Just venting

I've had all this pent up frustration in me this week because of last week's show. In this video post, I just wanted to get it all out in the open and out of my system. I didn't want to contaminate Thursday night's show without (kind of) resolving in my own mind what happened last week. So, I apologize for the whinnyness (is that a word?) of this video post, but at least I feel better and I can really focus on having fun again on The Doctor Anonymous Show.....

Med 2.0 blog carnival

I'm a big fan of Bertalan Meskó and his blog called Science Roll. If you haven't checked out his blog, I highly recommend it. He has an interest in genetics and in technology. And, I'm looking forward to having him on The Doctor Anonymous Show sometime soon in the future.

Many people are familiar with the blog carnival called "Grand Rounds." But, Science Roll anchors a blog carnival called "Medicine 2.0" where there are links and stories about web 2.0's impact on medicine and healthcare. I was pleasantly surprised to be included in the most recent edition of Med 2.0.

You should check out and follow the live shows of Doctor Anonymous.

There is even a BlogTalkRadio badge over on the Med 2.0 post. Thanks so much to Berci for mentioning the show and for including a BTR badge. I really appreciate it. I'm looking forward to when our schedules can match up for you to be on The Doctor Anonymous Show. So, if you've never experienced Medicine 2.0, check it out! You'll be glad you did.

You've been traded - To Japan

It's baseball spring training time again, and I've had enough of all the talk about steroids and congressional hearings and all that stuff. I heard about the video above last night. And, it's a practical joke that had one young recruit going until the last minute.

The way the video above goes, the young pitcher is brought into the managers office and is told that he is being "traded" to Japan for a player named "Kobayashi Iwamura." You can see that this guy is totally dejected - not only because he was traded, but because he's going to have to go to an entirely different country.

His next move is to let his teammates know what the news is. Of course, his team is in on the joke. Not only his teammates, but his manager, his agent, and the press who are interviewing him at the end of this video. Finally, to save him, one of his teammates say, "You've been Punk'd." I really felt bad for the kid, but in the end, it's all laughs.

Mac users are snobs?

This is according to this video report from The Street (via Insanely Great Mac and The Unofficial Apple Weblog).

The assertions made by this report include the following: Mac users more likely to use teeth-whitening products; Mac users bought on average five new pairs of sneakers in the last year; More likely to buy organic food; More likely to frequent Starbucks; More likely to own a hybrid car; Mac users are perfectionists; Prefer to drive station wagons; More likely to pay for downloaded music.

To me, this report is pretty funny. I hardly resemble any of the characterizations above or in the report. (I'll let you sort out which ones you think I am.)

But, I will not stand for this painting of a broad brush of all Mac users. There is too much discrimination going on in this country right now. Can't I stand on my own merits? Does the computer that I use determine the person I am and how you should treat me? I think not. I will not stand for this. I am a Mac, and I'm proud of it! YAY!

Flu Epidemic

(This is a continuation of part one from yesterday)

Last night got a little better for me. The coughing was still there, but not as bad. In fact, the coughing is still here right now as I write this. The muscle aches have pretty much resolved. And, to be honest, this was the main symptom that was bothering me. The headache and sore throat are continuing to improve. It's a good thing, because I'm on call tomorrow and the weekend coming up.

As I was doing more research this weekend, I found this article from the Associated Press from February 15th saying that this year's flu vaccine is effective for only 40% of this year's flu viruses.

Infections from an unexpected strain have been booming, and now are the main agent behind most of the nation's lab-confirmed flu cases, said Dr. Joe Bresee, the CDC's chief of influenza epidemiology. It's too soon to know whether this will prove to be a bad flu season overall, but it's fair to say a lot of people are suffering at the moment. "Every area of the country is experiencing lots of flu right now," Bresee said.

If you haven't seen it already, check out the map on my previous post from the CDC which states that most of the country is under the "Widespread Flu" designation. Now, I know what everybody is going to say, "Well, Dr. A, why even get a flu shot if it's going to be 40% effective?"

The way flu vaccines work is that they have to try to predict ONE YEAR in advance what the flu viruses are going to be. For the most part, they have been right. But, as I have been seeing in interviews over the weekend, researchers have been playing the "cover your butt" game saying things like - "We predicted that sometime in the future we would be wrong and there would be a flu epidemic."

In my book, 40% is better than 0%. Here are the facts from the CDC. Every year in these United States, 36,000 people die each year from the flu and more than 200,000 are hospitalized from flu complications. These complications may vary from dehydration to respiratory failure and needing to be on a respirator or breathing machine. Now, wanna flu shot? Well, it takes weeks to get working in your system. That's why the big push is in the fall to get your flu shot.

Another interesting observation is that the popular media has not really picked up this story yet. Usually, they are all over stories like this to cause panic in the public. They usually love driving patients to hospitals and doctors offices and having patients demand flu shots and prescriptions for meds like Tamiflu.

My prediction will be that when this flu story starts to intersect with the story of the presidential primary process - that's when you'll see headlines like "Flu Epidemic" all over the place. Three states vote on Tuesday and four states vote on March 4th (including my state).

You'll see headlines like, "Disenfranchised voters have the flu - especially elderly; unable to appear at voting station due to illness." Then, you'll see candidates trying to take political advantage of the flu. I hope I'm wrong. But, if not, you heard it here first. I'm Dr. A, and I approved this message....

Gov. Strickland has marching orders

This is definitely not a political blog. But since the US presidential nominating process is going to be rolling through my state 16 days from now, I thought that it may be interesting to make a few observations. Channel surfing this evening, I saw the interview above, which I thought was fascinating.

The interview has two governors from the same Democratic Party who are supporting two different candidates for the nomination. The first is Governor James Doyle from Wisconsin (pictured to left above) who is supporting Sen. Barack Obama for the Demorcatic Presidential nomination. The second is Governor Ted Strickland from Ohio (pictured to right above) who is supporting Sen. Hillary Clinton. I have particular interest in this because Gov. Strickland was my congressman before being elected to the Governor's Mansion.

Even if you don't know anything about politics or don't care about politics, I encourage you to check out this eight and a half minute interview. I think it will summarize what is happening in this race. You'll see Gov. Doyle enthusiastically supporting his candidate. He seems very calm and more conversational.

Meanwhile, Gov. Strickland seems very tense, and at times defensive. It looks like he was given the talking points to repeat time and time again during the interview. It looks like he's been put under a lot of pressure to deliver Ohio to the Senator from New York.

Finally, the most interesting answer I saw was when Gov. Strickland was asked whether he would accept the Vice-President position if it was offered to him. "I don't want to be Vice-President," was his first response. That's telling me either that he was told to say that, or he's looking ahead to 2012 for a Presidential run of his own.

One thing that I think will definitely happen is that if Ohio does go for Hillary on March 4th, and if she is eventually elected president, Gov Strickland will be moving back to Washington - probably in a high-up cabinet position - because, basically, that's how politics works. And, if anything else, Ted Strickland is a good politician. I'm Dr. A, and I approved this message....

Influenza Case Study: ME

The following is a anecdotal case study of a guy who has influenza. I apologize in advance for the long post. But, if you want to know how it feels to have influenza, read on. As you can see from the graphic above from The Centers of Disease Control and Prevention, the flu epidemic is practically nationwide.

Here's my story. I was on call the day before Valentine's Day. A typical busy day and night - having to go back and forth into the emergency room to see people. While making rounds on Valentine's Day, I was talking with some people who said the hospital was starting to see cases of influenza. Of course, those words passed right by me because I got my flu shot last fall.

A few hours before the worst. show. ever., I was starting to feel some muscle aches in my legs. And, then, I was feeling pretty tired. But, I always feel tired after being on call. I mean, you hardly get any sleep. I was hoping to sleep things off and feel better in the morning.

The next morning comes, and the muscle aches are still there. A new symptom, a cough, appeared over night. "Oh great," I thought to myself. "I'm starting to get another sinus infection." I'm getting a little sore throat. I'm getting that typical sinus headache. I'm thinking to myself that it's Friday and I can get through one more day of work and I can nurse this sinus infection over the weekend.

My first patient in the office is at 8:30am. As each hour goes by, the aches in my legs become more and more apparent. You know the feeling of overdoing a workout after you haven't been to the gym for a while. That's what my legs felt like - only I really haven't been to the gym in a while. The fatigue was starting to become overwhelming. "Why am I so tired all of a sudden," I'm asking myself. The cough develops more during that morning. So, much so that my patients started to remark on my cough.

Then, I did something that I have almost never done before. I went home to lie down so that I could try to get some energy for and entire afternoon of seeing patients. "Four more hours," I kept telling myself. Even I can get through four more hours and then take care of this illness over the weekend.

As each hour went by, I was walking slower and slower down the hall to and from my office. The body aches were bad, the headache was pounding, the cough was overwhelming at times. At three o'clock I heard from the front desk that three patients wanted to come in right now to the office if they could. Part of me really wanted to say, "Oh yeah, I'm feeling sick, too. And, I want to go home early today for the first time ever." But, I told them ok, I'd be happy to see them.

I finally finished past 5pm. I didn't do any of the paperwork (it's still sitting on my desk). As I was leaving the office, one of the other docs said, "Sounds like the flu to me." What? I had my flu shot. But, even Dr. Val says that It Doesn't Always Work. As like other docs, I'm a terrible patient and I hate taking meds unless necessary. But, I did start Tamiflu about 24 hours ago.

Last night was tough - tougher than the night before. The muscle aches, the cough, the headache, the fever and chills, the night sweats - needless to say, I did not get too much rest. I was even up in the middle of the night to watch reruns of MASH (what a great tv show).

Now, finally, I'm just starting to feel a little bit better - at least better than yesterday. The body aches are pretty much gone. The cough is still there but not as bad as last night. The headache and sore throat are still there, but not as bad as last night. The fatigue is still kicking my butt. I've been sleeping most of the day....

Whoa. That's all I have for now. Another wave of fatigue has gotten a hold of me. I'm feeling tired again. Going back to bed. Hopefully, more to comment on soon. We'll see what tonight brings.....

Worst. Show. Ever.

I'm so mad right now that - that - I don't know what I could do. I'm just venting. You know this is what happens when I really try to promote a show. The problem started from the first minute. There was this annoying echo that I could hear. At first, I thought that one of my guests was causing the feedback, but it wasn't.

The echo really threw me off for the entire show. It felt like I was in a tunnel for the entire thing. Thanks so much to Dr. Val, Jenni, and Crzegrl for sticking with things and wanting to go forward with the show. Thanks also to Mother Jones who called into the show to add some banter.

What we found out later was that the audio from my show was cutting into the audio of another show. The host of the other show called in and explained the problem. Seemed like a pleasant chap, but what I found out later was that they were encouraging people to get into my chat room and call in to disrupt the show - that's not cool.

I haven't heard the audio yet from the other show, but that is what I've been told. I guess that other show had nothing else to talk about because they ended their show 30 minutes early. I guess after my audio stopped messing up their show, they had nothing else to talk about. But, I'll have to listen to their show to see exactly what they were talking about.

So, for those of you who listened to the show live - I really appreciate you listening. I apologize for the bad audio, and I'm sorry that the other show was disrupting things. I'm going to try to contact BlogTalkRadio to see what the problem was. If I don't get a satisfactory answer, I may have to move the show over to Talkshoe. I think they would appreciate a medblogger talk show host. Don't you think? Have a great weekend, everybody!

Estrofest Live TONIGHT

Thursday, February 14th, 2008 at 9pm Eastern Time

Finally, officially, Happy Valentine's Day, everybody. Don't forget to join us tonight for The Doctor Anonymous Show for the Valentine's Day Estrofest.

What is it and how did it come about? Well, Dr. Val, one of our panelists tonight explains it in this post. Also, scheduled to be on the show will be Jenni from ChronicBabe.com, Crzegrl, and EE. Who knows what we are going to talk about? You'll just have to tune in to find out!

Also, take part in the chat room, which is the "show within the show." A great opportunity to interact with medbloggers you've only read about. You can even call into the show to talk and/or ask a question. See you tonight!

For first time Blog Talk Radio listeners:
*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.

*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.

*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.

*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!

Fewer Primary Care Docs

In a shocking report (not really) released by the General Accountability Office (ie - the US federal government), they stated that there are fewer primary care docs now than there was about 10 years ago. The first thing I have to comment about is the name - "General Accountability?" - What's up with that? To whom are they accountable? Let me answer that - nobody!

Anyway, in this Associated Press article, the report goes on to say that in 2006, there were about 22, 146 American docs in residency programs across the United States. In 1995 (when I was in medical school), the number was about 23, 801. For the next few years after that, the number plateaued. Then, right when I graduated is when the fall started to happen.

"It is troubling to me that the number of Americans pursuing a career in primary care has declined," said Sen. Bernie Sanders, I-Vt. Overall growth in the number of primary-care physicians "has been totally due to the number of international medical students training in America," Sanders said. "We are increasingly dependent on international medical school graduates to meet our needs. Currently, one in four new physicians in the U.S. is an international medical graduate."

These quotes just kill me. What do you mean legislators and the federal government don't know and cannot explain why this happened? It confuses and frustrates me because they are the ones, in my opinion, that CAUSED this situation. They did choose and continue to choose to reward specialists, especially those doing procedures, the higher payments. What happened when they did that? Read on...

For specialists, the number of Americans in training went from 45,300 in 1995 to 47,575 in 2006 and over the same period international specialists grew from 11,957 to 12,611, GAO said.

Does anyone know who that is a picture of at the top of this post? That guy is Willie Sutton. That name should ring a bell to some of you - especially history buffs out there. He was one of the most prolific bank robbers of the early 20th century. When asked why he robbed banks, he is attributed with the famous quote, because "that's where the money is."

It's not rocket science. Why did the number of specialists grow during this time? Because that's where the money was (and is). Why did the number of primary care docs shrink? Because that is where the money is not. And, who is filling that primary care gap? It is international medical graduates.

I don't want to start an entire international medical graduates debate. I'm just saying that if graduates from US medical schools are not going into primary care (and that is happening), who are going to fill those residency/training spots?

So, one of these days, the legislators and the government will figure it out. Unfortunately, it will not be until medicare, medicaid, and social security go bankrupt. Or, when the voters (meaning patients) rise up and tell the government something like "Fix the Health Care System Now." Oh yeah, isn't this an election year? Maybe this year? But, probably not....