Information Is Free

2009-07-16T20:07:00.002-04:00

Dell 2100 N - Coming to terms

Here are more notes on the adaptation of carrying this little guy around.

Battery life: no problem. I find that I can go all day long without using the charger, provided I suspend when not using. In fact, I may have > 4hrs of battery life at the end of a very long day.

Space bar-touchpad issue: I have gotten a reasonable solution to this. I tried simply disabling the touchpad altogether, which worked, but there are some things I want to use it for since I don't want to carry a mouse with me. Plan B has been pretty good: just disabling the touch of the pad to act as a mouse click, which was the biggest problem by far.

Unfortunate PgDn key problem: Not sure why someone thought this was Ok, but the right lower corner of the keyboard has this configuration:

PgUp Up PgDn
Left Down Right

where Up, Left, Down, and Right refer to arrow keys. The problem is that when I am using a text editor, I frequently am wanting to reposition the cursor with arrow keys, and time and again I try to go from Up to Right arrow and go to PgDn instead. I've tried to remap the PgDn key (to right-Ctrl) without success so far -- it's doable, I just need to get the commands down in the .Xmodmap file.

Still no DVD drive, so still using Ubuntu.

2009-07-11T19:06:00.005-04:00

Dell 2100 N

I received my Dell netbook a little over a week ago. (I tried making a link, but it didn't work -- just go to Dell's site and search "2100 N", and don't forget the space between the number and the letter.) For the reason I bought it, it's been excellent. I'm not so fond of Ubuntu as a Linux distro, but plan to replace it (probably with Fedora 11) once I get my USB DVD drive.

One ongoing design issue is that the space bar is only millimeters away from the touchpad, but gradually I'm learning to position my hands (thumbs) differently. Key size is Ok ,and in general the layout is Ok. Battery life is excellent. As I'm making rounds I put it into suspend mode in between uses, and battery use is very minimal then. So I can carry it around with me all day and not have to recharge.

It's already reduced the headache of trying to remember who I've seen, and what their diagnosis is when I get to the office. I'm hoping to work with some other applications once I get the OS switched. In a pinch I can use it to log into the hospital's system, by way of first connecting with our office server, then running Internet Explorer, which is what the hospital's system requires. Sounds like it would be slow, but it's probably as fast as using my Windows computer at home.

I'll post more after I get used to using it.

2009-06-23T09:18:00.007-04:00

Maelstrom

Obviously, I haven't posted in a while (whatever happened to May?). A course of events ensued, the outcome of which was that I rather suddenly (over the period of a few weeks) became the only neurologist seeing patients at my primary hospital. This is a 400-bed hospital, so my workload suddenly and rather dramatically shifted.

Actually, shifted is not the right word, since I didn't stop doing the other things I have been doing, like office work, doing some EMGs, and so on, so this was all just added on.

I'm not sure we ever had "enough" neurologists here, but in the last several years, some have left, but also there has been this redistribution, with various ones of us restricting our work to fewer places, some neurologists only seeing office patients, and a few only seeing hospital patients. It's most likely a combination of lifestyle issues, having a more dependable workday, but to some extent realizing that it's not efficient economically to be running around from one place to another, better to stay in one or a few places.

Now I've gone from a variable handful of patients at a time to having 6-8 new consults on any given day (sometimes more), and I may have a running list of 30+ patients to follow. It used to be I could keep what was going on with various patients in my head pretty well, but this is breaking down. After I see 5, 6, 7 new consults, then go to the office to submit the charges I can have a time remembering who each patient was, especially the earlier ones. I figure it out, but there goes some wasted time in the process.

Handing off patients to see for the weekend coverage also becomes a chore, but I had already set up a system where I make out a list with annotations and print it out. I just can't imagine going down a list verbally and the guy on the receiving end keeping things straight.

The worst time for me is at the end of a weekend, or this coming Sunday at the end of my vacation, getting some 20-30 patient list of people I don't have a clue about. Every followup becomes a chore as you have to review each chart to get the gist of what's been going on, even with the heads up info I will get from this or that person in the group.

Solutions?

I've ordered a netbook, something I can carry with me on rounds to keep track of things better. Sometimes it's a big help just to prioritize patients, like who needs to be seen first, who definitely needs to be seen today, and so on. The model I've ordered, a Dell 2100N, has a rubberized case and with the extra batteries will last for several hours on a charge, so I am hoping I can just have it running as I go on rounds and carry it along with my "black bag" -- I'm getting an optional carrying handle, so I won't need a case.

Like any hardware solution, it's not automatic or magical, so I've been trying to find software that can help. I think I've found it; it's something called basket, or I guess more formally BasKet Note Pads. It's a free-form note-taking app that works very fast. You work with a blank page, and simply by clicking on an open area you create a small text box that you can enter info into. You don't bother to save anything, it's all automatic in the background. If you shut down the computer with it running, it pops up right where you were when you start up again. Each page is called a basket, so I figure one basket per patient, then I just click from one to the next as I go.

So once I get it, I'll post about it after I've seen how this goes. Should be interesting.

2009-04-20T11:39:00.002-04:00

Recherche du temps perdu

It has become shall we say "fashionable" to add a message in charts, either hand-written or dictated, avowing something along the lines of, "40 minutes was spent with the patient, 60% of which involved discussing the diagnosis and treatment." I realize the fashionable nature relates to issues of billing, since now we are urged to document what we do, so that maximum billing and reimbursement can occur.

I wonder if these statements can live up to the laws of the space-time continuum, though. No one seems to spend a mere 10 minutes with anyone, it's always something like 40 or 50. If a doctor such as this were tracked on a given day, and these amounts of time were totalled, how many hours of the day would be consumed? Would there be any time left for going from one place to another, eating meals, engaging in idle chitchat, sleeping? Would the time on occasion exceed the hours in the day?

Another thing I see, now with everyone using computers for wordprocessing, electronic medical records, is that it can be hard to tell the report of a followup visit from the initial one. Each report has a complete history, a complete physical exam, a complete discussion of the facts, and of course the obligatory "XX minutes was spent with the patient..." One reaction I have to this is that if one takes this at face value, that yes, all of this was done every single visit, this is an obsessive-compulsive person in need of treatment -- the doctor, not the patient.

But the reality check is that, once again, it's all about the billing, all about being able to justify that maximum category and charge in every single patient. On the receiving end of such reports one doesn't know what to believe...is it true that all of this history and exam was done? Sorry, I've got doubts about that.

Sooner or later, people will get called on this. Someone will do the math, check the office practices, the templates, the copied-over notes from one visit to the next. The results aren't going to be pretty, I'm afraid.

2009-04-19T10:57:00.002-04:00

The Republicans
Poster Children for Unintelligent Behavior

As far as I can tell, the Republicans are working very hard, very hard at digging themselves a deeper hole and thereby further alienating themselves from the public as a whole. It seems to be a rather graphic illustration of how out of touch they are. I suppose that if you believe that the most important thing is having access to media like Fox News whenever you want to engage in political commentary, which seems to be any time of day anymore, then this becomes an end in itself.

Part of the behavior that they have chosen is to start with the premise that the American people have no memory. No memory of the Republican policies that caused some of the problems we have, so they pretend that it was the Democrats that caused them. Not smart.

Another part is absolutely no acknowledgement that anything that Obama is doing has any good to it. Also not smart. Even W didn't do everything completely bad. When you get to the point of sounding like you're against everything Obama wants, like less dependency on foreign oil, better relations with other countries, a better environment, better healthcare, you'd better sound like you have some sensible alternatives. Here's a clue: the old policies got us where we are now, so suggesting we go back to them is not sounding like there are signs of intelligent life in the Republican party.

It's easy, very easy to be anti-something else. But it's also very dumb to be anti-everything about someone else. Sooner or later you have to be for something, or you'll be dismissed come the next election. Maybe the Republicans will go the way of the Whigs, and simply become irrelevant. It's up to them.

2009-03-22T22:12:00.004-04:00

Scribus
The Official Manual

Here it is, my book. Strictly speaking, not just my book, but the collaborative book I blogged about, I don't know when.

It's been an interesting experience, and no one's going to get rich from it. In fact, I'm donating any money I might have made to the software project that wrote the software that the book is about.

So, if you're interested desktop publishing, you might check out Scribus, and the book.

2009-03-01T11:34:00.004-05:00

Health Insurance Reform

Health care reform seems to be on the horizon, and I think like many, I would say it's hard to be optimistic. Doctors are perceived to be the source of a lot of problems, even though we're just out here trying to follow the rules we are compelled to accept, meanwhile the primary ones liable when something goes wrong.

Health care reform needs to begin with health insurance reform. As I look at various other ways countries around the world manage or try to, I think we don't necessarily have to adopt anyone else's method, but perhaps some modification of the German system is worth a serious look.

Here are the features of reform as I see it should happen:

Everyone must have health insurance, regardless of age, health status, employment or lack thereof. This encompasses a responsibility of the insured to obtain it, and to insurance companies, who cannot deny coverage to anyone.
There needs to be free access to whatever plan you choose, and it shouldn't be any more guaranteed if you are working for a major corporation than if you are self-employed or unemployed. There will likely be a need for government subsidy of those in lower economic brackets. You should be allowed to switch insurance companies at least quarterly, if not more often.
Private insurance companies should be the main source of health insurance. This allows for competition, and helps prevent some massive bureaucracy from eating up health care dollars.
There needs to be tight regulation of insurance company profits. When profits increase, they need be reflected in lower premiums to policyholders. Bonuses to health insurance executives for increased profits are forbidden. This is a conflict of interest. Similarly, doctors and other providers should not make more money by denying care.
In general, the goal of the system should be to ensure that a high percentage of health care premiums are spent on health care, not administration of benefits, not to shareholders. This will require a simplified process for reimbursement.
There should be a level playing field for reimbursement. This may or may not necessarily involve identical fees countrywide, but there should be little or no variation in fees paid by one insurance company versus another for a given region or to one provider versus another. This simplified billing and payment process by itself will save a very large amount of money. Thus you can also eliminate the possibility that a given provider may or may not accept your insurance.
When healthcare is delivered, fees are paid, and in a timely manner. There can be room for questioning the legitimacy or necessity of care which is delivered, but this occurs after the fees are paid, with any decision affecting future billing, not already paid fees.

Regarding this last point, if there are questions regarding the care that a doctor delivers, regarding necessity and other questions that we now face from health insurance companies, these should be handled by licensing boards and other standards of care organizations. We don't need to try to affect the quality of care by the way reimbursements are paid, since too many times we see that withholding payment is more about profit than it is about the needs of the patients.

2009-01-29T20:05:00.004-05:00

Doing Nothing

It can be hard to do nothing when you see someone. Nothing meaning nothing. No tests, no treatment, empiric or otherwise, or at least not change any treatment. Many, maybe most patients expect you to do something.

One of the situations where I mostly do nothing is with the late at night call about someone found on the floor, known to have fallen, banged something in a transfer, something in that category. Many times the nurse might say, "We found Mr. X on the floor. Looks like he was trying to get up by himself and slipped. Do you want us to order any Xrays?"

Uh, X-ray what?

"Well, he might have hit his head or his back."

Is there any scrape or bruise or tenderness, or...

"No."

So are we going to X-ray his whole body? Why? Unless someone has had a fall that was of itself clearly serious, you need some help in knowing what to X-ray, what to look for, what to be worried about. Furthermore, what are we going to do about it at 3am in the morning? Nothing. So you put them to bed, wait until morning to assess the patient and ask for feedback about something somewhere that's not right.

Last week I had a patient tell me that her foot got twisted during a transfer. I checked the foot. It looked Ok, had no pain with palpation, no pain with motion, so I decided to just wait, ie, do nothing. Within the next few days, the foot became tender with weight bearing, and an X-ray showed a metatarsal fracture, so now she's wearing a boot.

Do I feel bad about "missing" the fracture? No. I needed to have some indication of what to look for, and there wasn't anything lost by waiting to know what to look for and do it efficiently. And this one fracture occurred as a rarity given all the other patients with a similar story who subsequently had no problems, so in the end I've saved a lot of money on unnecessary X-rays.

2009-01-23T09:36:00.004-05:00

American Idol and Neurology

I was watching AI the other night, because my wife had it on and because the show was about auditions that happened in Louisville.

One failed contestant, that they spent some time on poking fun of, both with an interview before his audition and showing his audition at length, seemed strange indeed. He was apparently quite gifted intellectually yet had his own take on things, like wanting to make his own particular arrangement of Chinese glyphs, and he also was rather socially inept -- when asked if he wanted something to drink, he went over and drank from Paula Abdul's cup, using her straw. Needless to say, the quality of his singing compared to his own assessment was bad.

My wife's assessment, and I think it was likely correct, was that he probably has Asperger's syndrome, a form of autism in which those affected can be high-functioning, yet show this marked social ineptness.

What I think this brings up is the inappropriateness of American Idol organization using and making fun of this man. To be sure, this is someone who, because of the Asperger's is not in a position or likely to complain about how he was used, but of course that's the nature of his problem. This does not, however, mitigate against the AI staff for their decision-making.

If he had some obvious physical disability, some disfigurement, we can safely say this would not have been seen as so much fun, but behaviorally it should have been obvious that something wasn't right here.

2009-01-11T11:12:00.002-05:00

Just the Facts, Please

I might have titled this, Just Answer the Question, but at any rate it can be surprisingly hard to get people to give you the information you want/need as opposed to what they think you need or want you to know.

This comes into sharp focus when I am getting ready to do an EMG. This is not a situation where I need a detailed medical history, it's really what called a "problem-focused" evaluation, revolving around the question of why this test has been ordered. Beyond that, I have to decide what is a reasonable list of things to consider based on my own history, not just relying on the referral slip that says, "possible carpal tunnel syndrome."

So after introducing myself, I ask, "What symptoms are you having?" It seems more often than not the answer will be something like, "My doctor thinks I have a pinched nerve," or "I have some bulging disks." Not symptoms at all, but tentative diagnoses, or related findings from other tests.

So I repeat the question, or rephrase it, trying to get to the problems they were having that led to them going to the doctor. So then I might hear something like, "Well, I was talking to some people at work and they thought I might have carpal tunnel syndrome." Great, very helpful.

Eventually, I can usually get to some sense of the subjective problem they are having, stripped of all assessments, all references to family members that had the "same thing" and other such relatively irrelevant stuff. But sometimes I have to just give up and go with what terse and sketchy information I have on the referral papers. I just don't have an hour to spend on getting a history for this purpose.

2009-01-01T10:24:00.002-05:00

Giving Patients What They Want

The nonmedical press in particular, and many other groups, have been touting this for many years now, that this is where medical care "needs to" go. The problem with it is that it doesn't mesh well with basic human behavior and the economic problems we face in the delivery of affordable care.

People have a natural tendency to ignore their health, eating what they want, not exercising, not being aware of and controlling things like high blood pressure or diabetes. Then when something bad happens, they want it fixed. Now. Then go back to their unhealthy lifestyle.

Giving people what they want is really part of the system of marketing things so that they can be sold at a profit, so it really is about convincing people that they want something, not that they really need it. So we have a vast industry of products and services of unproven or dubious value. Look at things like NutriSystem -- as if people need a magic diet to lose weight. Or things like all these exercise devices sold on TV only to collect dust somewhere.

So I'm here to tell people things they don't want to hear, that it's their attitude, their behavior that is important, not something they can buy. It's time to stop procrastinating, time to get up each day doing what they know they should do to take care of themselves, and do it before they have some major problem that only leads to regrets.

It's part of the recursive problem of ERs. If you allow people to put off things, then go to the ER, then give them everything they want, pain pills, antibiotics, all kinds of tests, regardless of the expense, guess what? They'll be back. Again and again. It sounds a bit callous, but if someone is having frequent headaches, the role of the ER is not to have them pain-free when they leave, unless you want to create "frequent flyers", because they'll be back the next day, maybe even later the same day. What they really need is an incentive to get proper headache care outside of the ER experience. This also applies to patients with headache admitted to the hospital. It's not possible generally speaking to have these patients permanently headache-free when they leave. All I want to do is to have enough control that they have what they need for headache at home, so they're not using the ER, not calling me everyday for more and stronger medicines.

One aspect of all this is handing responsibility for healthcare squarely in the patients' laps. Taking responsiblity includes doing what you can to help yourself, and that if you won't, you pay for it and accept the consequences. In short, you become an adult rather than a spoiled child.

2008-12-25T09:46:00.003-05:00

Bringin it all back home

Inasmuch as Christmas is a celebration of beginnings, and just prior to the beginning of the new year, after some careful thought I've decided what I need to do is to split. Not split as in leave, but split as in start a new blog in addition to this one.

This one I'll keep as a medblog/scienceblog of sorts, and restrict the postings to those areas. My new blog, as yet to be created and named, will be on more wide-ranging topics, but especially about technology, computers, and maybe some politics and general comments on the state of the world.

One of the reasons for doing this is that I sensed that, as I considered blogging about anything and everything here, it actually seemed to get harder to blog about anything at all, a strange form of writers block, it seems.

So we'll see how this goes. Can I maintain two blogs, or will one (or both) die a miserable death? At a time when others seem all atwitter about Twitter does this make sense? Let's just say I'm not impressed by the stream of consciousness flavor of Twitter -- there are many streams out there I'd rather not step into.

2008-12-05T08:47:00.003-05:00

Dressing Appropriately

I'm still running in the mornings, 3 days a week at about 6am. We've had a noticeably cold spell here for Kentucky, with below freezing temperatures more often than not lately. This is the time of year when I pay attention to the forecast overnight lows, so I have an idea how to dress for running when I get up.

The norm for summertime temps is short-sleeved Tshirt and shorts. When temps get down to the low 40s I usually switch to a long-sleeved T-shirt. In the 30s, it's time to start wearing gloves. I have had some episodes of Raynaud's phenomenon, which are quite painful, so I've learned to keep my fingers warm. In the low 30s to 20s I will add a headband to cover the ears, and another layer of shirt, but still running in shorts. Even in the 20s, while the legs get cold, it's not especially disturbing, and when your thighs get numb, it's not a big deal. I would add that everything I wear is porous -- even though cold air does leak in a bit, occusive clothing causes a serious buildup of sweat underneath. I can't say that's bad, but just that I don't like it.

Today it was in the upper teens (19 when I got in my car to go to work), and at this point, it did become a little painful in the thighs, not so much the skin as the muscles underneath (or seemingly so). I also was reminded of why I have used some running pants when it gets in the teens. There was a noticeable genital chilling this AM, and even in my short run (I'm only running about 1.5 miles), it was, shall we say, a bit distracting and disconcerting by the time I finished. Penile frostbite is not something to sneeze at, so to speak. So I'll keep this in mind as I peruse the paper on the nights before running.

We'll see how the winter goes, but generally, I get careful when temps are in single digits. There is some risk of lung injury when it gets that cold and colder, so in the past I have skipped some of those days. If I do run, I usually add some kind of scarf to loosely wrap around my face, since if nothing else, 0 degrees on the face, especially with wind, gets to be quite painful.

2008-11-23T10:55:00.003-05:00

BMI Update

Here is the periodic yet irregular update to the monitoring I do of new patient BMIs, stratified according to age.

Age	under 30	30-39	40-49	50-59	60-69	70-79	80 and over
BMI
Underweight	0 (0%)	0 (0%)	0 (0%)	1 (1%)	0 (0%)	1 (1%)	2 (6%)
Normal	13 (52%)	4 (16%)	12 (22%)	11 (15%)	17 (22%)	18 (26%)	15 (44%)
Overweight	5 (20%)	9 (36%)	21 (39%)	30 (41%)	25 (32%)	30 (44%)	15 (44%)
Obese	5 (20%)	8 (32%)	20 (37%)	27 (36%)	29 (37%)	17 (25%)	2 (6%)
Extreme obesity	2 (8%)	4 (16%)	1 (2%)	5 (7%)	7 (9%)	2 (3%)	0 (0%)
Totals	25	25	54	74	78	68	34

As I recall, this one is arranged differently than I have done in the past, with age going across rather than down, but this is also an interesting way to display.

2008-11-20T20:21:00.005-05:00

Progress with Linux

Further investigations into getting information about buying a new computer with Linux, reveals that Dell has no online help with buying, no live chat for pre-sales. You have to call sales. I decided to check with HP, where there is pre-sales live chat.

Ah, sticky wickets abound. HP, while having pages that show compatibilities with various Linux flavors, doesn't sell computers with Linux. In the words of Maria, "if you needed to get help with the computer, they couldn't help because all the troubleshooting software is Windows-based."

So much for the page that touted HP's heavy involvement with Linux since 1995 – I guess it takes longer than 13 years to really get to know Linux, since it's such a difficult operating system.

So I guess the thing to do will be to go back to Dell.

2008-11-16T09:47:00.004-05:00

Progress with Linux

I recently listened to an audio summary of the book, The Tipping Point, written some years ago. The subject of the book is the phenomenon of how something might be introduced to rather lukewarm response, then at some point suddenly take off and a large or massive demand happens.

After using Linux for a decade or so, each year reading this or that prediction of the next year being the Year of Linux, it finally seems that, whether or not next year will be the Year of Linux, we may be reaching the tipping point. This is remarkable, since not only has there been the innate resistance that people have to something new, something different, as far as Linux goes, there has been a well-funded campaign and behind the scenes effort by Microsoft and others to attack, discredit, threaten (or actually carry out) legal action against Linux.

But the times are different now. I am considering buying a new computer for someone this Christmas, so I went to Dell's site, where not only does it immediately become obvious that non-Windows computers are available, but there are entire pages on Dell's site where you can buy computers with pre-installed Linux. Gone are the days of "we don't support Linux" as the canned response, when all I really wanted was any information or even rumors as to whether the hardware on a PC might have issues with Linux.

Toys R Us advertises ASUS netbooks (mislabelled laptops) with equal-sized spaces for Windows and Linux versions. I haven't checked HP's site yet, but who knows, maybe they're coming around too. Update: HP has some information about compatibility. On the plus side, several Linux distributions are shown, eg, Red Hat, Novell, SUSE, Mandriva, Turbolinux, and Asianux. On the downside, it's not obvious that this exists from HP's home page (I entered Linux as a search term), and when you get to it, it's like trying to grasp the meaning of a large spreadsheet.

Freedom to choose is such a good thing.

2008-11-05T09:56:00.002-05:00

Thank you, W

Thank you for being such a bad president that seemingly impossible things came to pass. Like a woman and an African-American being the 2 top candidates for the Democratic nomination, like the African-American succeeding at getting that nomination. Thanks for making it possible for someone like John McCain to become the Republican candidate, a man who is respected, but has a history of not standing with his own party, and therefore was compelled to (pretend to) become someone else in the ensuing campaign.

Thank you for making a choice of VP running mate like Gov. Palin come out of the blue, like a game of pin the tail on the, err, elephant. Someone who provided ample material for SNL sketches when we needed to laugh about the course of events.

For being someone that his own party's candidate shunned like he had some infectious disease, I thank you. I was tired of hearing you speak long ago, since you not only didn't have much to say, you said it so poorly.

There is credit to be handed out to Mr. Obama himself, to be sure, credit to his campaign managers who refused to sink to the lows of hate-mongering that characterized the opposition, credit for not being rattled by the Rev. Wright, terrorism, Islamic innuendos, socialist labels, and the ever recurring tax-and-spend predictions. (Now we just spend and spend, passing the bill on to future generations to handle.) And thanks to his supporters, who did not shout out boos every time McCain's name was mentioned, did not yell, "Kill him" in the public rallies.

But W, you really laid all the groundwork for this. To be sure, like much of anything else you did during your terms, you did not and could not have managed alone - you needed the constant advice from Mr. Cheney and the rest of the crew at the White House, so you could always know what to decide, what to say.

For all of these gifts, I thank you.

2008-11-03T08:22:00.006-05:00

Too Many Polls

We have had an incredible number of polls done this election, compounded by the length of time the campaigning has gone on. As a scientist, this all becomes very fishy. How do you manage to keep polling people so many times? Are they polling the same people over and over? It's like using the same group of experimental animals or human subjects over and over again.

I've never seen any explanation of how the validity of these polls is assessed. Aside from questions of whether one could reproduce the same results twice, there are three aspects to validity.

The first is whether this truly represents the beliefs of those who answer. Many times people will espouse an opinion, will state a position that is belied by subsequent behavior. This repeatedly polled category of "likely but undecided voters" is especially suspect to me. How many likely but undecided voters are there? Where are they? What is their demographics?

Secondly, what is the information that suggests that various samples of opinion are valid for larger groups? The whole process should be based on using a "representative sample." How is that decided? I have to wonder if, in this year's election, some previously determined tenets of this process will be found to be in gross error.

Finally, there is extrapolation, and this generally doesn't just involve simple math, of multiplying the sample by some factor. Usually it seems in political polling, the factor may be variable, depending on some subgroup analysis.

We're never told anything about these methods, never told about what sorts of statistical tests have been done to evaluate reliability or validity. It's a big problem when the companies doing the polling are paid for it - they have no incentive to say, "Well, we did all this work, but we don't think the results are valid."

And the last problem is selectivity. One party or the other, one media outlet or another, chooses which polls to report. Just like unreported negative research sponsored by drug companies, how many poll results never came to light, because they were judged to have come up with the "wrong answer"?

One thing I do know. Tomorrow brings the only poll that really counts.

2008-10-29T12:36:00.002-04:00

Bumper Sticker

I saw a bumper sticker in the hospital parking lot today. It said:

Worse than Nuclear War:
A life without God

So, I'm thinking: "Is that the only two choices?"

2008-10-23T09:13:00.004-04:00

The Election

Aside from all the incessant news, and the vitriol from various camps, people are surprisingly mum about the election. You know that people have opinions, you know in brief snippets of conversation who this or that person favors for President, but we don't have many extended conversations. Some of this comes from the fact that we're drowning in a sea that's a mix of loud-mouthed reportage and loud-mouthed commentating.

I can't stand to watch any of these panel "discussions" that are characterized by people interrupting each other with increasingly loud voices. No wonder there is a loss of civility in society when we're exposed to this on cable news all day long. What's almost as bad are the little sound bites of negativity that get played over and over again, with ever-expansive discussions on this new thing is really going to turn this campaign around.

One of the reasons why I think we need to elect Obama is so that we can take a big step toward getting over the whole race thing. Get over the paranoid ideation about catastrophe if an African-American is President, the doomsday visions. And this doesn't even count the hysteria about a middle name like Hussein. We're just finishing up 8 years of the worst President in modern history, maybe the worst ever. Even Joe the Plumber would probably be a better President.

It's also time for people to stand up against the Republican party's modus operandi: negative, scare-laden, fear-mongering, and outright lying campaigns. They need to pay the price for such tactics, and not just by losing the Presidency, but also need to be reduced to a minority in both houses of Congress. I'm not sure about the difference between a pit bull and a hockey mom, but we now know that you can dress up a pit bull and put lipstick on it.

2008-10-09T20:16:00.002-04:00

The Critically Ill

Maria is back at intueri.org, and she's posted about a topic that I gather neurologists and psychiatrists share, seeing a very sick patient to evaluate their cognitive status. I'll let you read her post to see how her anecdote came out.

From my point-of-view, I am doing much the same as she does with these patients, maybe spending a bit more time on the prestidigitation of neurologists, looking for this or that reflex, pulling out the little toys (exam tools) from my "black bag" (my bag isn't black, and it doesn't look like a doctors' bag. Actually it's a bag designed for carrying your toiletries and such on a trip), but the conversation is much the same.

Yes, the person looks quite out of it, looks as if they are oblivious to the world, but even in the presence of such an "obvious" state, you still try to carry on a conversation with them. Not that I am expecting them to say or mouth "What!!" when I call their name, but there can be a lot of body language that happens to speech that you don't see with poking and prodding. You're just looking for any clue of some level of what we might call cognition.

In many respects these unresponsive patients make for a brief exam, but not necessarily a short visit, since the questions always are there about what the family needs to know, what questions they have, how are they handing this emotionally, are there financial issues coming to play, so that the family becomes part of what you evaluate, what you treat in the process.

Sometimes we see patients make a remarkable recovery, some don't make it out of critical care, and many others have this long protracted illness with varying degrees of problems, running up astronomical bills, maybe eventually succumbing, maybe surviving, and it becomes harder to tell if everyone, patient, family are better off if they die or they live, since living usually means a very different life, not only for the patient, but for the rest of the family too.

2008-10-04T10:50:00.008-04:00

Smoking Safety

Our hospital has had a completely "nonsmoking" campus for some time now. An effort was made to get smoking employees to quit, with various classes set up for that, but of course many weren't interested.

So what we see is a trickle or stream of employees going outside on the mission of travelling to a park next to the hospital campus, taking their puffs, then returning.

Since this is straight across one of the entrance roads to parking, I thought we should do something in the interest of safety, since Lord knows that when the need for nicotine strikes it may be hard to think about anything else.

So here is my effort, built from scratch, so no worry about copyright issues.

2008-09-25T14:36:00.007-04:00

McPanic

McCain is increasingly worrying me. We're almost through 8 years of panic and fear-mongering, and I don't think I can take any more. He complained about Obama overstepping his bounds as a candidate when he went to Europe.

Since then, McCain has expounded at length about the Georgia-Russia conflict, totally siding with Georgia, who actually precipitated the problem (realizing that Russia may have in part set them up for it).

He then wanted to cancel the Republican Party convention due to his "need" to be on the scene for Hurricane Gustav.

Now he wants to delay the debate with Obama (do I hear weak knees rattling in the background?) because of the dire situation of the economy, after the President and Sec'y Paulson have already attempted to scare the country into a "fecal absence state."

This guy is frightening.

New motto for the Republican Party: Fear is our most important product.
Submotto: Overreaction is our second most important product.

Update: Here's a capsule of the debate.

McCain: "I know exactly what to do. Obama is an idiot and what he says won't work."

Obama: "If you're so smart, why have you agreed with everything Bush wanted when it came time to vote?"

2008-09-20T14:49:00.003-04:00

Powerless

We're going on 7 days without electricity. Curiously enough, considering it is here in Kentucky, it's all about Hurricane Ike.

Last Sunday, Ike roared up the midsection of the country, causing no torrential rains here, no surge, but VERY strong winds, causing a massive number of large limbs and whole trees to be thrown to the ground, taking power lines with them. We had no rain at all.

It was estimated that more than 300,000 were without power initially, and recovery has been slow. I heard that in Cincinnati, more than 800,000 were without power.

On the good side, we have hot water and the weather has been cool enough that the absence of air conditioning is a non-issue. We also did not have any storm damage on our house.

Update: We got our power back on a 5:38pm!

2008-09-06T11:30:00.004-04:00

Housepainting

Here is the tail-end of finally working my way around the house painting the trim, gutters, and so forth. When we bought the house 20 yrs ago, someone had decided to paint the brick, which I can never understand in terms of house maintenance. You have a brick home for low maintenance, then you paint the brick, so you get to repaint the brick every several years? So we had it water-blasted off.

Yes, I do this painting myself. Somewhat for the money savings, but I enjoy getting up there, scraping away, then painting, then standing back to see what I've accomplished. Very much different than doing neurology. I just wish the temperate hadn't gotten up to 90 degrees that day.

My wife worries I'll fall off the ladder one of these days -- this picture is up some 16-18ft in the air to the end of the ladder. This particular part initially involved killing some wasps between those louvres a couple of weeks ago, then cleaning out the nests.