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Chip Implants: Ethical or not?


Would you want your loved one to have a radio frequency identification chip placed in her/his forearm? This is the debate that is going on at Alzheimer's Community Care in West Palm Beach, Florida. (AbcNews.Com)

The chip, which is slightly larger than a grain of rice, is implanted under the skin of the right forearm. Each chip will contain a unique 16-digit number that, when scanned in an emergency room, will link to the patient's medical records.
Seems pretty simple and straightforward to me. Taking care of Alzheimer's patients, I've always found it difficult to try to get all the information that I need when the patient presents to the emergency room in the early hours of the morning. Going through photocopies of information from the nursing home can be very confusing and time consuming. And, family members are not always available immediately to answer questions.
"This whole medical trial … really raises some pretty important issues about informed consent," said Katherine Albrecht, the founder of the advocacy group Consumers Against Supermarket Privacy Invasion and Numbering.
Officials at the facility state that this program is voluntary and issues of informed consent will be addressed with the patient and families before any procedure is performed. Ms. Albrecht continues...
"There are other technologies that are far less invasive and can achieve the same goal," she said.

Albrecht promotes the MedicAlert bracelet as the ideal way to solve the problem of Alzheimer's patients who cannot relay their medical information reliably. MedicAlert bracelets bear a recognizable medical symbol on the outside and have the patient's medical conditions listed on the back.

The article goes on to interview a couple of medical ethicists about their opinions about the placement of an identification chip.
But he [Jeffrey Spike of Florida State University] worries because the chip program has not yet been evaluated by a review board. Such a board, Spike said, would need to look at potential risks both physical and psychological -- and let prospective participants know their right to withdraw by having their chip removed or deactivated.

"If this has not been reviewed by [a review board], then it's natural to be suspicious that it has been carefully thought out," said Spike.

Presuming that the ethical and logistical details can be worked out (and I assume that they will), I don't see a problem with placing these identification chips in these patients. The wave of the future will be to somehow have your entire medical history easily accessible. I don't know if these ID chips are the answer, but they are certainly worth a try.

Going home


It's been a long week here in Lexington. And, it was a great conference. I didn't talk about it much more because of all the other stuff going on this week.

And, what a week for the "other stuff." What happened this week in the medical blogosphere is going to have repercussions for a long time. The silver lining is that there is more of an awareness now than ever before of the benefits and risks of medical blogging.

In case you were curious, I believe that the new blog is going well. If you haven't had a chance to check it out, I would encourage you to do so. We're accumulating quite a troupe over there and it's a good time. Join us for the fun!

Have a great weekend! It's time to head home (image credit). Hopefully, I'll be resuming "normal" blogging (whatever normal is) next week. Ek! I have to go back to work next week. That'll be fun....

Midwife reality check


Although I do not deliver babies or perform prenatal care, many of my family physician colleagues do. Some even perform C-sections. You probably didn't know family docs could do all that, huh. Well, with malpractice premiums going up and payment/reimbursment going down, it's getting harder and harder to find any docs doing maternity care. Even some ob/gyn docs are dropping the ob (obstetrics/maternity care) part and doing more gyn (gynecology).

A story in today's Washington Post is outlining the reality of the medical economic environment for midwifes. Apparently, there are two huge birthing centers that are going to be closing in the Washington area. Seven other birth centers have closed their doors over the past decade.

"There are countless women scrambling to find out-of-hospital birth support," said Mary Beth Hastings, 39, a board member of the new Birth Options Alliance. The group, with about 300 members, will advocate "for a full range of birth options" in the Washington area...
Now, in my experience, most women I've talked with have no problem giving birth at the hospital with their midwife at their side. What's interesting about this article is that it highlights the small percentage of women who are anti-hospital, anti-doctor, pro-birthing center, and pro-midwife. Here is the reporter's bias coming out...
For a relatively small but devoted group of women, the idea of giving birth in a hospital with a physician connotes unwelcome images of being tethered to machines, talked out of natural childbirth or talked into a non-emergency Cesarean section.

A birth center, they say, provides a more relaxed, homelike environment without anesthesia or C-sections. Others say they want the option of an epidural for pain relief in a hospital but believe midwives will provide more personal support and be less likely than physicians to intervene with machines, surgery or medication.

Like I said above, I don't deliver babies nor do I perform C-sections. But, I'm definitely insulted by the statements above. These people want it both ways. Sure, treat my pain and/or if there is a problem - well then I'll see a doctor. Other than that, keep doctors away from me. Why is the perception that midwifes are "better?" Well, it's because they see the less complicated cases - thus the birthing experience may be seen as "easier."
Most midwives treat only healthy women with low-risk pregnancies. Anesthesia, such as an epidural block, and medications to speed up labor are available only in hospitals, and only physicians may perform C-sections.
Here we go. You saw this coming. Starting to make the case for "those bad doctors." It's the bad doctors who are driving the midwifes out of business. Yes, it's the doctor's fault. Here is more bias...
Those same [financial] pressures are felt throughout the health-care industry, but birth centers are particularly hard hit because they operate on slimmer profit margins than most physicians, midwives said. Several also cited problems unique to midwifery, including the growing popularity of C-sections, which they don't perform. Moreover, unlike obstetricians and gynecologists, midwives can't offset lower health insurance reimbursements for office visits with higher-paying surgeries.
This article is so politically motivated it makes me sick. The columnist wants you to think that there is a lack of access to maternity care in the Washington area and that physicians are to blame for this. With smoke and mirrors, it's subtily making the case that midwifes, in an effort to increase access to maternity care, should be given everything from C-section to epidural privileges.

And, oh by the way, doctors should decrease midwife malpractice premiums and increase payment/reimbursement to midwifes. Like physicians have any control over that. Want to make an impact in that, well do what everybody else does and go up to Capitol Hill and lobby Congress like the rest of us have to. Good luck with that.

For too long, physicians have always been the punching bag for the press - and I'm sick and tired of that. Physicians have been the target of every "health care provider" and the reason why physician's scope of practice has slowly been eroded away - especially in primary care. I'd better get off my soapbox now. Suffice to say, I didn't like this Post article and I hope people see through it for what it really is.

Dr. Dork goes private


Very quietly this morning, Dr. Dork now is "open to invited readers only." Am I still an alarmist? Do people still think I'm making up the seriousness of this situation? You be the judge....

Perception IS Reality


Comments and analysis on the events of May 16, 2007 continue. Some are going to all this a juvenile analogy, but to me, it's feeling like Star Wars: Episode 3 when all the good guys are being eliminated - thus leaving the bad guys to take over the universe. (Yeah, I know, kind of cheezy.)

In reading Kevin, MD this morning, he has an interesting grouping of opinions of the meaning of what happened yesterday (and the trend of medical bloggers leaving the blogosphere). What's more interesting is the comment section. Some have made the accusation that this situation is being blown way out of proportion.

Has even one person filed one claim against a doctor for putting their info out? Can you guys be any more dramatic?
# posted by Anonymous : 9:18 AM

I am sorry to see that blog go, but it is not the death knell of med-blogging, the end times, nor dogs and cats, living together, nor physicians stripped of their first amendment rights.
# posted by For whom the blog rolls : 10:09 AM

I'm not going to respond to these, because the "comeback" comments are a lot better than what I could have written. I encourage you to check them out. I admit that in the big scheme of things, people like me may be causing some unnecessary hype.

But, when it comes to the medical blogosphere, I think that we're in the midst of the aftershocks of a seizmic event that culuminated with what happened yesterday. What does it all mean? I think people are still trying to figure it out. But, in trying to sense some trends, many medical bloggers are perceiving a problem out there and I really do believe that Perception IS Reality.

Here are two comments from the grassroots which really concern me:

This week I chanced across a blogger whom I recognise. Whilst I'm pretty sure they haven't yet recognised me, I'm certainly not going to take the chance of waiting and hoping. These betrayed bloggers ought to be evidence enough that it's better to be safe than sorry. For this reason, on the afternoon of Sunday the 20th, I'm going to make this blog private. (from Tea at Ten)

Wow. This reiterates why I am “anonymous”. But I do fear what has happened to Flea and Fat Doc. People are jealous, vindictive, and generally out to make others miserable while trying to make a buck off you. It makes me consider making my blog by invitation only. Which I would hate to do. (comment made on Emergiblog)

Perception IS reality. The "demise of the medical blogosphere" will not occur with the already established blogs with lots and lots of traffic. Their future is secure. What I am concerned about are those smaller blogs with less traffic (like mine), those who have just started blogging, and those who are considering starting a medical blog.

The demise will occur because of the lack of growth of the medical blogosphere from the grassroots. These people will (or already have) changed to private blogs. And, those who have not started blogging - they will be more hesitant to publically blog, or even blog at all. That's another reason for the "I'm A Blogaholic" blog - to try to catch these people before they leave the public blogosphere or to welcome those considering medical blogging (or any blogging for that matter) in a group environment.

Will the I'm A Blogaholic blog work? Who knows? Am I still blowing this problem out of proportion? Possibly. But, I feel that people are going to be voting with their feet - leaving or not even entering the public blogosphere and we won't hear about it until most of medical blogging has already been wiped out.

Time To Be Proactive


Wednesday, May 16, 2007 is a day that will be remembered in the history of the medical blogosphere. The demise of the Dr. Flea blog and the closing of the Fat Doctor blog is still rippling through blog land. Reactions that I've seen include the following: Moof, Kevin, Scalpel, Scanman, SuperStenoGirl, TBTAM, Rita. (sorry, i probably forgot a lot of other people out there)

This whole day I've had this negativity going through me - feeling sad, feeling scared (who will be next, me?), feeling defeated. Well, I'm here to tell the world that I'm not going to take it anymore. (image credit)

It's been more than a year since blogging found me and almost a year since I've had my own blog. Sure, I had my tough time a few months ago. Sure, I almost stopped blogging as well.

But what happened then? It's the same thing that's happening now. We're coming together to support our fallen bloggers. I still think that the medical blogging community is a strong one. We've seen a lot and we've been through a lot.

There are some out there who say that it's only a matter of time until the entire medical blogosphere fades away. "The lawyers are picking you off, one by one," someone sent me in an e-mail today. In my heart, I think that our community too strong to allow that to happen.

To try to get out of this negativity and to try to be proactive, I have an idea. I don't know if it's going to work, but I'm going to try it anyway. I want to try to reach out to those fallen bloggers out there who still have the urge to blog.

Curious and intrigued by this concept? I invite you to my new blog where people will gather for the love of blogging. Don't worry, I'll still have this blog (for the time being - HA!) The name of the new blog? It's simple -- I'm A Blogaholic. Check it out and join in the fun. You'll be glad that you did.....

Fat Doctor Gone Too

What the heck is happening out there? Just twelve hours ago, I posted about the demise of Dr. Flea. Thanks to a tip from Xavier Emmanuelle - I was notified that Fat Doctor has also closed up her blog.

Someone in my department printed out my blog and showed it to my boss. He tells me he didn't read it and won't interfere in what I do with my own time as long as I do a good job at work.

Still, I'm heartbroken.

Why, whoever did this, did you not come to me?

It's been fun, folks. I will miss you all.

What's going on out there? Who will be next? Hopefully, not me. Blog land is getting scary out there. I may have more to say about this later. Meanwhile, back my bored review lecture...

Bored Review - Day 4


After two days of sun and warm temperatures, today, it's raining and a little cooler. This is a perfect day to be stuck indoors for another eight hours of didactic lectures. (image credit)

Had some psych topics this morning - especially psychiatric illnesses in children and adolescents. I have some patients in my practice at home, but I really wasn't aware of the nationwide impact of these diseases.

In surfing the news today, I came across a Cnn.com and an article entitled, "Push To Achieve Tied to Suicide in Asian-American Women." Here's the alarming statistic from the Department of Health and Human Services:

Asian-American women ages 15-24 have the highest suicide rate of women in any race or ethnic group in that age group. Suicide is the second-leading cause of death for Asian-American women in that age range.
The article from CNN goes on to theorize that Asian-American families put a lot of pressure on their children to academically achieve. According to the researcher in the article, females are more affected than males. There are also cultural differences in which, "you don't question parents."

Growing up in an Asian family, with both my parents being Asian, I can definitely relate to some of this article. Of course, I cannot give an objective view of my family, but although I felt some pressure to do well in school, I did not perceive an overwhelming pressure to academically excel.

In talking with my friends through the years, I personally don't believe that this is a cultural thing isolated to Asians. A lot of people I've met from different nationalities have reported being pressed by their family to receive high grades. But, I do admit, anecdotally, of those who perceived parental pressure, most of them have been of Asian descent.

I guess the question is this: Does parental pressure to excel in school directly relate to suicide? This is an interesting question. The right answer for questions like this is always "multifactorial." However, I would agree with the author in that in the Asian culture there is perceived pressure being felt by Asian-American children/adolescents/young adults to excel academically. Is this good or bad? I guess it depends you to talk to.

Dr. Flea Disappears


Here's what Medgadget posted on January 19, 2007 in reference to the 2006 Medical Weblog Awards:
The winner of Best New Medical Blog is...

Flea, a weblog by an anonymous pediatrician "in solo practice in the Northeast U.S." On his website, Flea tackles many issues facing pediatricians today: from childhood obesity to anti-vaccination moonbats and their websites that scare parents with pseudo-scientific proclamations. Congratulations, Dr. Flea! Job well done.

Now, if you click on over to the Flea blog or on the Flea profile, you'll see that it's all gone (Thanks Carrie for the heads-up). If you have been following over there, you know that Dr. Flea is/will be going through some litigation.

It was actually an interesting series that he was putting together over there. But, probably his lawyer or the lawyers from the other side somehow found out about his blog and pulled the plug.

This is a concerning trend. There's been previous mention of Barbados Butterfly (in Grand Rounds) leaving the blogosphere. Cathy recently had her blogger URL hijacked. Now, there's no Dr. Flea. What's going on out there in blog land?

I know that I'm not going to be the only one saying this, but I'm going to very much miss Dr. Flea and his witty rantings. Dr. Flea, if you're still out there, you have an open invitation to guest post on my blog any time. Best of luck in your court case. We're all pulling for you.