I wrote about my feelings of receiving inappropriate consults on a previous post. Since then, I tallied an additional list of observations I’ve noted in consultation requests. Some of these are absurd:

Me: This is ophthalmology returning a page.

Consultee: You have to see this consult…

Others are even more direct:

Me: This is ophthalmology returning a page.

Consultee: Five-One-One-Eight… [reading medical record number of presumed patient needing consult]

On other occasions, the interaction becomes insulting:

Consultee: (At 3 am) Sorry to wake you. This isn’t an official consult yet, but can I borrow your Tonopen? (Device to check eye pressure). This guy with a history of glaucoma fell and hit his head last night….

I suppose that direct blow to the eye could cause an eye pressure spike, but there are a few other incongruities in this consult request (We take home-call).

The ultimate insult:

Me: Can I borrow your stethoscope?

Consultee: Do you even know how to use one? (I was one year senior to this guy in medical school, and I taught him about renal failure in a review group)

Sometimes I just want to scream.

medicine ophthalmology, rant

Obtaining a concise and accurate medical history is an art, and it often takes a lifetime to master. For the majority of us, we train for it daily in our clinical practice. On most occasions that we successfully arrive at a diagnosis through the history, the feeling is bliss. Rarely, however, it elicits anger.

Several weeks ago while I was on primary call, I was called by the emergency room (ER) attending physician about a woman who had left eye pain. The ER doc had dutifully checked the vision in her eye and found it to be 20/200 while the unaffected eye was 20/20. He added that she complained a sudden loss of vision in that eye as well.

I had just stepped into my apartment right before getting called, around 12:02am. Painful loss of vision is concerning by all means, and I rushed back to the ED while glancing through my Will’s Eye Manual for help.

My patient was a 40-yr old woman comfortably sitting in the exam chair. Her eyes were white, and on first glance, I could not determine which eye was in question. On brief exam, her vision in the left eye was indeed poor, although she did not have an afferent defect or a shallow anterior chamber. The fundus on the left eye was clearly severly myopic compared to that of the other eye. I suspected that she had poor vision in the left eye all along. Read more…

misc medicine, rant

Back in the heyday of Intel 80486 processors, there were many opportunities to run software on underpowered hardware. I remember those days when Doom! required a math co-processor (DX chip), for its polygonal rendering. Most of us still had the standard SX chips. We found ways to bypass that, as well as the 4mb extended memory requirement. In the end, the software ran, albeit sluggishly.

It seems like hardware has caught up the power race, and most desktop systems are capable of handling all but the most processor-intense applications. I’ve been one to believe that current computers are overpowered for their intended purposes. Who needs a dual-core with 2gb memory and 1gb video ram to browse the ‘net and word process? Indeed, there is no role for this in routine use, but I recently discovered that new hardware helps even with light software use.

I recently installed Microsoft’s Visual Studio with SQL Server onto my 1.7ghz Thinkpad. The installation burned through about 15gb of disk space (out of a 40gb disk) and took over an hour to complete. After the ancillary drivers were installed in place (.NET, Powershell…etc), the laptop ran like a 500-lb man after going through a Vegas buffet. I promptly uninstalled the software.

It’s probably time for an upgrade.

computing rant, tech

Several months ago, I mentioned the pain of being a USPS customer, especially at some branch locations. I would like to make an addendum today.

I had the displeasure of trekking to the post office today to pick up a piece of certified mail. The local branch opens its doors at 9am. I came at 8:50am in hopes of beating the crowd. Apparently, the lobby opens its doors 8:30am in preparation for the day. When I arrived at 8:50am, I was the 8th person in line! I waiting approximately 1 hour to reach the front of the line, and another 13 minutes for them to find my mail.

It may be time I invest in a 3rd party mailbox service, such as mailboxes at the UPS Stores. Does anyone have experience using these services?

misc rant

Even if you aren’t tech-oriented, you’ve probably gotten wind of the ongoing Consumer Electronics Showcase this weekend in Las Vegas. Every winter, electronics and computer companies get an opportunity to dazzle us with the latest technological breakthroughs. I’ve never been to any of these conventions before. I’m not there now, as I am on call this weekend. It does amaze me that some innovations are simply spectacular, while others appear impractical.

It seems like the common theme this year is digital screen technologies, like OLED televisions and E-books. The concept of e-book readers like Kindle and Sony’s Reader is enticing, but the weak .pdf support and huge restrictions on certain file formats makes the device an imperfect scientific reading device.

I wonder how many of these devices have application in the medical community. Portable readers? Not really. See-through OLED screens? Nice, but not a necessity. Portable dictation devices? Absolutely. We need to transcribe our referral letters. I will be following Android’s dictation engine closely. Since Google has been harvesting 411 voice data onto its Voice system for the past few years, I can only expect things to improve. It will be an exciting year.

computing rant, tech