Lordy, Lordy: Grand Rounds 40

David Williams' Health Business Blog is hosting Grand Rounds XL (though it looks the appropriate size). Go check out the latest and greatest from medical bloggers around the world, and get your submissions to Medical Connectivity for next week.


Today, Lileks compares antique stores to funeral parlors -- the sadness that surrounds forgotten treasures of our past, abandoned when we go off to school. Coincidentally, I was just musing to a friend about my old Snoopy pencil-case today, which always signified the end of summer and start of another year of elementary school.

It's taken twenty-five years, but I'm not a student anymore. Tomorrow is my first day of work.

I wish I had more to say, more I could articulate about this transition. I'm going to try to heed Doc Shazam's advice, and record my early impressions of doctoring and internship. But for these past few weeks, it seems I've lost my voice. Blogging, for me at least, requires some modicum of stability, and these heady times have been anything but stable.

But I've found a new home, and a busy schedule is about to be thrust upon me. Order will reassert itself soon enough. And as Ben Folds reminds us on his new album, it's not wise to get nostalgic about the last ten years, before the last ten years have passed.

I think I get what he means. But of course, it's his song about airlines and new beginnings that really speaks to me:
If you wrote me off, I'd understand it
'Cause I've been on, some other planet
So come pick me up... I've landed.

The entry below is actually something I wrote a few weeks ago, around graduation, but couldn't quite bring myself to post. Now seems like a good time to clear out the drafts -- a new wave of experiences begins in a few hours.


Graduation week alone should be more than enough to consume me, with its good-byes, fond remembrances, and the commencement of a grand and challenging career.

But add to the mix the ups and downs of apartment hunting, furniture shopping, trying to find a home for my cat and my car, a bachelor party in Cancun, and making sure I'm sufficiently overexposed, in print and on TV. I've got a full plate.

It's been over three months since I've seen a patient, and I'm missing it. This weekend our class heard some speeches about the privilege and noble duty of medicine, of treating the sick. Among the things that have stayed with me is a talk honoring a faculty member who passed recently. The speaker said:

"She was so enthusiastic about connecting with patients, really, deeply connecting. She sometimes called those encounters 'Level 5 Interactions' -- I have no idea what that means but it sounded really intense."

I think I know what she was talking about (and it's not hospital billing codes).

I think I need those kinds of encounters to stay grounded. I sometimes worry if that's pathological, but frankly, there's more pathology in the extremely fun but ultimately superficial interactions that have preoccupied me since I got back from Greece.

Our graduating seniors take the Oath of Maimonides, and the excerpt below seems particularly relevant:

The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily decieve me and make me forgetful of my lofty aim of doing good to Thy children.

I'm very, very lucky to be in medicine, and to have such family and friends.


The phenomenon that is medical blogging receives coverage in today's LA Times. The reporter, Marianne Szegedy-Maszak, chose to focus on physician blogs, but that's ok, what with me now being a physician and all. My Medgadget colleagues, Dr. O and Dr. Bradley, are also featured.

And I like how she introduces the topic:

The family pictures on the desk. The diplomas on the wall. A few magazine subscriptions, perhaps, or some sailing, tennis or golf memorabilia scattered around the office. In the past, a curious patient could only turn to these bits of evidence to try to know more about the individual behind the medical degrees, the white coat and the carefully scripted bedside manner.

The temptation is understandable. After all, when someone holds your life in his or her hands, it would be nice to know a bit more about what makes them tick. But today, anyone with an Internet connection can have access to the fevered, funny, angry and very human thoughts of these men and women who help us navigate the perilous shoals between illness and health. The vehicle? The doctor's blog. A blog is the name used to describe a weblog, the constantly updated platform for the idiosyncratic and highly personal musings (or rantings) of anyone who wants to set one up in cyberspace.

"It's a direct line to see what doctors think that you won't pick up in the office or from television shows," says Michael Ostrovsky, a cardiac anesthesiologist in Daly City, Calif...

I'm consistently surprised about what makes it into the final version of a story. For instance, the reporter and I were discussing how bloggers discover each other, how we cross-reference posts. Sure, there's medlogs.com, and now Grand Rounds (which she graciously acknowledged). I also mentioned one post which really seemed to put me on the map last year -- "Hard to Swallow", a pun-laden critique of a Austrian nose-picking advocate.

Well, very little of the conversation about blog cross-linking and meme propagation made it into print. But, naturally, my views on nose-picking are prominently excerpted in the sidebar (in stark contrast to the really insightful quotes from Dr. Charles, the Cheerful Oncologist, and others -- I suppose it's appropriate that the print debut of "Dr. Nicholas Genes" is a little... juvenile).

At any rate, the article provides a good survey of doctor blogging, and the various motivations behind it. And the reporter leaves her readers (and interviewees) with some good questions: will blogging improve the doctor-patient relationship? Will it help disseminate medical data amongst peers? Will it "spawn the next Oliver Sacks?"

I've tried to be cognizant of the risks in believing our hype, of overestimating the potential of medical blogs. So it's exciting to hear an outside reporter asking these questions. And I look forward to learning the answers, in the coming years.

Lacrimation Day

I was standing in the buffet line of one of the many graduation fetes this weekend, next to a dear physician on my school's faculty. But she was suffering:

Distinguished faculty: My eyes are watering, my nose is running, I feel awful.
Me: Allergies?
Distinguished faculty (chuckling): Yeah, how could you tell?

I smiled back and said, for the first time, "Well... I am a doctor."

Not surprisingly, at the ceremony today, quite a few of us graduates, faculty, and family members got a little misty-eyed. Must be the pollen.