Delightfully Palindromic

The Rank number of my book at Amazon.com goes up and down like a pogo stick on steroids, a phenomenon I'm told is perfectly normal. The best I've seen it is in the 100,000's, a range I've also been told is pretty good. The only reason I point this out is that at this moment, it reads the same backwards as it does forward:

#117,711

(h/t to GHS for making me find such inherently boring things like this so inordinately interesting)

Good News, Good News, Bad News, Bad News

Good News: Last minute invitation to a sold-out Phillies game (thank you thank you thank you D&C)

Good News: Gorgeous rainbow after the shower that caused a brief delay to the start of the game:

(It actually spanned a full 180 degrees over the ballpark; this was all I could get of it on my crappy cell phone camera.)

Bad News: Phillies got stomped 9-1 by the Atlanta Braves in 8 innings.

Bad News: Sudden impressive storm that wiped out the last inning, and soaked us to the skin getting to the car.

Bookstore Browsings

So there I was, wandering through my local Barnes & Noble the other day checking out my favorite professional section:

Why look! Down in the lower left-hand corner:

There it is! My very own book.

I must say, it's one (pretty cool) thing to actually hold your own published book in your hand. But seeing it on the bookshelf in an honest-to-deity bookstore, in public, for everyone to see (and hopefully buy) is an order of magnitude greater excitement.

This concludes our Saturday morning kvell. We now return you to your regularly scheduled weekend.

Beauty and the Beast (in Reverse Order)

Dino and Daughter:

House of God; House of the Dinosaur

There's been a bit of a buzz recently over the 30th anniversary of the publication of the "raunchy, troubling and hilarious novel that turned into a cult phenomenon devoured by a legion of medical students, interns, residents and doctors" known as the House of God.

I read it many years ago at a time when it was already quite well known. My impression was that it was a rather overwrought, hyperbole-filled version of what medicine would look like if there were no such thing as a Do Not Resuscitate order: inhumane to both patients and physicians-in-training. Still, although not formally required, reading it was a rite of passage that allowed me to sagely concur that gomers did not die (although they did go to ground), the patient was the one with the disease, and that there was no body cavity that could not be reached with a #14 needle and a good strong arm.

Time passed. I survived my medical training (although my mother did not) and went on to practice medicine, start a blog, and write a book whose First Law ("The art of medicine consists of amusing the patient while nature takes its course") looks suspiciously similar to the House of God's Thirteenth Law:

The delivery of medical care is to do as much nothing as possible.

That's not where I got it from. Really. It was a gift from a friend, and is unattributed only because the plaque was unsigned.

Reading through the rest of both sets of laws I find a similar snarky tone, but no specific correspondence of content. This is because the Laws of the House of God are specific to the hospital setting -- actually, the training hospital -- whereas the Laws of the Dinosaur apply to outpatient practice. Truly, each set of Laws embodies these different aspects of medical practice.

Just as the House of God, while dated in some respects, may have words of wisdom for future generations of physicians, it is my outrageously conceited humble hope that Declarations of a Dinosaur; 10 Laws I've Learned as a Family Doctor may serve a similar purpose for those who practice in the office setting.

Grand Rounds at Dr. Charles

Talk about coming full circle; Grand Rounds this week is hosted at one of the original sites of the medblogging world, The Examining Room of Dr. Charles:

Welcome to Grand Rounds, a weekly gathering of medical people interested in sharing their best writing from the past week. I was there in the beginning, back in 2004, when Grand Rounds first started. Some might say that makes me old, but I prefer the term old school.

Welcome back, Dr. Charles. Your eloquence and style have been sorely missed. We rejoice at your return.

Digest This

Maureen Mackey, of Reader's Digest Book Fare blog, has this to say about my book:

Do you feel fine? Really? Or are you ignoring a physical symptom (small, big, or somewhere in between) that's been nagging you?

Either way, check out this captivating insight from a new book, Declarations of a Dinosaur: 10 Laws I've Learned as a Family Doctor by Lucy E. Hornstein, M.D. (Kaplan Publishing, August 09, $24.95)

That would be from the Second Law of the Dinosaur: It is impossible to make an asymptomatic patient feel better.

Go read it (if you haven't yet).



Oh, by the way:

Thanks so much to whoever left the wonderful message on my home answering machine last night telling me how much you enjoyed the book, how amazing it was and what a great job I did on it.

Um, just one thing though: I'm so sorry I didn't recognize your voice. Who are you?

Public Service Announcement

Use your computer to print out a free wallet card with all your up-to-date medical information here. No gimmicks; no catches (though of course they want you to but your MedicAlert jewelry from them). They don't save your medical information on their site or anywhere else. It's just a document generator, but a really handy one.

h/t Diane S.

No-Brainers

Reams have been written on how medical students ought to select their field of medicine. There are even personality-type tests that ask questions about what kinds of situations you like, how you react to problems, and your working style that purport to predict for which specialty you are suited. (I came up as an oncologist or a nephrologist.)

Others have opined that once you crunch the lifetime salary numbers, and then compare those to the intangible lifestyle factors, avoiding Family Practice and other primary care specialties is a "no-brainer."

I beg to differ.

So much of life has involves things you can't count, add up or analyze on a spreadsheet. In terms of financial return, no one ought to be going into medicine when there are so many faster, more effective ways of simply amassing the benjamins. For all the hullaballoo about the sorry state of medical education today, there is still altruism aplenty to be found in the candidate pool. As tired and trite as it sounds, people really still go into medicine to help people.

I'm not saying that all doctors don't help people, but the opportunity afforded by family practice and other primary care disciplines to form long-term relationships with patients* makes our job qualitatively different from that of other medical specialties. Despite the fact that so few students are actually entering family practice, I cannot help but believe that many more of them would find it incredibly rewarding. It seems to me that too many of them are scared off by "rational" discussions from their peers and immediate superiors about the financial and alleged lifestyle drawbacks.

I also believe that there are plenty of specialists out there who aren't exactly unhappy with their career choices, but who may have the sense that they aren't as happy as they could have been if they had had the nerve to follow their dreams, shaking off the "logical" arguments of the naysayers they encountered earlier in their careers.

Not all decisions in life are strictly logical. People marry completely unsuitable partners for love all the time. Parents of children who dream of careers in the arts and professional sports often try to dissuade such "irrational" career choices, frequently producing unfulfilled adults who may never have made it big, but who wouldn't have to spend a lifetime wondering "what if?" if they had only been given the chance to try. The choice of primary care as a career isn't nearly as precarious a decision. Family practice may not pay as much as other medical specialties (and absolutely deserves to be paid more) but it's hardly the life of a starving artist. Those for whom this purest form of medicine is a true calling should not be afraid to follow their heart.

When it comes to choosing a career in primary care, I agree it's a no-brainer. Some decisions should be made with the heart instead of the brain.



* ER (ED, if you're WhiteCoat) frequent fliers notwithstanding.

Translating Gibberish

I found this via Google Alerts. Someone (swear to Deity not me) appears to have translated the Laws of the Dinosaur into another language, and then back again. Verbatim:

1. The skillfulness of drug consists of amusing the patients while constitution takes its traversal.
2. It is unfeasible to make tracks an asymptomatic passive conjecture bigger.
3. The imperativeness of the investigation is inversely analogous to the IQ of the indemnity congress preauthorization clerk.
4. There is no marinate for the benefit dopey.
5. Bad things absolutely do come about to fit people.
6. The bigger the surgeon, the more careful he is to conduct.
7. Part A: Mostly it has to be control up to deriding. Part B: If it isn’t control up to deriding, probe Part A.
8. Half of what is said in medical procedure of life is illicit, but no entire knows which half.
9. Poor planning on your duty does not constitute a dilemma on my duty.
10. A louse-infested concept held via myriad people for the benefit a great continually is unmoving a louse-infested concept.

Whiskey. Tango. Foxtrot.

(Original laws on the sidebar, between Author Events and Contact Me.)

Understanding Patients

Time: 4:30 yesterday afternoon

Everyone else has left (regular office hours are 7:30 to 3:00) and all their computers have been powered down. On my lap, a tiny dog is snoozing as I catch up on my blogging.

The phone rings.

"Hello, I have a question about a bill I received."

"Okay. Here's the thing: everyone else has left and all their computers have been powered down. I'm sitting here with a dog sleeping in my lap. If you want me to, I can put the dog down, go turn on the computer, and find the answer to your question. Or you can call back tomorrow morning."

You can tell this patient is a true dog lover:

"I understand completely. I'll call back tomorrow."

I *heart* my patients.

Real Writing

I've written a book, so one might think of me as a writer.

So one might think.

Read this.

This is real writing.

(Link: fixed.)
(Face: red.)

Rehab Suggestion

Dominating the news here in the environs of Philadelphia was yesterday's signing of convicted animal abuser Michael Vick by the Philadelphia Eagles. Commentary was all over the place, from "What a great talent in the backfield," to "How could they associate with someone who did something as cruel as he did," to "He's paid his debt to society," and everything in between and beyond.

I saw an interesting suggestion from a friend of a friend (on FaceBook) that Philadelphia Phillie and All-Star second baseman Chase Utley take Vick under his wing, in order to show him the error of his ways in a more concrete and helpful way than perhaps was done in prison.

(For those who may not know, Utley and his wife, Jen, are generous benefactors and tireless activists for the prevention of cruelty to animals. The link above is to his foundation.)

h/t AF

Sigh of Relief

Thank Deity there's still sense in the world. If a fat, 83-year-old Texas woman gets it this clearly, perhaps there's hope for us yet:

Margaret is it just me or did combing your hair become optional when going out in public? I’ve been watching news clips of these town hall free-for-alls and we have definitely become a nation of tired, poor, and huddled masses clearly tempest-tossed, but without access to a good beauty salon. Universal Hygiene – now that is something I could get behind. And all of them are asking for their America back. I wonder which America that would be?

Would that be the America where the Supreme Court picks your president instead of counting all the votes? Would that be the America where rights to privacy are ignored? Would that be the America where the Vice President shoots his best friend in the face? Or would that be the America where an idiot from Alaska and a college drop-out with a radio show could become the torchbearers for the now illiterate Republican party?

I fear that would not be the America they want back. I fear that the America they want back is the one where black men don’t become President.

I remember that America. In that America people screaming at public gatherings were called out for what they were – an angry mob. Of course, they wore sheets to cover up their bad hair. Let’s be clear about something: if you show up to a town hall meeting with a gun strapped to your leg, the point you are trying to make isn’t a good one. Fear never produced anything worthwhile.

Maybe there really are more people in this country quietly sitting in their homes thinking the same things Helen expresses so clearly than there are goons crashing town hall meetings. Perhaps there's a chance -- a small one, but a chance -- that we won't go crashing back into the Middle Ages. I'm not holding my breath, but maybe I can risk a tiny sigh of relief.

Eventfulness

Guess what: I wrote a book.

Okay, so I suppose that's pretty much common knowledge by now. But what may have escaped notice is that my first AUTHOR EVENT will be taking place on:

Saturday, September 12th, at 1:00 pm

It will be at:

Chester County Book & Music Company

which is an absolutely dynamite indie bookstore in West Chester, PA. If you've never been there before, you're in for an amazing treat: books as far as the eye can see, with music as far as the eye can see through the door on the right. Passing through the door at the back of the store, you find yourself in a smaller chamber -- still surrounded by books. Continuing backwards, you pass through another door -- into another room as big as the first! As I say, books as far as the eye can see. Awesomeness!

Come on out and get your book there on September 12th so I can sign it for you, and meet you, of course!

Let's Hear it for Bronze

I won!

Okay, it was third place in a sub-24-hour haiku writing contest by the amazing Janet Reid.

Still!

I saw this yesterday, and jumped on it, promptly sending my entry. Today I slowly scrolled down the results, realizing that the longer I went without seeing my name, the better the potential outcome. Scrolling...scrolling...there it was!

Like I said, it was third place. But trust me, Janet got a ton of entries (she always does for these things) and not all of them even got onto the blog. So I did a little Snoopy dance of happiness and got on with my day.

Now that I'm out of the closet, in the blogging sense, I can also announce with pride that Janet is my amazing agent. By the principle of reciprocity, this also makes me one of her fabulous clients, as can be seen here. Seeing that post produced more than just a little Snoopy dance, let me tell you. I may have been a doctor for over twenty years, but as a writer, I'm finally on my way!

What Patients "Know"

A set of three cautionary tales:

TALE THE FIRST

What the doctor says: Happy Hospitalist gives non-compliant diabetics his "lecture" on the dangers of not taking care of their disease, because the patient never heard it from the lazy-ass outpatient primary care doctor.

What the patient says to him: "No one ever told me that before."

What you can't possibly expect the patient to say: "I've heard all that stuff from my family doctor so many times before, I just tune it out. I wasn't really paying any attention to you either."

What the outpatient primary care doctor really said: Every visit for the last 10 years has included a documented discussion of the importance of managing diabetes, including lifestyle issues, medications, and complications.


TALE THE SECOND

What the patient says: Doctor, the surgeon says I need an operation, but he didn't tell me anything about it.

What I do: Spend forty-five (uncompensated) minutes having an extensive discussion about the need for the surgery, the possible ramifications of not having it, and so on.

What you can't possibly expect the patient to say: I was too nervous to pay attention to what the surgeon was telling me, so I have no idea what he said.

What the surgeon really said: Pretty much the same things I did.


TALE THE THIRD

What the surgeon says: The hospitalist sent you here for a surgical procedure that didn't need to be done while you were in the hospital, but can be done as an outpatient now that you've been discharged.

What the patient says: What?? Dr. Happy never said anything about an operation.

What you can't possibly expect the patient to say: That guy talked about all kinds of things, I couldn't make heads or tails out of most of it. I tuned him out after the first twenty-four hours.

What the hospitalist actually did: Reminded the patient every single day about the unrelated problem that wasn't keeping him in the hospital but would have to be dealt with once he was well enough to leave. Made a special point to discuss it in detail at the discharge visit, and carefully documented it both in the medical record and the patient's discharge instructions.


WHAT WE SHOULD LEARN FROM THESE TALES:

Assume that patients really have heard the basics already. Whether or not they understand what they've heard is of course a completely differently pigmented equine. But all of us -- and I do admit my own not inconsiderable guilt in this matter -- need to give our colleagues the benefit of the doubt in terms of what patients have been told. Remember that it's far easier for the patient to claim they've never heard what you're telling them (and oh-so-flattering for us as well) than to admit that they've either forgotten or ignored the same material in the past.

Lawyers With Too Much Time on Their Hands

Last weekend, DS and I went to visit this crotchety old guy in his 80's who I've known for years. The Jock took care of the cats for us, but we took the Rolling Peke along. Although I thought we were pretty good about picking up after ourselves and bringing back everything we brought, we failed. I later received the following email:

On August 2nd, 2009, at 10:17 PM, it came to the attention of the management of a certain residence in McLean, Virginia, USA, that a canary yellow circular plastic dish 6.0 inches in diameter, 1.75 inches high, weighing 1.85 ounces, stood on the floor next to the kitchen table, near the window, and contained 4.3 fluid ounces of a clear liquid that appeared to be water.

[This dish] was not recognized as being part of the household culinary equipment. It may be, therefore, that the dish served as a container for liquid refreshment for a temporary occupant of the residence who is believed to have been of the canine persuasion. As a security measure, the dish was emptied, washed and dried and is now in safe storage at a secure location on the premises. Should it turn out that the dish was brought into the residence by human companions of the canine occupant, there are two possible courses of action that can be pursued, namely,

(1) should the canine and/or the human companion(s) desire that the dish be dispatched, by mail or other suitable delivery service, to the permanent residence of the canine, such action can be caused to be initiated by so notifying the management, or

(2) the dish may remain at the residence, at no storage charge*, until the canine, preferably together with the human companions, returns for a further visit.

It is requested that an election be made, within a reasonable time, as to whether course of action (1) or (2) should be pursued. Should any other course of action be [desired], the management will consider appropriate suggestions.

Should it be believed that this notice is more verbose than it need be, please feel free to notify the Whiskey Tango Foxtrot foundation.

Sincerely,
The Management


My response, in its entirety:

"Surprise us."



*Yeah, yeah, I know. This phrase raises suspicions that the author couldn't possibly be a real lawyer, since everyone knows that with a lawyer, there is *always* a charge.

You Know Your Kids Have Really Grown Up When...

DinoDaughter's facebook status reads:

I want school to start so badly!!

Today is The Day

Today is the *official* release date for DECLARATIONS OF A DINOSAUR; 10 LAWS I'VE LEARNED AS A FAMILY DOCTOR. Not that this means much; Amazon has been shipping it for over a week. Still, the book is now officially out there.

Thanks to all who have already bought it; I hope you are enjoying it.

Thanks in advance to all those who are planning to buy it; I know you will enjoy it.

To everyone else: you're missing a great read, so make with the clicky:

Emergiblogiversary

Everyone knows Kim, the nurse who took the blogosphere by storm on this date back in 2005.

Shane suggested that everyone help her celebrate by posting something about what Kim has meant to them on this, her 5th blogiversary. Fortunately, Ramona the quilter (which means she can count) noticed that it's really only been 4 years since Kim started Emergiblog. 4th, 5th, whatever.

Whenever you're looking for intelligent blogging about nursing, ER medicine, burnout, continuing education, blog networking, NASCAR, old advertisements, or nurse's caps, look no further than Emergiblog. For four (five, if you're Shane) years now, Kim has by turns excited, informed, educated and amused us. If she wasn't the first nursing blog, she was certainly among the first, and she remains among the very best.

Thanks for everything, Kim. Happy Blogiversary, and many more.

T-Shirt Musings

The highest grossing restaurant in McLean, Virginia is called the McLean Family Restaurant. I was there for breakfast this morning wearing my new favorite t-shirt, which has this design on the front:

The shirt never fails to get attention and frequent comments. Many people want to know where I got it (Amorphia Apparel). Many more just smile and nod. Both happened today at breakfast, along with a couple of, shall we say, more interactive reactions.

One person just looked at it, smiled and said, "Nothing?"

Understanding instantly what he was referring to, I answered immediately and assertively, "Nothing! Nothing at all. Not one moment!"

But the best was also the last. As I waited for the rest of my dining party to exit the restaurant, I accepted several more compliments from prospective diners waiting to enter. Then one man looked at me quizzically and said, "Your name wouldn't happen to be Cheney, would it?"