The hospital where I used to work kept tabs on personnel use of hand sanitizers. They encouraged us to clean our hands before and after entering patient rooms to minimize disease transmission. These alcohol-based sanitizers were advertised as an ideal alternative to frequent hand-washing; no more dry hands and hand-washing eczema! For every five to seven times we used the hand sanitizer, we were instructed to wash our hands, to clean off the grime residue of the gel.

Of course, we all know that hand washing with soap and water is the only means to eliminate C. difficile, the badness responsible for super-foul diarrhea and pseudomembranous colitis.

I hated using the alcohol sanitizers. It left a sticky residue on my fingers that did not instill the feeling of cleaniness. I only used it as an intermediary agent when I could not reach a sink in the vicinity.

It was only when I returned to NYC that this slimy waterless cleaning agent became useful, not in the hospital but in the city. On a busy day, I travel via subway at least twice daily, and exchange services with weather-beaten NYC cash (many vendors do not accept credit). One can only imagine how filthy subway handrails and doors are. I once witnessed a guy scratching his unspeakable bodily areas and then gripped the subway pole. Another guy wiped orange duck sauce from his take-out food onto the subway seat. Having Purell in the subway could never hurt.

Yesterday I prided myself for bringing Purell on my trip around the city for errands. As I was waiting for Sunny, the local falafel vendor, to prepare my lunch, I witnessed a sight no amount of hand sanitizer could cleanse. The vendor loaded my falafel using the same gloved hand he handled my cash in. So much for wearing gloves.

Sunny may never get my business again…

medicine medicine

For the second time this week, I saw a sports vehicle with a handicap parking tag. It always amazes me that a disabled person can be capable of driving a fast sports car. Perhaps this is a reflection of my narrow-mindedness, but doesn’t it seem odd to see a Nissan 300Z (manual transmission) sport the universal man-in-wheelchair logo on its plates and rearview mirror?

While the rules that govern distribution of the handicap permit vary by state, the general qualifications are similar. I believe that you must meet one or two of the following criteria:

• Inability to walk at least 200 feet without stopping to rest
• Use of portable oxygen
• Diagnosis of NYS Class III or IV heart failure
• Diagnosis of COPD, either end-stage or severely limiting.
• Wheelchair bound

The list continues with about a dozen more criteria, but I don’t believe that any of those disabilities actually prevent you from being able to work a clutch on a fast car.

The driver of the Nissan 300Z was a middle-aged man wearing thick-cut jeans and a flannel shirt. He didn’t seem like the heart failure type, and he wasn’t obese either. He did, however, light up a cigarette on his way out of the car to the Papa John’s pizza store.

Ah, the luxuries we have in the U.S…

medicine medicine, rant

One of my initial concerns in location of residency training was the cost. A metropolitan area like New York City and San Francisco comes with a hefty cost of living price tag. Do I want to pay $800 a month for a 2 bedroom gated condominium with swimming pool and tennis courts in Augusta, Georgia, or $2000 a month for a closet in Manhattan? While you should probably focus more on the quality of program and location in residency training, an extra $1200 a month in savings can be applied to important use (like repaying loans).

In retrospect, the cost differential isn’t as significant as I initially thought; the salaries are usually somewhat proportional to cost of living. One of my friends training in Boston ended up with similar funds as I did, simply because he had a higher salary and did not have a car to maintain. He’s now moving to Los Angeles, which is a sprawling freeway wasteland with traditionally crappy resident salaries.

I gave the salary issue a more quantitative analysis, and indeed it holds true to a certain extent. Take, for instance, the medicine residency program at St. Luke’s-Roosevelt Medical Center in NYC. For 2009, the PGY-2 salary is $58,463.  A subsidized studio runs about $1,600/month near the hospital. Wilmer Eye Institute in Baltimore pays its PGY-2 residents $44,192. An apartment in Baltimore away from the ghetto will cost at least $1,000 a month. The nearly $14,000 annual salary difference in NYC ought to cover the extra housing costs and hefty city taxes. In addition, you’d have to maintain a car in Baltimore.

But wait, you’re comparing a Yugo to a Rolls-Royce! Indeed, higher profile academic centers will still draw residents despite being in a seedy location and offering a lousy benefits package. It actually depends on the city.  MEEI offers a PGY-2 salary of approximately $52,000. Doheny offers a PGY-2 salary of $48,000, but a PGY-3 receives an extra $5,000 annually.

Ultimately, the end result is negligible. Instead, you should ask yourself whether you can tolerate living in a cramped apartment instead of a suburban home with a yard. Can you handle living in Utah if you typically spend your Friday nights at the bar? Or can you handle waiting in line for hours in Central Park to play tennis (don’t forget to buy a public tennis pass, or you’ll be fined!)?

economy, misc life, money

The much-hyped Palm Pre, dubbed the “iPhone killer”, was released last week. Its operating system succeeds the antiquated PalmOS that had only received incremental updates over the last decade. The initial reviews have been generally promising, and Palm’s Me2 device appears to offer a viable alternative to the Iphone and HTC Android phone. While useability and eye candy are critical to Palm Pre’s future, how does the device suit the medical community?

It’s important to realize that Palm has been the de-facto standard for medical software. Windows Mobile devices also offer equivalent software packages, but not nearly in as much breadth or stability. This is the main reason why I’ve stuck with my aging Palm TX.

Skyscape and Epocrates are the two main companies that produce medical software for portable devices. As a physician, I basically only need two applications: a drug formulary and a reference manual for my specialty. For ophthalmology, the reference manual of choice is the Wills Eye Manual.

Overall, the medical software availability for the Palm Pre is disappointing. Epocrates does not have a native WebOS edition available yet; the only means to access the drug formulary is to load a legacy hack. Likewise, none of the Skyscape applications have been ported to the new interface–you have to purchase the legacy emulator.

Given that the bulk of a medical application is reference text, you only need to write a user-friendly frontend to load the data. With the Skyscape applications, only one new frontend is needed for all of its manuals. Coding an intuitive interface is no overnight project, but not having useable software by the time your killer device is released will dispel customers.

I’ve noticed that Skyscape has also implemented a graded pricing scheme for its products. It offers a subscription service which provides free upgrades and phone support for one year. Afterward, it appears that the application stops working until you renew. Alternatively, you can purchase a “standard” package for about $20 more that allows you to use the product indefinitely but without updates. A subscription service makes absolutely no sense to anyone who never calls customer support anyway. While medicine is an evolving field, any new medical breakthroughs will unlikely make it into text within a year. I continue to be skeptical about this pricing scheme.

I assume that both Epocrates and Skyscape will eventually offer a discounted upgrade for early adopters once they release a native Palm WebOS application. In the meantime, I’m going to wait until these applications mature.

computing, medicine medicine, tech

I found a photo from an ice sculpture carving competition I attended in 2007 up in Cooperstown, NY. Around that time, we experienced about 2 – 3 ft of snowfall in the course of one evening. Those were fun times.

misc life, photos