Dashing MD

I can't imagine there's many of you out there still checking the podcast or the blog, after all these months. But if you're still out there, I don't want to be one of those blogs that just fades away into the ether. Now, granted, it's probably a little late for this but: good bye.

This project was a delight. In many ways, it was a salvation. But time moves on, and the way I tell my stories has moved on with it. I'm doing well, having fun, and exploring a number of exciting ways to bring the stories of medicine to the outside world. I hope you'll see some of them sometime soon, but when you do, it will be under a real name.

Farewell, fair winds, and be well.

-D, M.D.

One of the newest trends in medicine is data mining -- taking vast reams of data drilling down into it to find answers to unexpected questions.

Here's a great example of that -- using the locations of Google searches for the symptoms of diseases to track outbreaks . This sort of thing is the future of science, where getting the data won't be hard, but finding what you want in it will be.

D, M.D.

The Obama/Biden Transition team has the best named website around:

change.gov

It's worth perusing for many reasons. Here are three.

One: it's just a nicely designed site.

Two: it has all sorts of little indicators of the way this administration is going to be run, such as a flow chart of the executive branch that puts it UNDER the constitution and includes the Office of the Vice President.

Three: it's got a link where you can apply for a job with the administration. And my personal feeling is that if you believe in these people, and more importantly you believe in what these people stand for, then you should apply and see what happens. You should give them the chance to refuse you. This is not difficult -- the form is very short .

I did it this morning. Not sure what I'll do if they actually ask me to take a job with them, since it would disrupt my medical training something awful, but I'll cross that bridge when I come to it.

D, M.D.

Well folks, I'm back again . And reading from the mailbag, where Amanda writes in with some great questions about naturopathy.

Also, in the podcast, I mistakenly refer to graduates of Osteopathy schools as ODs. This is what's known, in this political season, as a gaffe. They are actually DOs. Apologies.

Here are some associated links, if you want more:

Here's a Wikipedia article on Naturopaths ...it's interesting for some basic information on naturopathy, and it's also a fascinating exploration of how Wiki articles are made and debated about, if you look at its associated discussion page .

And an article on placebos .

The good folks at South Park have addressed this issue , too.

This week's case (an exercise that I'll make a regular feature if you guys like it):

An 88 year-old woman with a history of advanced breast cancer 30 years ago, and a bad history of high blood pressure and osteoarthritis complains about her right hand, which is turning white. Her primary care doctor can't find a pulse, but he sends her to a vascular surgeon who can find a signal of a pulse using a doppler. He tells her to come back in a month. What do you tell her?

Enjoy! And keep in touch!

D, M.D.

You responded to Episode 24 with aplomb, I have to say. Tons from the mailbag -- enough to form an entire episode. We hear from Moof on why I should be a doctor, ZeroRocker on why he wants to be one too, and another emailer with some compelling questions on transplants.

In 26, look for a diagnostic puzzle...coming soon(ish)!

Until then, enjoy, and keep the conversation going!

D, M.D.

P.S. In this episode, I talk about how altruistic liver donation doesn't happen in the US. Turns out there are a few programs starting up, slowly, and with a lot of trepidation.

I know, I know...

You could argue, rightly, that I already went. But hey, I'm back, and glad to be here. No drama, no amnesia, no fugue state in which I woke up months later washing dishes in a diner in New Mexico, no kidnappings or secret missions. Just a lot of living, and then, towards the end, some technical difficulties.

But I'm back, and here is Episode 24 . And here is the link to the article from the NYT that I talk about therein.

Keep in touch. I'll do the same.

Hi All,

First, a very happy New Year to you all! I'm really excited about where this podcast is headed, and about this first episode for 2008.

This episode is in three parts:

Part 1: The story of a recent tragedy, and what it makes me remember and consider.

Part 2: A look at a couple of recent issues that have appeared in the mainstream media that have direct implications on surgery. The first is a story from This American Life about a heart transplant recipient who comes to know her donor's family...I have a few thoughts on what a bad idea that is.

The second is an article by Atul Gawande that appeared recently in the New York Times, telling a story about the latest example of research methods and research ethics failing to agree on what's best for patients. A really interesting read.

Part 3: I've been struggling to figure out where the podcast is headed. Now, I'm also struggling to figure out where I am headed. Which, at the very least, gives me a sense of some things to talk about in the weeks to come.

Enjoy ! As always, look forward to hearing your thoughts!

So. A year. Amazing. Both in how long it seems, and how it seems like just last weekend I sat down and wondered "what's this podcast thing all about."

I'd thought about a greatest hits episode, but in the end, with questions from the listeners waiting (very patiently) for answers, I went for new content. Hopefully that will be the theme of Year 2.

The poem I read, Miniver Cheevey, can be found all over the Internet, but here's one place .

My Facebook account, discussed on the show, is "Dashing Docteur." Hope to see you there.

Here is the episode .

And the kittens, well, here are the kittens:

Hi All,

Had a great evening interview with Dr. Anonymous tonight...a good conversation that I hope you'll all listen to. It's linked here .

Also, I was contacted by a guy named Nathosh Relhaak, who's a listener of the podcast and just started a blog of his poetry, inspired, he says, by the Dashing MD podcast. There was only one poem up on his site when I last checked, but I liked it a lot...it reminded me a lot of my last birthday. I linked his blog on the right, or click here .

Enjoy!

D, M.D.

I've not provided a button for easy subscribing in a while, I realized. Consider that problem resolved:

Shazam.

For all of you who are listening to the podcast, I'd love it if you would leave a rating and comments on whatever service you use to get the podcast, be that iTunes, PodCastAlley, Yahoo, Google...whatever. As you know, I keep this anonymous, which means I can't do a lot of self-promotion. So if you like the podcast, please let others know about it. And if you have thoughts about how it could be better, post them, or let me know! Thanks!

Also, I've just realized that this is the anniversary month for the podcast...how time flies! My next post will be an anniversary issue, I think, so if you have favorite episodes, I'd love to hear what they are (ERDiaries seems to be the most downloaded, along with Episode 8...why is that?)

Hi All,

First, some pressing news: I'm going to be on the Doctor Anonymous radio show tomorrow, Sunday the 21st, at 9 PM Eastern. Hope you can join us there...I'm excited about having a chance to interact with the Listenership in real time. The show link is here , and the Doctor Anonymous blog, which is much more prolific than my own, is linked on the right.

Episode 21 tells the story of some recent rites of passage: my completion of the trilogy of board exams (the USMLE Step exams), my trip to the American College of Surgeons Clinical Congress in New Orleans, and a walk down memory lane in my first home town. Enjoy !

So...summer was great. So great that I didn't really get to the podcast much. That, and some technical difficulties. But I'm back now, with some great listener mail. Episode 20 hits some big topics:

- Medical school for non-traditional students

- Universal healthcare, and my feelings about it

- Coping with bad days

Hope you enjoy! I'm glad to be back.

Keep your thoughts and questions coming!

Hi Everyone,

It's moving day...when I next broadcast, it will be from the East Coast of America. Sorry I haven't got an episode to share with you right now, but if residency is busy, residency and moving is doubly so. My transplant rotation was all that I'd hoped it would be, story-wise, so when I'm settled again in a week or two I'll have some tales to tell. And there's been some good mail, too!

Thanks for your patience. Be well.

D, M.D.

The rewards of medicine are sort of obvious: taking care of other people is one of the great privileges of life, and the fact that we get paid at all to do it sometimes seems like an unexpected, unnecessary pleasure. But the fact is that medicine asks more from us than simple patient care, and making that worthwhile is another question all together. As it is, there's no incentive to do anything more than just get by in medical residency, for instance...no matter how hard you work, you spend the same amount of time training, and get the same pay. The impact of this - a complete deviation, after all, from the American Dream - is underappreciated. I try to appreciate it a little bit this week .

The article I mention in the podcast, about how one hospital is trying incentive programs for surgeons, is here .

Haven't subscribed yet? No time like the present:

Here's Episode 16 . We start with some letters from the Listenership, then take a quick trip to the newswires, where we check on the medical accuracy and completeness of recent stories about Tony Snow's cancer diagnosis and Jon Corzine's car accident. Then, at long last, we arrive at the stated topic: questions you should ask your surgeon before having an operation, and things you can do in the hospital to be sure that you're getting all the treatment that you should.

Of course, I'm not your doctor, and you should take my medical advice the way you take any advice from a complete stranger who won't tell you his name...

For convenient reference, I'll put the main points here:

1. Be sure your attending is going to be in town while you're recovering, not heading to the airport from your operating room.

2. Is your attending surgeon going to see you every day while you're in the hospital? I used to take that for granted. No longer.

3. What's the patient to staff ratio going to be? If you're going to be in ICU, will you have 1:1 nursing, or at least 1:2 nursing? And what sort of physician coverage is going to be present at night and on the weekends? Will there always be a senior-level doctor in house, or are the interns sometimes left to their own devices?

4. How many cases like yours has your attending done - AS AN ATTENDING?

5. When you get to the hospital, ask about the following...and keep asking:
a. Prophylaxis against Deep Venous Thrombosis (DVT)
b. Peri-operative antibiotics
c. Beta-blockers (not everybody needs them, but be sure your team is thinking about it)

Hope this proves a useful reference. If you have things that you think should be added to this list, please, let us know!!

Here's the letter from "Denise", as read in Episode 16. What do you think?

-D, M.D.

Dear Dashing MD,
I haven't listened to many of your podasts yet, but I'm so glad I've found you. Thankyou so much for sharing your world and your point of view with us, for crossing that barrier. What you're doing is something seriously lacking in the medical profession, and very much needed.

I'll try to cross the barrier in the other direction.
I've recently had an experience that has radically changed the way I view doctors. It should have been for the worst, but there's no way I can see it that way.
In November, I went into hospital with a fracture. Things went wrong over a very busy weekend, I was not seen, complications developed and have been ongoing. Forgive me for not being more specific but it isn't important to the story anyway.
I should be blaming the doctors for not coming to see me post-op. I should be blaming those that did come for not diagnosing the complications and letting them develop. I should be blaming them for not prescribing antibiotics afterwards. But I can't. I should be furious at the injustice of it all. I should be saying "why me?" But I'm not.
Instead, I've learnt some really valuable lessons about what it means to be human.
Now I've seen that doctors are allowed to be humans, to have emotions, to make mistakes and be forgiven, I'm really inspired. I'm ready to be one. I was previously holding off going to medical school because I was afraid of the responsibility that comes with being a doctor, but now I see that only the most inexperienced registrars are afraid to ask for help. Surgeons consult each other all the time. And that's the way it should be. You're not supposed to shoulder that burden all by yourself.

Another reason I didn't want to be a doctor is that I was afraid of being too cold and impersonal. Now i've seen the alternative.
You said something along the lines of "doctors don't have the time to be there and hold hands". I'm not entirely certain about that.
I've had interactions with many doctors during this experience. My respect for them doesn't rank with who was and wasn't responsible for the lack of communication that allowed things to go wrong, nor does it rank with who was the most senior, who operated on me and solved the problems. It ranks with who took the time out to reassure me. I think the most important role of the doctor is to control fear. Without fear, things can heal. The doctor has the power of information. We patients thrive on information. Even if it's the same information over again. Also, just knowing that someone out there is keeping track on you so you don't get lost in the system, that means the world.

And metaphors aside, hand holding itself is so important. Just touch. In that big sterile impersonal place, a hand on the shoulder just means so much.

It seems to me that there are two types of doctors, the ones who give out their mobile phone numbers and those who don't.
I hope I'll be one who does. I have no idea how they cope with the emotional burden they take on from each patient they engage with, but I'm going to have to find out. The hospital system wouldn't function without them. If they let me become a doctor, I pledge to devote my life to the battle against Lack Of Communication.

Anyway, I can't wait to hear more of your podcasts. I know there will be some answers there.

In this week's episode, I go to the front pages of the last week, trying my hand at a little bit of political commentary from the medical perspective and trying to put some scientific sense into our reading of news headlines.

The two issues I talk about are based on articles about Dick Cheney's blood clot and the Walter Reed Scandal.

As always, I can't wait to hear your thoughts on this week's episode !