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2 Medical Blogs Shut Down

Superstar medical blogger KevinMD calls today (May 16, 2007) “Black Wednesday” – the day when two of the Internet’s most popular blogs were officially closed.  Both Flea and Fat Doctor were forced to shut down their blogs due to privacy concerns.  The two bloggers had been posting anonymously – in order to protect themselves and the privacy of the people they wrote about.  It seems that Fat Doctor was outed by a co-worker, and Flea… we don’t know what happened exactly, but he was in the middle of a malpractice lawsuit, and was revealing the unsavory details of how the trial was going.

And this news is timely, coming on the heels of an interview I did with USA Today about blogging and patient privacy.

This seems to me like a wake up call for medical bloggers – there is no such thing as true anonymity.  Your identity can only be hidden for so long.

I have never blogged anonymously – and I recognize that anything I post can be read by anyone, anytime, anywhere.  This knowledge has resulted in extreme caution in posting information that could even remotely be linked to a real patient.  And yes, I have also refrained from blogging about issues and events that I sure would have liked to because of the associated risks.

It may be time for us medical bloggers to create and adhere to a code of conduct to protect ourselves and our patients from harm.  I had actually proposed this to Dr. Rob a few weeks ago…

What do you think?This post originally appeared on Dr. Val’s blog at

The wounds of childhood

I was reading a touching post in Fat Doctor’s blog about her
son – how she wanted to protect him from mean kids who would inevitably hurt
him at some point along his school career.
She spoke about how painful child vs. child cruelty can be, and how some
of us carry those wounds and insecurities into adulthood.

I was a bookish little girl, pudgy with pale skin, freckles
and braces… unathletic but enthusiastic.
Our gym teacher liked to begin each class by appointing two team captains
and allowing them to choose teammates one after the other until everyone had
been assigned a team.  So whether we were
going to play softball, floor hockey, basketball, or any other sport, it always
began the same way, two captains vying for the top athletes to build a team
that could crush the other.

The outcome was predictable.
The top “jocks” were usually selected as team captains, and they
proceeded to invite their favorite friends to their team, followed by the
mediocre kids, and finished with the chubby or clumsy kids at the end.

I was usually chosen second to last.  But there was one little girl who finished
last every time – Tina Appleberry.  She
was book smart like me, but although she wasn’t chubby, she had poor eyesight
and thick glasses and was rather uncoordinated and fearful of balls.  Most kids didn’t like Tina because she was awkward
and unattractive.  And I used to watch
her facial expression as she listened to the reticent team captain calling her
name last… because there was no one else to call.

Tina was a sad girl, and the years of being selected last
for sport teams had taken a toll on her.
She lacked self confidence, she was easily embarrassed, and she fully
believed that she wasn’t worth much at all.
I felt so badly for her… and shared her pain.  Being second to last wasn’t that much easier
– and I loathed gym class.  I would try
to get my parents to write as many excuses as I could think of to get out of
it, so I didn’t have to suffer the humiliation of my peers testifying in unison
that I was nearly the worst person in my grade at sports.

One day we had a substitute gym teacher.  She clearly had no idea who the jocks were or
what the pecking order of kid selection was supposed to be.  I was putting on my sneakers in the corner,
wishing that I could be invisible, when she walked up to me and announced that
I would be a team captain that day.
There were sighs and snickers as I followed her to the middle of the gym
floor and stood next to the class’s top jock, Johnny Tanner.  The rest of the class lined up in single file
in front of us so we could see our range of choices.

The teacher told me to choose first.  I surveyed the children lined up against the
wall, eyes fixed on me, eager to see who I’d pick first.  I paused.

“I call Tina Appleberry,” I said.  And you could have heard a pin drop.  Tina almost fell over in astonishment.  She slowly walked towards me to stand by my
side, lopsided pigtails and all.  I
smiled at her, she smiled back.  The
other kids didn’t know what to make of my choice – some thought I was stupid,
others thought I didn’t understand the rules (that you choose your favorite kid
first).  But that day I knew that I had
won a small victory – a victory that outweighed the sum of all gym game
outcomes in grade school.  And I can only
hope that Tina remembers that she was not always chosen last –and that her childhood
wounds are a little less deep because of that day.

This post originally appeared on Dr. Val’s blog at

My first day as a doctor

Panda Bear, MD (a feisty young blogger) gives some advice to
new medical interns in his recent post.
Internship, for those of you who may not know, is the first year of
residency training.  It is the first time
that a doctor, fresh out of medical school, has responsibility for patient
care.  The intern prescribes medications,
performs procedures, writes notes that are part of the medical record, and
generally learns the art of medicine under the careful watch of more senior

Internship is a frightening time for all of us.  We’ve studied medicine for 4 years, memorized
ungodly amounts of largely irrelevant material, played “doctor” in third and
fourth year clerkships, but never before have lives actually been put in our hands.  We know the expression, “never get sick in
July” because that’s when all the well-intentioned, but generally incompetent
new interns start caring for patients. And so, as Panda describes the experience,
we tremble as we begin the new stage in our careers – applying our medical knowledge
to real life situations, and praying that we don’t kill anybody.

I’ll never forget my first day of internship.  I must have drawn the short straw, because
not only was I assigned to the busiest, sickest ward in my hospital (the HIV
and infectious disease unit), but I was on call that day (so I’d be working for
24 hours straight) with the most hated resident in the program (he had a
reputation for treating interns poorly and being arrogant to the nurses).  As I reviewed my patient list, I noticed that
the sign out sheet (the paper “baton” of information handed to you by the last
intern who cared for the patients – meant to give you a synopsis of what they
needed) was supremely unhelpful.  Chicken
scratch with diagnoses and little check boxes of “to do’s” for me.  I was really nervous.

So I began to round on my patients – introducing myself to
each of them, letting them know that I was their new doctor.  I figured that even if I couldn’t completely
understand the sign out notes, at least by eye-balling them I’d have an idea of
whether or not they were in imminent danger of coding or some other awful thing
that I figured they’d be trying to do.

My third patient (of 15) was a thin, elderly Hispanic man,
Mr. Santos.  He smiled at me when I came
in the door – the kind of lecherous smile that a certain type of man gives to
all women of child bearing age.  I
ignored it and introduced myself in a professional manner and began to check
his vital signs.  I was listening to his
heart, and I honestly couldn’t hear much of anything.  There was a weird very distant beat –
something I wouldn’t expect for such a thin chest.  The man himself looked awful, but I really
wasn’t sure why – he just seemed really, really ill.

My pager was going off mercilessly all night.  I wondered if this was how the nurses got to
know the characters of their new interns – to test them by paging them for
anything under the sun, tempting us to tip our hand if we had tendencies to be
impatient or disrespectful.  But in the
midst of all the “we need you to sign this Tylenol order” pages, there came a
concerning one: “Hey, Mr. Santos doesn’t look good.  Better get up here.”

My heart raced as I rushed to his bedside.  Yup, he sure didn’t look too good.  He was breathing heavily, and had some kind
of fearful expression on his face.  I
didn’t really know what to do, so I decided to call the resident in charge
(much as I was loathe to do so, since I knew he would humiliate me for bothering

The resident appeared in a froth – “why are you paging
me?  What’s wrong with the patient?  Why do you need me here?  This better be good!”

“Um… Mr. Santos doesn’t look too good.” I said, frightened
to death.

“What do you mean ‘he doesn’t look too good?’  Can you be a little bit more specific” he
said, sarcasm dripping from his tongue.

“Well, I can’t hear his heart and he’s breathing hard.”

“I see,” said the resident, rolling his eyes.  He marched off towards the patient’s room,
certain to make an example of me and this case.

I trotted along behind him, hoping I hadn’t been wrong in
paging him – trying to remember the ACLS
protocol from 2 weeks prior.

The resident drew back the curtain around the man’s bed with
one grand sweep of the arm.  “Mr. Santos,
how are you doing?” he shouted, as if the man were deaf.

The man was staring at the wall, taking in deep, labored
breaths of air.  I saw that the resident
immediately realized that this was serious, and he placed his stethoscope on
the man’s chest.

I approached on the other side of the bed and held his
hand.  “Mr. Santos, I’m back, remember
me?”  He smiled and looked me straight in
the eye.

He replied, “Angel.” (in Spanish)  Then he let out a deep breath and all was

The resident shook the man, “Mr. Santos?  Mr. Santos?!”
There was no response.

“Should I call a code?” I asked sheepishly.

“Nope, he’s DNR,” said the resident.

I was flabbergasted.

“Yep, you just killed your first patient.  Welcome to intern year.”

As I thought about his cruel accusation, I was comforted by
the fact that at least, as Mr. Santos released his final breath, he thought he
had seen an angel.  Maybe my presence
with him that night did something good… even though I was only a lowly intern.

This post originally appeared on Dr. Val’s blog at

Gluten-Free Cooking Spree

I’ve been meaning to write about what happened at the
Gluten-Free Cooking Spree event that I attended last week… it was a pretty
funny story.

Gastro Girl and I were invited to a cook off for celiac
awareness – we were told that we would be helping a chef to create a gluten
free entrée on a stage in front of a large audience with CNN’s Heidi Collins
presiding.  There were 7 teams consisting of a chef, a doctor and a reporter.  It
sounded like Iron Chef (with a hint of “Scrubs” since I was cooking).  On the debriefing phone call we were told
that our chef would be provided with all the necessary ingredients (thanks to
Wegman’s sponsorship) and that we only needed to show up 30 minutes prior and
take instructions from our chef.  We had
1 hour to prepare the entrée and our meal would be judged against 6 other teams…

Sounds easy enough… but wait till you hear what really went
down.  First of all, much to the surprise
and amazement of Gastro Girl and me, all the other teams brought sous chefs
from their respective restaurants to the cook off.  Not only that, but they had cooked and
prepared most of their meal in advance, and were using the kitchen time to mix
and heat things.  They were dressed
impeccably in white cooking smocks and hamming it up for the CNN camera crew.  Our poor chef, Chef “Rock” (Rahman Harper)
from B. Smith’s Restaurant, got caught in some heavy DC traffic (this happens
when a motorcade of some ilk appears out of nowhere) and arrived about forty
minutes late.

Now, far from being an Iron Chef TV set, our facility was
actually a real hotel kitchen – steamy hot, grease covered tile floor, one
industrial gas stove, and stainless steel pots and pans hanging on wires
dangling above metal tables.  Gastro Girl
and I had come straight from work, and were wearing business attire, with heals
and the whole bit.  As I slid my way to
an unclaimed table, trying not to fall down in the grease in front of the CNN
cameras, I put my head together with Gastro Girl about how we could at least
find all our ingredients and have them ready for Chef Rock when he appeared.

We were the last team to arrive in the kitchen, and all the
ingredients had been handed out to the different teams… a box of groceries was
left for us in the walk-in cooler.  As we
removed all the items we realized that many of our ingredients were missing (we
were planning to make cheese grits and a sort of spicy shrimp Jambalaya).  In fact, there were only 2 cups of shrimp
(frozen and unpeeled!) in our box… and we were supposed to be cooking for 50
people… near our table was a group of sous chefs from a competing team, with a
large bucket of shrimp, grinning from ear-to-ear as they watched Gastro Girl
and me talking about our predicament.

Our situation was not lost on the organizers, however, and a
very kind lady asked us to give her a list of our missing ingredients so that
she could send someone to buy them for us.
Chef Rock appeared, and allayed our fears – “we can make this work, even
if we need to change the recipe a bit.”

Well, the other teams took up most of the burners on the
stove, and we had to wait until the last minute to cook our shrimp… and with 30
seconds to spare, Chef Rock came through with a gorgeous dish of soul food that
was whisked away to a large judge’s table in a crowd of hundreds.  Gastro Girl and I wiped the nervous sweat
from our brow and followed him out to the booth we had in the ballroom.

There were several presentations made, with introductions of
the various teams (Gastro Girl and I shouted “wooo-hooo” when our team was
announced, and waved to the crowd – we had the best team spirit)… and finally
the winner was announced… it wasn’t our dish unfortunately (coriander crusted
skate won), but several members of the crowd told me that they liked ours best.

And so, the Gluten-Free Cooking Spree was a great success,
raising money and awareness for celiac disease.
The chaos behind the scenes went unnoticed by the participants, and I
felt proud of our little team – having pulled off a near miracle against all

Next year, we’ll be back with a vengeance… Watch out, sly
competitors – Dr. Val, Gastro Girl, and The Rock will be armed and dangerous!

This post originally appeared on Dr. Val’s blog at

The $456 Billion Meme

Many thanks to Dr. Rob at the Musings of a Distractible Mind
blog for tagging me with the 456 billion dollar meme…  The idea of this game is to think of the best
way to spend 456 billion dollars.  Sam at
BlogMD started this meme when considering how the total amount of money spent
on the war in Iraq may have been better spent (he suggests that we could have
cured cancer by giving that money to the NCI instead).  By contrast, Rob’s proposal is rather whimsical, exploring
the number of llamas and goats that could have been purchased for that amount
of cash.

I’m of two minds – part of me wants to be silly, the other
wants to be serious (a tension that is part of Rob’s daily inner struggle)… but
in this case I’m afraid that silly wins.

Silly Val

My apologies to Sam for allowing his noble meme to
deteriorate so rapidly into chaos but what did you expect, tagging a goat loving
guy who blogs about the history of accordions?
It’s not surprising that his pals would wander off into uncharted animal
territory, rather than suggesting solutions that might actually achieve world

I myself have a special fondness for any animal whose face
bears an expression of astonishment, goofyness, or inquisitiveness.  Some animals are just plain cute because of
their whimsical behavior.

Given my recent concern about melamine and pet food tainting
– I suppose the 456 billion could be used to create US regulated, safe, animal
food factories to support the culinary needs of kitties and doggies everywhere…
except in China, of course, where they make pet food but eat pets.  There’s some kind of irony in there somewhere…

Of course, humans are people too… and I also worry about the
safety of the food supply for them.  The
latest food debacles (salmonella in Cadbury’s chocolate bars and in US
peanut butter, as well as the E. coli/spinach issue) highlight the fact that
even the West’s attempts to regulate and monitor food safety have fallen down
on the job.

So… in honor of the culinary medical blog “The Blog That Ate Manhattan” – our Grand
Rounds host this week – I am voting to use the $456 billion on safe food for
pets and people.  Since math isn’t my
forte, I’m not sure exactly how the cost break down will go, but I think it’s
something like:

Cost of creating internationally safe pet food: $50 billion

Cost of creating an air-tight FDA process for ensuring human
food and drug safety: $100 billion

Cost of setting up safe, organic producers of healthy food
all over the world: $306 billion

The cost of a fat, juicy, 100% Salmonella-free wild fish
steak on summer barbeque grill… priceless.

I tag the following bloggers to tell me what they would do
with $456 billion…  Dr. Charles, Dr. Joe,
Dr. Charlie, Dr. Jeff, and Mira Kirshenbaum.This post originally appeared on Dr. Val’s blog at

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