Sunday, August 31, 2008

Where'd I go?

Long Story Short:

My computer crashed and I've been busy studying for Step 2 of the medical board exam in the midst of a rather busy psychiatry service.

I'm still working on recovering everything from my old (Windows) lappy. Once that is done, I'll be more happy. Yes - that rhyme was sappy.

But at least I'm back.

Wednesday, August 20, 2008

Psyche Me In!

Just a brief update:

I finished the third day of my psychiatry clerkship this evening. The patients my team cares for are on the lowest acuity section of the floor, but that means there are a lot of interesting - and sad - personality disorders (versus the floridly psychotic). The learning curve is steep, but I think I'll get a basic hang of the topics in a few weeks. What I am really excited about is honing my interview skills. This is the perfect place for that.

Tuesday, August 19, 2008

Big News!

One of the things that has been keeping me from posting new entries here is a little project I've been working on for the past 4 or 5 months. Today, I received an email from the chair of UW's Medical History and Ethics department that opened with,
We are happy to endorse the plan for an ER Ethics course as you outline it, and look forward to providing it as an MHE offering.
Whoop Whoop!

I mean, "My, what a fine outcome. I cannot wait to see this effort come to full fruition." Or something.

The bottom line is that back in March, I was in the emergency department admitting a patient to the medicine floor when I ran into an emergency attending who I knew as a sophomore medical student back in what they call the day. We knew each other to be writers, so we caught up about each others' activities. She told me about a cool medical humanities 'zine she was writing a proposal for (since funded!). I told her about my gig at The Differential. And she mentioned an idea for teaching an ethics class based on cases from the ER.

Schreech!!! My mind and body did a double take.

I don't exactly recall what condition the patient I was admitting had, so will take some narrative privilege (and play the statistics) to report that I thought: "the guy with hepatic encephalopathy can wait a few more minutes." In truth, it was 3AM, we had already examined him and written orders and I was checking lab results in the fishbowl (which we call the central command center of the ER) before getting a couple hours of sleep. As usual, sleep takes the back seat.

The bottom line is that sleep was sacrificed for this project more than once. The opportunity to apply what has always been an extra-curricular (or at best co-curricular) interest in ethics to my chosen profession was amazing. As the chips lie today, this winter I'll be co-teaching (with the emergency medicine attending) a class to first through fourth year medical students called "Ethics in the ER." The curriculum is discussion oriented, is based on numerous actual cases, will employ a blog/discussion board and require a small amount of reading from medical humanities and ethics sources.

I think the curriculum we're developing is a unique approach in medical ethics education, and are excited about testing it and reporting our experiences for others to learn from and improve. I am also looking forward to a few more energized late nights turning theory into practice.

Monday, August 18, 2008

Getting By On Metaphor

I take my metaphor extended, not mixed. Need proof? Read my latest post at The Differential. It's about the residency application and interview process. I'm only at the opening round of the process, and I've already had to lean on allegory. If John Bunyan were a senior medical student, I think he'd approve.

I am only slightly comforted by the fact that my understanding metaphor rules out certain psychiatric diseases. Today was day one of my psychiatry clerkship, and I've already determined that I'm one major depressive episode away from a Bipolar Type II. (Anyone who knows me can appreciate the hypomania I've experienced over the years. I guess I'll just have to settle for cyclothymia. And as my psych attending pointed out today, people don't get admitted for cyclothymia - it's just to close to normal!

By the way, look for additional self diagnoses in the next 6-10 weeks. I hear it's pretty common on the psychiatry clerkship!

Thursday, August 14, 2008

The HIPAA in the Room

I've been a little gun-shy of my posts on Hope for Pandora recently. It seems as though a Seattle medical version of big brother may be watching... watching blogs. One of my friends - a blogging friend and real-life friend - was asked to remove material or shut his blog down because a compliance officer at a hospital where we train was concerned that certain of his posts violated patient confidentiality. Check out Noel's blog, aptly named, Constructive Procrastination.

I have sought to maintain the integrity of my writing by anonymizing my stories or asking permission of my patients to write about them or folding several patients into one pseudo-fictional account in the interest of telling a good story. Each of these techniques fall within the guidelines of the Healthcare Blogger Code of Ethics. What bothers me is that my friend had also observed these behaviors in his writing.

What bothers him is the manner in which he was approached. I'll let him tell the story in his own words, which started a couple of weeks ago. It seems as though our hospital wants to have more control over what gets into the public domain from experiences inside the hospital. Since I have vague aspiration to publish some of my own expereinces in a format more commercial than a blog, this got my ears up. After all, I already write for lunch money over at The Differential. I contacted folks in the community relations department before starting that gig - I wonder if someone else is trying to enforce some element of control or oversight on writers like me.

I think that my hospital administration is a little out of its league right now. One in ten Americans have tried their hand at blogging or something like it. I'm betting that health professionals are no exemption to that. I'm a little worried about an Orwellian move here. Why isn't the Health Care Blogger Code of Ethics or something like it good enough?

The compliance office may be full of friendly faces and good intentions, but do they really know what they are trying to do? Fortunately, my friend has volunteered to provide a voice for us bloggers.

Facebook Pages

Here's a little entry to bring the blogosphere and the facebookosphere (?) a little closer together.

I've recently joined some Facebook groups that some of my readers may be interested in:

  1. The American College of Emergency Physicians (ACEP), where I've started a little thread about ethics in emergency medicine.
  2. The American Scientific Affiliation - a group of Scientists who are Christians... all perspectives are welcome - even extreme ones - but most of us seek paths that makes the two fully compatible.
  3. The Student and Early Career Network of the ASA... there isn't a lot of support for younger Christians who are scientists. Perhaps this group could help with that.
  4. Science Bloggers. Yeah, I think I am one of those.
Oh, and if you want to be my Facebook friend, drop me a note.

Saturday, August 09, 2008

Seven Years

August 9, 2001: A day that will live in infamy. (Among stem cell researchers, at least.)

That's when President Bush announced his policy regarding human embryonic stem cell research.

In remembrance of this day, I wrote up my thoughts at the seven year point over at Clashing Culture. In a way, I am glad Bush made that speech. I probably would not have gotten so invested in science policy and the public communication of science, may not have involved myself with FOSEP, and would not have developed a self-conception of myself as a citizen-scholar.



Hopefully you've noticed that some battles between countries are not merely figurative (as in Beijing right now). As war breaks out between the small republic of Georgia and its enormous neighbor, one cannot help to recall parallels with previous conflicts between a superpower and a thorn in the side. And if you've any confusion about what I'm referring to, consider this snippet (made in Beijing, where the speaker had just eaten lunch with Russia's president):
“Georgia is a sovereign nation, and its territorial integrity must be respected,” Mr. Bush said in a hastily arranged appearance at his hotel. “We have urged an immediate halt to the violence and a stand down by all troops. We call for the end of the Russian bombings.”
It seems to me (in my simple mind) that Russia's just taking a lesson from the good ole U S of A. I would like to see the above quotation replace 'Russia' with 'America' and 'Georgia' with 'Iraq.' but that's just me.

Thursday, August 07, 2008

With a Little Help From Your Friends

My latest article for Medscape's The Differential includes some tips about how to make the most of the teaching you'll encounter on your clinical rotations. If you listen closely, you'll encounter help from people all around you. Even from the gruffest nurses and most militaristic scrub techs. Check it out.

Wednesday, August 06, 2008

Podcast From the ASA Meeting

The talk I gave last weekend at the annual meeting of the American Scientific Affiliation about blogging as a useful tool for talking about ethics, science and religion in the classroom and in the public sphere is online. Listen to it here. It features my motivations for blogging, my experience here and at Clashing Culture, and some ideas about how blogs could play a larger role in dialogue about science and society in the public and within the mission of the ASA.

Man, is it painful to listen to yourself. Follow the link to the audio file at your own risk. I'll figure out how to post my slides, too.

I did talk a little about PZ Myers and Pharyngula as an example of discussions about religion that are more one-sided than I like. What did not come across until late in the discussion was how PZ linking my page once was a great boost to my activities on the web. For his notice and the associated traffic it brought I am thankful.

I did meet some other bloggers at the conference. One of whom lives about two miles from me.

Don't worry! There will be plenty of responses to the meeting coming up, mostly at Clashing Culture. See you there!

Monday, August 04, 2008

In LA for an Exam

I'm typing this entry from a hotel in Los Angeles. A few days ago I was in Portland for a conference about issues in science and Christianity - more on that later.

Tomorrow I take an 8 hour clinical skills exam in which I interview (and am evaluated by) standardized patients who act as though they have diseases. For this opportunity to demonstrate my bedside manner and English proficiency, I get to pay about $1500. I'm sure I'll have more to say about that. My wife and I are taking the test at the same time, so at least we can split the hotel room!

We went for a walk around the neighborhood tonight - the test center is just across the street from a Raytheon plant. Yes, the same Raytheon that makes bombs and missiles. And there's a huge oil refinery in the other direction. Awesome...

Friday, August 01, 2008


Hey You!

Go check out two recent blog carnivals that I happen to have entries featured in. There's a moving collection of "Why I'm in medicine" posts at the Grand Rounds hosted by Edwin Leap, and my Differential colleague, Ben Ferguson assembled and reviewed a great collection of cancer articles at nosugrefneb.