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A Doctor’s Feelings About Caring For “Abnormal” Kids

I’ve been practicing for sixteen years now, doing both internal medicine and pediatrics. One of the joys of that is watching kids under my care grow up and not having to give up their care just because they get older. The spectrum is wide, with some kids growing up in “normal” families with “normal lives,” others in “abnormal” families, and yet others with inherently “abnormal” lives due to illness or disability.

But the kids aren’t the only thing that has changed over the past sixteen years. Their doctor has changed as well. My comfort zones have widened, not getting rattled by “abnormal” as I once did. I used to feel uncomfortable with the mentally and emotionally disabled, now I am not. I used to feel sorry for parents with “abnormal” children. I used to feel bad for kids who were “abnormal.” I still do now, but not nearly as much. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

A “Touch” Of Outer Space For The Blind

NASA, in an attempt to have visually-impaired people get a glimpse of what’s “out there,” has created a reconstruction of a Hubble image of the Carina Nebula in a 3D touch map.

Different textures applied to the image help in identifying the various parts of the giant dust cloud. We even think that visually-okay folks can get a better sense of the cosmic anatomy when offered such a presentation.

Read more on this from NASA here.

*This blog post was originally published at Medgadget*

Subway Scenes: Priority Not Given To People With Disabilities

subwaysceneAs many DC residents know, the local subway system has launched an etiquette campaign to insure that priority seating is given to the elderly and people with disabilities. The four seats nearest the center doors are clearly marked with “priority seating” signs, including “You don’t have to stand for this” posters. Conductors even read scripted reminders to riders at various stops.

So how is this campaign working out? I snapped a photo of this guy sitting in the priority section (and taking up 2 seats with his bags) – just after an elderly man with a cane limped by.

I gave him the evil eye… he returned the glare.

So I decided to feature him on my blog.

As a physician who works with people with disabilities this really gets my goat.

War Amputees And American Culture

At the recommendation of my dear friend and fellow blogger, Dr. Ramona Bates, I attended a lecture entitled, “Limb Labs: Getting Amputee Soldiers Back to Work After World War I.” The lecture was held at the National Museum of Health and Medicine on the Walter Reed campus in Washington, DC. Both lecturers (Beth Linker and Jeffrey Reznick) did a wonderful job of transporting the audience back in time, outlining the cultural beliefs and historical context of the day. This is what I gleaned from their commentary:

Roughly 100,000 men became amputees as a result of injuries from the American Civil War (1861-1865). At the time there was no government-sponsored program to fit amputees with prosthetic limbs, so veterans were on their own. Prosthetists catered to the middle and upper classes who paid cash for their custom prostheses. Veterans of lesser means could only afford a peg leg, and some would sell photos of their stumps (like baseball cards) to support themselves. Many veterans were not effectively reintegrated into the work force after their injuries, and were considered “charity cases” by the American public.

By the time World War I began, there was significant social stigma associated with amputation. Peg legs and hook arms were synonymous with “blood thirsty villains” like Captain Ahab from Moby Dick, and Captain Hook from Peter and Wendy. As America braced for a fresh round of young amputees, the government prepared occupational rehabilitation programs in an attempt to reduce deliquency among injured veterans. An entire PR engine was developed to set expectations that veterans would become “active workers, not charity cases.” And authors like John Galsworthy, began describing the vocational reintegration of war heroes as “sacred work.”

Around the turn of the 20th century, technology had advanced to allow mass production of various goods. Factories were created to produce large quantities of standardized items like clothing, and the corresponding reduction in cost revolutionized the standard of living for many poor and middle income Americans. Not surprisingly, enterprising individuals looked for ways to mass produce costly, custom products – and be the first to market with a new, affordable option.

Seizing on the opportunity that World War I created (i.e. a new market for prosthetic limbs), a couple of orthopedic surgeons recognized an opportunity to take over the prosthetic limb market by creating a “one size fits all” solution that they could sell to the government. The government was eager to avoid the costly mistakes of the Civil War (i.e. not having a plan for reintegrating young men into the work force), but couldn’t afford the prosthetist’s fee of $200 per custom prosthetic limb. The “E-Z leg” was born, and at a cost of only $20 per prosthesis, it seemed like a steal.

The E-Z leg solved a few problems for the government – 1) it allowed injured veterans to walk off the ships (instead of being carried on stretchers) that brought them home from Europe, thus minimizing the public appearance of the toll of war 2) it allowed them to offer cosmetically appealing prostheses, rather than peg legs, to amputees 3) it increased the vocational rehabilitation potential of veterans.

Of course, the “E-Z leg” didn’t have the best marketing ring to it, so it was rebranded the “liberty leg” and hailed as a triumph of modern technology. In reality, though, it wasn’t much of a functional improvement over a peg leg. In prosthetic design, a “one size fits all” approach ensures that no one gets a truly good custom fit. But psychologically, the veterans were pleased to have a cosmetically appealing limb, and most had no idea how much better a custom limb could be. The public was satisfied by the government’s generosity, not realizing that the government had actually budgeted $75/amputee at the beginning of the war. What happened to the $55 savings? We’ll never know.

One thing’s for sure, the orthopedist owners of E-Z leg made out like bandits. John Galsworthy became so disillusioned with his push for “sacred work” that he wrote, “Empty promises and rhetoric of heroism… The war killed the self-importance, faith and idealism in me.” He never spoke of vocational rehabilitation for war veterans again.


As I watched the NBC nightly news yesterday, I noted an interview with a young Marine recovering from bilateral leg amputations (caused by an IED explosion in Iraq) at Walter Reed. When asked if he was worried about walking again he simply replied, “I don’t worry about that. With the artificial legs they have these days, I’ll probably be better than ever.”

And I thought to myself, “the more things change, the more they stay the same.”This post originally appeared on Dr. Val’s blog at

Bravo To Intel: New Way To Keep Patients Out Of The Hospital

Intel just received FDA approval for their new in-home monitoring devices. The press release notes:

The Intel Health Guide enables caregivers to provide their patients with more personalized care at home, while also engaging and empowering patients to take a more active and positive role in their own care.

Intel said the interactive guide integrates vital sign collection, patient reminders, multimedia educational content and feedback and communications tools such as videoconferencing and e-mail. It can connect to specific models of wired and wireless medical devices, including blood pressure monitors, glucose meters, pulse oximeters, peak flow meters and weight scales.

Now this is a good idea – imagine how much pain and suffering we can alleviate by intervening in illnesses before they become acute? For example, when a patient with CHF begins to decompensate, physicians can intervene before the patient experiences severe shortness of breath and requires a hospital admission via the ER. What about catching a hyperglycemic episode early on? What about a hypertensive emergency that has no symptoms until very late in the game?

Avoiding the hospital can reduce exposure to infections, medical errors, insomnia, stress, and disorientation. Early intervention in disease keeps people out of the ER, and saves money and resources – while improving quality of life for the patients. The data gathering tools not only empower patients to be as independent as possible for as long as possible, but they empower physicians to care for their patients more effectively.

Unlike services that are aimed at replacing physicians, this one is designed to make them more efficient and effective. One day I imagine that a primary care physician will be able to keep an eye on her patients on one web page - with input from all the terminals combined into a dashboard. Alerts can be set at customized levels for different patients, and with a glance of an eye the physician will be able to see which patients may need help.

This is a brave new world of real-time health communication, and with technologies like this one, we may be able to bridge the gap between growing care needs and decreasing care resources while actually improving quality to boot.

Personal, affordable, telemedicine for the chronically ill. Bravo, Intel.This post originally appeared on Dr. Val’s blog at

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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