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

I always assumed that tertiary academic medical centers were bastions of excellence. We always received transfers from “outside hospitals” (OSH) with half-assed workups and piles of meaningless nursing notes. As a medical student, I’d spend some time in morning rounds with my residents and attendings belittling procedures done at OSH’s.

I’ve begun to reconsider the notion that these academic centers are anything beyond extraordinary. For one, academic centers are training centers. There are residents of all levels caring for the ill; no matter how qualified the housestaff are, there will always be shortcomings. I’ve been at the blunt end of poor decisions too many times already.

One morning, I received a page at 5am from a medicine PGY-2 resident who noted that one of my colleagues had written “I/L: 2+ NS OU” on one of the consults but failed to address any intervention in the plan (The consult was for diabetes evaluation, which is already a dubious inpatient consult). The same resident called me again last weekend at 5:09am requesting a consult for a gentleman with multiple myeloma who was bleeding from his gums and was anemic. He had read of some reported complications of central retinal vein occlusions in hyperviscosity syndrome. The patient had absolutely no ocular symptoms. Moreover, the medicine resident congratulated me for recognizing that there were no pathognomonic ocular findings for hyperviscosity syndrome, but demanded a stat consult anyway. Since when does the “consultee” openly flaunt demands to a consultant? At the same time, I had a corneal ulcer that I was managing in the ED.

It is disgraceful for a notable academic institution to have such prideful individuals with limited insight. I trained at a community center during internship, and never called a stat ophthalmology consult. Most people knew their limitations. In fact, most cases never need emergent eyecare intervention.

Some might say that the mission of the academic center is different from that of a community center. In these differences lie a training and research center that necessitates inefficient consults and a higher operating overhead. Not so much. The community center I worked in certainly had a higher inpatient load than my current academic institution. The community center isn’t burdened by deadbeat unionized employees who show up to work half the time. Many workups are governed by protocol; those that are not are rightfully so. The profit that the community center–a non-profit organization–is converted to education and expansion of the hospital. Complicated cases are indeed transferred to the local academic center, but rarely so. The more common cases are managed far more efficiently than their equivalents in a large academic center.

Indeed there is a role for each type of hospital in every city. However, the discrepancy in the two is startling. Academic centers should excel in “complex case report worthy” medicine, but they should not have to sacrifice quality and efficiency of the entire hospital in doing so.

medicine ophthalmology, rant

Most laypersons and medical personnel have no idea what an indirect ophthalmoscope is. I always get suspicious glances when I’m carrying around my indirect scope in the hospital. It’s black, and looks like a weapon. Ophthalmologists use it to examine the fundus. It provides a light source parallel to our sight, and gives us a stereoscopic view. Last night I got about 5 double-takes when I was walking to the emergency room around 2am. One security guard actually stopped in his tracks and grabbed his gun from his holster.

Bastard. What do people think I’m doing? I’m sure that everyone tries to be particularly alert, but there’s no reason to be paranoid.

misc ophthalmology, rant

One of the consequences of carrying the hospital ophthalmology on-call pager is that you end up becoming the primary eye consultant for anyone who knows your number. ANYONE. This includes people outside the hospital’s referral network.

Last week I received a call from a gynecologist who worked at the hospital but was 2 hours away. She noticed that her eye was  “bloodshot”, and described to me signs of a subconjunctival hemorrhage. Of course there was nothing I could do except offer her a ticket to my emergency room if she wanted an examination. She declined.

On Saturday morning at 4:30am, I received a page from the hospital’s cardiothoracic (CT) surgery fellow worried about his own red eye. I had just stepped foot in my apartment 10 minutes earlier, after a horrible slew of ED consultations. I asked him to drop by our weekend clinic at 8:30am for examination, but he stated that he was scrubbing into “a case” and probably would not be finished until 10am.

As angry as I felt for being paged for likely non-emergent personal consultations, I actually felt sorry for the CT fellow.

Then I realized the reason for the high volume of non-emergent calls is that people, no matter how educated they are, know very little about the eye. Who knew that you shouldn’t wear daily contacts for 4 days straight? Yes, if you wear inch-thick eye liner, some of it will get into your eyes.

I guess that’s why ophthalmologists still have jobs.

medicine rant

Every year, the Academy of Ophthalmology holds an annual meeting that most ophthalmologists attend. Those that are usually left behind are junior surgeons who end up covering the on-call pager.

I was unfortunate to be covering the primary pager for the hospital this weekend, which is Academy weekend. Generally speaking, this is the worst weekend to have an eye problem, because your primary ophthalmologist is probably out of town in a meeting (or getting drunk). My pager rang early yesterday morning with a long distance callback number. Bad news. When the emergency room or floor resident pages me, I usually receive the hospital extension. A long distance number always means that you’re getting shit that you don’t want to (and should not have to) deal with.

The call turned out to be from one of my attending’s wife. She woke up with an itchy eye and foreign body sensation. Her husband was at the AAO meeting in San Francisco, and she did not wish to bother him with a call. Her son-in-law, daughter, nephews, and nieces were all ophthalmologists at the meeting as well. Her primary ophthalmologist was in town, but she did not wish to bother him either because it was Saturday (Jewish sabbath).

WTF?

I suppose that leaves me, the on-call resident. I offered advice to the best of my abilities over the phone and offered to see her in the emergency room (the one where patients wait 4 hours to be triaged). She politely declined.

Lesson to be learned: if everyone in your family is an ophthalmologist except you, you should go with them to the Academy meeting.

medicine ophthalmology, rant, work