kill as few patients as possible

Case of the week

I saw the first case of Staphylococcal Scalded Skin Syndrome since way back in once upon a time time, er, I mean, since residency.

Not a happy camper, this kid, but he did quite well. No long term sequelae anticipated, but a miserable week for he and his folks. And nothing makes a family feel better than having dozens of other docs, nurses, nursing students, and others coming in to "see what this looks like." They were troopers, though.

this might actually be the real quentin tarantino

I just ran across QT's Diary, which actually appears to be real live weblog from the writer/director. This is your explicit language warning, so don't visit if that's going to bug you, but for film fans, this is an interesting site.

This alleged "research" annoys the hell out of me

This stupid study was done by a couple of researchers at Texas Tech and was published in Texas Family Physician this month.

It looks at the attitude of physicians toward euthanasia and physician-assisted suicide (if you're still wondering where I fall on these issues, consider the title of this weblog). It surveyed family medicine residents during their first year and then again in their third year of postgraduate training. I am personally not surprised to find that fairly liberal thinking on these issues in the first year became more conservative by the third year.

The authors make the following idiotic conclusion:

The overall conservative attitude seen in the graduating residents in this study is similar to the one seen in our previous study. This trend reflects a fear of the unknown that exists in a training physician, which could be detrimental in this rapidly evolving and liberalized society, which is well aware of its rights and privileges.

That makes no sense at all and is a conclusion clearly born of an idealogy that does not value the sacredness of life, and not a conclusion based in rational logic.

The author's want to say that it is the inexperience and fear in these training physicians that makes them more conservative, but if that's the case, then why weren't they more conservative at the beginning of their training? And why didn't they grow more liberal during the three years?

In truth, exposure to three years of family medicine residency has made these training doctors more attuned to the value and sacredness of life than when they started. In other words, the more experience they got, the more they felt euthanasia and physician-assisted suicide were areas in which they should be cautious.

Good thinking, young docs.

And shame on you, Texas Association of Family Physicians, for giving a pulpit to such blatantly idealogically biased "research."

I think the film industry calls them storyboards

In an effort to combine humorous stories from my practice with the incredible photographic content you've come to expect from this weblog (as well as trying to stick with the current movie theme), I am proud to bring you a series of photos of what I found on the whiteboard in the office breakroom the other day after my son had come up to pick up the key to the storage building where he was going to pull charts for us (I guess I shouldn't have kept him waiting so long while I was in that room with a patient).

In case you can't read the captions, they're provided below each picture (click for full size images, which are again taken with my crappy Treo camera).

"Dr. Bradley impresses the waiting room with his incredible feats of strength and prowess."

"Dr. Bradley saves patients from raging bear attacks through the use of his medical ninja training."

"Dr. Bradley cures ailments with Jedi healing techniques."

Is it just me, or is anyone else worried that the only one smiling in these drawings is...me.

A Village worth visiting

I saw this Friday night with my eighteen year-old son (who by the way is off to college to major in film in two weeks) and I have to say I was just blown away.

This is just a wonderful movie. I've heard some mixed reviews, seemingly with two main criticisms. First, Shyamalan's movies all repeat the same formula. Second, the famous M. Night Shyamalan "surprise" is a letdown.

I just don't get it. This is such a wonderful film. The characters are flawed but magnetic. The love story is touching and real. The atmosphere is dense. The soundtrack is haunting. And, as always with Shyamalan, he has a point. And that point is basically a positive one. In fact, we left the theater saying, "Yeah, he's saying this about society," "Yeah, but not only that, he shows us this, too," "Yeah and this." I mean, there are morality lessons on good and evil and innocence and the power of love and truth and lies and fear and it's all wrapped up in this short little story about this tiny little village.

I think the reasons some critics don't like the movie are inconsistent. They criticize on the one hand that Shyamalan is repeating the same formula, but then they get mad when the surprise isn't as surprising as it was last time. It seems to me they're criticizing it for what it has in common with his earlier films and for how it differs. You can't have your cake and eat it too. I suspect that the other reason some critics haven't liked it as much as they expected is because it's not as frankly pop-out scary as anticipated. But to me, the fear it creates is palpable and is sustained by the filmmaking longer even than logic should allow (you'll only know what I'm talking about after you see it).

Maybe I'm too simple. I want a movie to suck me into its world and I want it to reflect some truths about my world. I want to care about its characters and their choices. I want to feel what they feel and learn what they learn. The Village succeeds brilliantly on all counts, for me.

I'd be afraid to flush it the first time, but...

This is an interesting new take on the toilet/acquarium genre.

[via engadget]

Shouldn't the lingual nerve ennervate an audio blog?

In addition to not posting lately, I've been not reading a lot of my usual web stuff. This evening, watching the rerun of the final stage of the Tour de France, I did a bit of exploring. Allen's still contributing good tales from the ER over at GruntDoc, but I was also interested to note a new multi-author medical blog to which he's contributing. While I'm thinking it might have more appropriately been called RadialUlnarMedianNerve, my first impression is that it will be a good source of regular medical insight sprinkled with a liberal dose of humor. Check it out.

Two tales worth reading

After nearly two months without a post, I found a couple of articles worth sharing, so I thought I'd see if I could remember how to make a post on this sucker.

As noted below, I've left the FastTrack and reopened my private family practice, which is the big reason I've not been posting anything here. As many folks know, it's crazy opening a small business, and a medical practice is no different.

Anyway, no funny ER stories from me today, but there are two articles I've read recently that I do want to share.

The first is this story about Jason Read from today's USA Today. I usually skip over these human interest pieces, but his one caught my eye for some reason. This is an amazing story from someone who, unlike much of the rest of the country, will never forget how truly horrible 9/11 was. It's also a great story of faith.

Then there's this horrifyingly matter of fact account from the New York Times (free registration required) of a woman's decision to undergo selective reduction when she found out she had triplets. I love that term, selective reduction. In fact, I love it so much, I think I'm going to start thinking of Ted Bundy as a serial selective reducer. But before I begin to rant, I urge you to read the story. It's unbelievable. I can't believe that the same person who wrote of her boyfriend:

But Peter was staring at the sonogram screen thinking: Oh, my gosh, there are three heartbeats. I can't believe we're about to make two disappear.

could go ahead with the "procedure" and say:

I would do the same thing if I had triplets again

Read them both.

I just changed a diaper on somebody's "Undue Burden"

moron.

Do Patients want Online Services from their Family Physician?

Since I'm reopening my private practice, I am strongly considering implementing some online services for patients into my website.

I'm pretty sure that some patients would be interested in filling out pre-registration materials online (instead of on a clipboard in the waiting room) and that online refill requests make good sense also. I'm less sure about online consultation for simple problems in established patients (e.g. Urinary Tract Infection in an adult female) and I'm also not sure if online lab results reporting would prove useful.

In any event, unlike my web colleague Jacob, I'm not able to develop a secured site for patient communications on my own, so I'm left with (as best I can tell) three options.

RelayHealth is option one and their site looks pretty slick and fairly intuitive, but the cost is $50/month and I'm not sure I'd use all of their services. Plus, as best I can tell, you can either get the whole enchilada or nothing. Finally, I'm not sure how well I can integrate the service into my existing patient site. I am planning on continuing to host my site on TypePad because I'd like to try to keep it updated frequently and because I can mess with the design on my own without getting in over my head.

A second option is Medem. This company which the AMA has semi-endorsed offers some online services for free, but the sites they design are just so darned ugly and are all based on just a slightly varying basic template. Additionally, they put advertising on the site, which is why it's free, I suppose. Look, I'm not opposed to some tasteful ads, but if it's my site, I think it should be my ad revenue (yeah, I wish).

Finally, there's Medfusion. I like the fact that these guys are willing to let me keep my weblog format and will replicate the basic look and feel for the online communications portion. I also like that they have integrated Instant Medical History's computerized patient information gathering product into their solutions. This is used in two ways. First, a patient could fill out a symptom assessment prior to their office visit to hopefully save time when they came in. Second, MedFusion is also going to be using the Instant Medical History to drive their online consult documentation, which as I noted above, may or may not be something I use.

My biggest concerns at this point are twofold. First, will my patients be interested in online services and will they trust the security (I am quite confident in the security of the messaging provided by all of these sites). Second, I'm very concerned about taking any information gathered from these internet communication methods and getting it integrated into the patients chart in the electronic medical record software we'll be using. This last issue may present some serious workflow issue for the office, I'm afraid.

Any thoughts.