The John Halamka Interview

The Doctor Anonymous Show is proud to welcome John D. Halamka, MD who is the Chief Information Officer of Beth Israel Deaconess Medical Center in Boston. He is author of the blog called Life as a Healthcare CIO.

I did want to share a couple of excerpts from his blog - The first of which I call the "Geek Doctor" portion from a post entitled "Designing the Ideal Electronic Health Record:"

I was posed a simple question - If I had infinite resources, infinite time, and no legacy compatibility issues, how would I design the electronic health record of the future?

The web is the way. Given the 24x7 nature of healthcare, the need for physicians to be in many physical locations, and the multitude of clinician computing devices, the ideal EHR should be web-based, browser neutral and run flawlessly on every operating system. I highly recommend the use of AJAX techniques to give physicians a more real time interactive experience. Client/Server may have some user interface advantages, but it's just too challenging to install thick clients on every clinician computing device. Citrix is an expensive and sometimes slow remote access solution. Native web works.

For the non-geek part of the blog, I reference a post simply called "Go Climb A Rock:"

It's Thursday, so it's time for a personal introspection blog. At times I get quizzical looks for being vegan, playing the Japanese flute, or wearing black. However, the most unusual looks from my peers occur when they see photos like this one of Dark Shadows on Mescalito North in Red Rocks, Nevada.

Winter mountaineering is a good way to get away from your cell phone (the battery life is 2 minutes at -40F), but why climb a rock? Think of climbing a mountain as a giant Rubik's cube - a wonderful mental exercise. Climbing requires a well orchestrated combination of gear, route finding, movement, and teamwork to make it to the top.

So, needless to say, this is interesting stuff. So, tune in Thursday, May 1st at 9pm Eastern Time where we will be talking about his blog and a whole lot more. You can also join us in the live chat room or even call into the show to ask us a question. Check back here tomorrow for details!

Praying parents of DKA child charged

You may remember this story from last month. An 11 year-old girl died following the complications of untreated diabetic ketoacidosis (DKA). Now, DKA is a serious condition and strikes fear in anyone who has diabetes. However, if recognized early, this is a treatable. And, for the most part, DKA has a good recovery rate.

The parents of this child did not see it necessary to seek medical attention for their daughter. Instead, they felt that faith alone along with prayer would be enough to heal their daughter. This Associated Press story continues:

Madeline Neumann died March 23 -- Easter Sunday -- at her family's rural Weston home. Her parents were told the body would be taken to Madison for an autopsy the next day. "They responded, 'You won't need to do that. She will be alive by then,"' the medical examiner wrote in a report.

Family and friends had urged Dale and Leilani Neumann to get help for their daughter, but the father considered the illness "a test of faith" and the mother never considered taking the girl to the doctor because she thought her daughter was under a "spiritual attack," the criminal complaint said.

The story states that each parent may face as many as 25 years in prison. What's unfortunate is that I don't think that these people really care about that. They probably still feel (and will always feel) that they did the right thing in not seeking medical attention. I do not see any remorse in these parent's future.

Now, I consider myself a spiritual-type person. But, as I read story after story after story of what people do in the name of some higher power somewhere - it really frightens me. For the most part, I still believe that there is more good in this world. But, even my faith gets tested sometimes. And, this story is one of those times....

Medical Marijuana discrimination?

Here is a simple, yet, controversial question: If someone has used marijuana - even if used for medical reasons - should this prohibit him or her from being considered to be on a transplant list? Hospitals throughout this great nation struggle with this question every day.

Timothy Garon (pictured above) is a patient at the University of Washington Medical Center. He has end stage Hepatitis C and, according to this Associated Press story, may be in his final days without a liver transplant.

But Garon's been refused a spot on the transplant list, largely because he has used marijuana, even though it was legally approved for medical reasons. "I'm not angry, I'm not mad, I'm just confused," said Garon, lying in his hospital bed a few minutes after a doctor told him the hospital transplant committee's decision Thursday.

With the scarcity of donated organs, transplant committees like the one at the University of Washington Medical Center use tough standards, including whether the candidate has other serious health problems or is likely to drink or do drugs. And with cases like Garon's, they also have to consider — as a dozen states now have medical marijuana laws — if using dope with a doctor's blessing should be held against a dying patient in need of a transplant.

Now, according to the American Liver Foundation, in 2005, approximately 6500 liver transplants were performed in the United States. Also, according to the site, it states that about 17000 Americans are on the liver transplant list. Interestingly enough, the CDC website states that the number of new infections with Hepatitis C has decreased from 240000 in the 1980s to about 19000 in 2006.

The issue of who should and who should not receive a transplant is always controversial. I think the issue of use of marijuana is interesting as I have blogged about it before here, here, and here.

Even though this gentleman's story is very compelling, I'm going to have to side with the hospital on this one. I agree with what was said by Dr. Robert Sade, director of the Institute of Human Values in Health Care at the Medical University of South Carolina. "Marijuana, unlike alcohol, has no direct effect on the liver. It is however a concern ... in that it's a potential indicator of an addictive personality." (And in my book, not a good candidate for a transplant.)

Show 32 Wrap-up

Thanks so much to my guests Kevin MD and Dr. Val for coming on the show. (See video post above) Not only did Kevin talk about his recent USA Today Op-Ed piece, but also why physicians should write opinion pieces for blogs, for newspapers, and other media sources.

Dr. Val talked about her great week which included her interview with the former surgeon general of the United States, her Grand Rounds hosting experience, her running of a conference call celebrating the first year anniversary of Revolution Health, and her quote in the Wall Street Journal.

I was only able to schedule 60 minutes live time and we went another 30 minutes over. In this last 30 minutes, we talked about personal health information out there on the internet. Great conversation and springboard for our guest next week who is John Halamka from GeekDoctor.

Thanks also to my callers MexicoMedStudent and Dr. Rob. I appreciate you contributing to the conversation. Thanks to those who were able to join us in the live chat room. And, thanks to all of you for listening to the show either live and/or on the archives. I really appreciate everyone's continued support of the show. Have a great weekend! (Don't forget to rate the show right here!)

Dr. A Show 32: Kevin MD & Dr. Val

Thursday, April 24th, 2008 at 9pm Eastern Time

Join us tonight for The Doctor Anonymous Show . Isn't it great how things come together? Two days ago, I had zero scheduled guests. But, how things change almost overnight... (See video post above)

I'm very happy to announce that Kevin MD will be back on the show to talk about his 4/23/08 USA Today Op-Ed piece entitled "Wasted Medical Dollars" talking about the reality of the practice of defensive medicine. As of this posting, there are already about 30 total comments on Kevin's site and on the USA Today site. Interesting discussion.

Normally, that would be enough for one show. But, wait, there's more! Dr. Val will also be joining the show at some point to discuss a bunch of things. First, Revolution Health is celebrating their one year anniversary and she was part of the festivities on that. Second, last week, she interviewed the former US surgeon general and that interview will be going up on her site soon. Finally, she hosted Grand Rounds this week. Sheesh! I'm tired just reading this. So, hopefully, she'll be updating us on how here week has been going.

Here are some other things that we may talk about:
*Hilarious post from Aggravated DocSurg called "We Don't Speak the Same Lingo"
*Clinical Cases and Images blog asks "Has Blogging Peaked?"
*Awake in Rochester wonders "What Do You Do When Someone Blogs About You?"
*My post about Preventing Prostate Cancer. Ugh.

You can even take part in the chat room. It is truly "The show within the show." You can even call in and say hello. A great opportunity to interact with medbloggers you've only read about. See you later!

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!

Prevent Prostate Cancer: Masturbate

The scene above is from Seinfeld. The episode is called "The Contest." The phrases "master of my domain" and "king of the castle" are in this episode. Check it out above to see the beginning of the episode. What does this have to do with preventing prostate cancer? Well, I'll let the story below explain itself:

Men who frequently masturbate appear to have a lower risk of developing prostate cancer, Australian researchers reported. Researchers from the Cancer Council of Victoria found that men who masturbated more than five times each week were one-third less likely to develop the cancer.

Researchers told the BBC last week that the prostate produces one of the fluids involved in ejaculation and that frequent masturbation appears to flush out carcinogens. Sexual intercourse may not have the same effect because it increases the risk of contracting a sexually transmitted disease, which could raise the risk of cancer.

Uh, yeah. Can you see me giving this advice to my patients? However, I can see some people bringing me this story this very afternoon and asking me about it. Usually for research studies, I say that I need to see more studies done. But, in this case, I think I'll pass on that. What do you think?

Update: This afternoon, US News & World Report is now questioning this entire study and story - even questioning the FoxNews.com quote from above. It really doesn't matter to me. It's kind of a funny story. But, I guess it shows that even the masturbation deniers are out there! hehe

Kevin MD & USA Today

Kevin Pho, from the Kevin MD blog (and former guest on The Doctor Anonymous Show), is one of the most recognized medical bloggers out there. This morning, Kevin has an op-ed published over on the USA Today website about defensive medicine entitled "Wasted Medical Dollars." Here's an excerpt:

A recent analysis by PricewaterhouseCoopers concluded that more than half of the dollars in our $2.2 trillion health care system are wasted.

Medical errors, inefficient use of information technology, and poorly managed chronic diseases were all cited as factors. Dwarfing these reasons is a phenomenon in which doctors order tests to avoid the threat of a malpractice lawsuit. This is known as 'defensive medicine.'

At $210 billion annually, defensive medicine is one of the largest contributors to wasteful spending, and it can manifest in many forms: unnecessary CT scans, MRIs, cardiac testing and hospital admissions. A 2005 survey in the Journal of the American Medical Association found that 93% of doctors reported practicing defensive medicine.

Kudos to Kevin for not only bringing more light on this subject, but also bringing more light onto the medical blogosphere through his writing and opinions. Spread the word about his op-ed today. Blog about it. This topic is very important, and Kevin has done so much for our blogging community. Keep it up, Kevin MD!

Reality Check: Surgeon Shortage Looms

There have been many in the medical blogosphere who have (correctly) predicted the soon-to-be disaster of a shortage of primary care physicians. I, of course, agree with my primary care and family physician brethren on this point.

Well, now, there is new data from the University of Washington stating that General Surgery as a specialty is soon going to be in a world of hurt because - frankly, there are no medical students going into it. Obviously, this is part of the super-specialty revolution where generalists - whether they be general medicine physicians or general surgery physicians - are going to be more rare.

I find it ironically funny (in some strange way) that the quote below used to describe the shortage for general surgeons is vaguely familiar and kind of deja vu like when I remember why medical students are not choosing primary care:

Young doctors put a higher value on their personal lives, making fields that require frequent and unpredictable hospital duties less attractive, said Dr. Dana Lynge, a general surgeon and lead author of the study from the UW. In addition, he said, many students leave medical training with a "mountain of debt" in school loans. By necessity, they are looking for careers that will help them get out of the hole. The combination of less-demanding fields and more lucrative payoffs draws students away from general surgery.

We're definitely feeling this in our small little community in Northeastern Ohio. When there is a demand like this, students who actually choose general surgery can go wherever they want. Why would they want to come to NE Ohio? So, recruiting new docs (in all specialties) has been difficult and will be difficult.

So, to the leaders of the general surgery specialty, all I can say is "I feel your pain" and "Welcome to my world." If you figure out a way to somehow increase the supply of general surgeons, let me know, because I'll "steal" your techniques to try to increase the primary care physician workforce. Because without primary care PHYSICIANS (not just primary care "providers"), general surgeons (and other specialties) will have no referral base. How 'bout them apples!

Grand Rounds

Grand Rounds 4.31 is now up and running over at Dr. Val and the Voice of Reason. She has grouped the post by feeling, which I don't think has ever been done before. And, she added a little cute tagging system to point out the especially good posts of the week.

I admit that I have been a slug and not writing as much and contributing to Grand Rounds. I feel badly about that. But, I'm feeling a little resurgence, so maybe the posts will start flying again. Thanks to Dr. Val for including my post this week:

Dr. A from Doctor Anonymous wonders if peace and contentment come from accepting one's lot in life. His post is called, "With Age Comes Happiness?"

If you don't know what Grand Rounds is, it is a weekly compilation of the best posts from the medical blogosphere that moves to different sites each week. And, who doesn't like reading about medicine and science? Next week, Grand Rounds moves to the site called Doc Gurley.

Pee brings the world together

Now, you're going to think that I'm totally making this story up and that it's untrue. Well, it's from MSNBC, so you can make your own conclusions there. Anyway, here's the first sentence from the story, "Pee from more than 4,000 volunteers shows that people from different nations often have spectacularly different metabolisms."

And, off we go! Ok, so, I'm trying to visualize the newspaper ad that had to go out on this one: "Seeking pee from people worldwide for research study." And, they got 4,000 people to participate? Fascinating. What did they find? Well, different people from different nations had different metabolites in their urine (no kidding).

"For instance, Chinese and Japanese people are almost identical genetically, which isn't surprising, since they diverged culturally only a few thousand years ago — but they are very different metabolically," said researcher Jeremy Nicholson, a biological chemist at Imperial College London.

"We know there's a huge difference in the diseases that different nations risk — broadly speaking, the Japanese tend to die of strokes, the Chinese of heart attacks — and we see those differences reflected in their urine," he added. "Of course they're different in terms of lifestyle — the Japanese tend to eat more fish than the Chinese as a whole do — but their gut bacteria are also very distinct as well."

Now, why is this important? According to the article, the substances found may help shed light on things like diabetes, vascular diseases, obesity, and even cancer. Sure, that's great. But, I'd hate to be the poor freshman college student asked to do all the grassroots work on this paper. Is getting a published research paper worth it to work with all this urine? I guess so. Wonder what the follow-up research will hold?