors is more of a chore than a challenge. We admit patients, and field a few dozen nursing pages that are usually manageable. I walked into call yesterday with my 95 year-old lower lobe pneumonia patient rolling into atrial fibrillation with a rapid response rate of 180. For some reason her blood pressure was also elevated to the 180’s systolic, which isn’t as common in a-fib. The kicker was that she wanted to be full code. Great.

As I was ordering a diltiazem push, an ICU nurse had materialized at the scene–apparently the floor nurses called a rapid-response code (RRT) behind my back. RRT codes are usually called when a patient needs of prompt attention when housestaff aren’t available immediately. I was, however, already at the scene. No time for hurt feelings though–I was glad that help had arrived, especially since my senior resident was nowhere to be found. My brain had already closed down to internal medicine knowledge, as I’ve since mentally moved onto starting ophthalmology residency.

Soon afterward, a cardiologist arrived to evaluate her. We transferred the patient to the ICU later that morning, and started her on a diltiazem drip. She stabilized for the next 12 hours until the evening rolled around. She then became delirious, pulling out her lines, jumping out of bed, and muttering nonsense…all typical of ICU psychosis. As I was redirecting her back to bed a third time, she decompensated, and spiraled down to a rapid heart rate again. She further deteriorated and required intubation.

Daytime soon rolled around, I signed out to the day team. I now have a 95 year-old woman on a ventilator. Great. I wonder what other excitement will be had when I come back on Monday…

medicine medicine

Since a portion of my web traffic originates from the medical community, I’ve decided to provide an update on a web technology that you’ve all probably heard about, Twitter. We see links to Twitter on websites, news links, and even television ads. Just what does this ubiquitous, cute bird do, and what role can he play in the medical field?

Those of you using Facebook are also probably wondering whether Twitter is any different from your Status. Well, the truth is, it’s not. To take a step back, Twitter serves as a one-way bulletin board. You can post whatever you want on it for the world to see, but others cannot write on your bulletin. Your viewer do not require an account on Twitter, nor do they ever have to log in. In contrast, your status page on Facebook can only be viewed by your designated friends.

The strength of Twitter lies in its accessibility. The owner can post links via SMS, website, email, desktop application, or portable application. It is concise, and viewable by the public with any of the aforementioned posting media. Your followers can receive automated updates on your bulletin. Therefore, it is an expedient means of communication.

I first saw the use of Twitter in medicine from Henry Ford Hospital, where they broadcasted updates directly from the OR. This was innovative, because it was a means for the public to become involved in the operating room. Imagine receving real-time updates on the carotid endarterectomy from OR #12:

“The shunt has been bridged!”

“EEG shows activity!”

“The resident calls for the yellow-tails!”

I would certainly try to incorporate the medium in my OR. Twitter’s application can also be extended beyond the OR. You can post updates from the clinic via Twitter.

“Dr. is running late today.”

“Two openings at 4:15pm today. Okay to walk in.”

The key is, of course, not to abuse posts to the extent that your patients become sick of getting updates. There is certainly a fine balance to be had. That’s it. Go to Twitter.com. Open an account. Play with it. In the meantime, you can follow my Twitter, also viewable on the side column. Real-time. Real news. Good stuff. If you have questions, contact me.

Update (4/23/09; 9:07pm): Mayo Clinic has even jumped onto the Twitter bandwagon, holding a webcast presentation on Twittering. Great stuff.

computing medicine, tech

I laughed the first time I read this question on my risk management training exam, which I am hoping to finish in between the 90hrs I anticipate being in the hospital this week:

The blunt end of the healthcare system can be described as:

a) action by clinicians

b) latent errors

c) inaction by clinicians

Oh boy, I have quite a bit to learn…

medicine humor