One of my attendings mentioned that she examined inmates routinely during her residency training.  These criminals would often sit in the same waiting room as regular patients, of course with supervision. After all, everyone needs eye care, right?

That anecdote reminded me that residents at one of the Georgian ophthalmology programs actually had a clinic in the local penitentiary. One day a week, the resident on service would sign in cataracts and other surgical cases in the “jail clinic”. In retrospect, it actually doesn’t sound too bad–no insurance issues to deal with (I’ve had my surgeries canceled because my patient didn’t have the right insurance) or accidental consumption of breakfast the day of surgery. Having prison inmates as your patients is a great system. They actually show up to your clinic on time and do what they are told. As their physicians, we’d be contributing to the governmental system.

In fact, my residency shares many similarities to that of a prison clinic. Last month, I examined an open globe laceration in the ED, similar to what I’d see in prison fights. Another one of my clinic patients came into the ED handcuffed (and foot-cuffed) to the exam chair. The only difference between my patients and those at the prison is that the cops guarding my patients are smoking outside the hospital while I am alone examining the criminal. What fun.

Indeed this is an exciting moment in my training career…

medicine, misc humor, ophthalmology

Ophthalmic pathologist Mort Smith sports a tablet PC for his lectures. I suppose that a nifty touch screen can come in handy when you’d like to circle some Merkel cells in your presentation for emphasis. Tablet PC’s are traditionally geared toward the mobile user who simply needs technology for note-taking and flashy presentations. These systems typically range from the 2lb-<4lb range, with limited video acceleration and slower disk platters (with the exception of those with solid-state drives).

I don’t find that tablet PC’s are entirely useful for medicine, since netbooks and superlights a la MacBook Air are plentiful. However, there is potential for tablet PC’s to be useful for the niche market of ophthalmology. We draw. We label diagrams with color, all in our progress notes. A touchscreen serves as the bridge between the ophthalmic exam and EMR. This union is not novel–Mayo Clinic’s ophthalmology department implements its own ophthalmic EMR that synchronizes seamlessly with the entire hospital’s records.

TabletPCreview.com, the de facto standard review site for tablets is a good starting point to explore the current product line. These systems do command a higher price tag than their non-tablet counterparts, but it is impressive how much power you can fit into the package. I’ve been entertaining the idea of acquiring a tablet for a while, and I almost made the jump until rumors surfaced about Apple’s venture into the table realm. That is a killer hardware that I’m itching to get my hands on.

It will be an interesting product cycle in the upcoming year…

computing, medicine ophthalmology, tech

I saw my first retinal detachment a few weeks ago. I have a slit lamp photo I took of my patient in the emergency department using my digital camera. His anterior vitreous was littered with a mix of pigmented and white cells. This finding is dubbed, ‘Shafer’s sign’. Its presence highly suggests a retinal detachment.

For those of my colleagues, this is named after Donald Shafer, of MEETH. Don Shafer graduated from Columbia University and Cornell Medical College. Some texts misspell his name as “Shaffer”.

medicine ophthalmology

An obvious facet of owning a business is knowing your competitor’s prices. If you don’t, then you’ll likely be out of business soon. We see this with taxi drivers. In NYC, there are city-governed yellowcabs and unmarked private cabbies. Most private cabbies command a higher rate, not because they provide better service but because they lurk around areas where yellow cabs are not as readily available. As a customer, the key is to negotiate a price prior to getting into the cab. However, even with informed preparation, you can still run into trouble.

I hailed a grey taxi to help me move an air conditioner 5 blocks away from my apartment.  I offered $10 for his assistance in carrying the unit to and from the cab in addition to driving me. He agreed. Afterward, he didn’t help me move the A/C, AND he charged me $15 because my A/C was “big”. Asshole. A $15 cab fare would normally get you at least 20 blocks.

My friend Bob had a more harrowing experience. After agreeing to a standard $8 fare to travel between hospital campuses, the cab driver demanded $14 when they arrived at the destination. Bob refused, and the driver locked the doors to the cab and refused to allow him to exit. He spent over 30 minutes in the cab until the driver gave in and let him out.

I understand that any business is difficult to run these days, but knowingly ripping off your regular customers is no way to remain profitable.

medicine rant, travel

We have a tunnel system that connects the eye institute with the main hospital.  At times, transport vehicles carrying trash whiz by precariously. The tunnel is usually only wide enough to accommodate unidirectional flow. I have had the fortune to transport patients through this maze. The last guy I moved had platelets of 29k. I had only an oxygen tank and a code box with me. Some say that this tunnel is treacherous for patients.

Well, if you make it out unscathed, you will definitely be stronger (physically and mentally).

medicine ophthalmology