I Hope My Doctors Aren’t Blogging Too Much

Today’s ACP Internist reports that nearly 1 in 8 doctors has a blog. This news comes from a study published by the Journal of the American Medical Informatics Association.

First, the study’s flawed from a methodological standpoint: The investigators, based at the CDC, used data from a 2009 DocStyles survey of 1750 primary care physicians, pediatricians, obstetrician/gynecologists, and dermatologists in the U.S. According to the paper, this sample was drawn from the Epocrates Honors Panel. So they’re a technically-oriented bunch. Besides, the survey didn’t include oncologists, cardiologists, neurologists, radiologists or surgeons, among other physician-types.

Red flag: “Physicians who completed the survey were paid an honorarium of US $55–US$95.” This tells me that the doctors who participated have time on their hands and could use an extra $75 or so; it’s unlikely they’ve got thriving practices.

Blogging was defined as “posting commentary, descriptions of events, or other material such as graphics or video on a website which serves as an online journal.” The featured result was that 13% of the paid, internet-using physicians in the study said they blogged in the prior six months. The 226 bloggers tended to be young and male.

Seriously –

It’s unlikely that 1 in 8 doctors in the U.S. are blogging. I say this not just because the study’s flawed, but because almost all the physicians I know and trust with my health care don’t have time to write, unless they’re taking notes for a book, or do so as a hobby. They might, for example, blog about video games, or vegan recipes. But as far as their work is concerned, most non-shift doctors are lucky to see and examine all their patients, finish their notes and answer patients’ phone calls and get home by 11 PM.

In my view as a patient, if you’re a doctor and you blog for fun, there’s no issue. Blog away, and mind HIPPA. But if you’ve got anything else to do with your time, like –

  • reading medical and scientific literature
  • enjoying time with friends, family and others in your community
  • resting
  • exercising
  • spending one extra minute with each of your patients
  • re-checking primary data and calculations before publishing research
  • watching a movie
  • having lunch with colleagues
  • gardening
  • bowling, if that’s your thing…
  • <insert your passion>

– live your life! Spend time wisely.

I want my doctors to be happy, up-to-date, and rested.

Besides, what’s the point of so many busy, needed health professionals writing about their experiences or opinions, except if it’s for their own satisfaction?


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A Picture of Periwinkle

Periwinkle plant – the source of Vincristine, a chemotherapy 

Dear Readers,

Your author has been busy writing other things, and revamping this site. Medical Lessons is, if nothing else, a work in progress.

For this week, I thought I’d simply share this image of periwinkle, Catharanthus roseus. From this plant comes an old chemotherapy drug,  called Vincristine (Oncovin). When I practiced, I used this agent to treat people with lymphoma, some forms of leukemia, Kaposi’s sarcoma and, rarely, patients with life-threatening cases of low platelets from an immune condition called ITP.

All for now,


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Remembering a Warm-Hearted Patient

When I was a resident I worked in a general medicine clinic. One afternoon each week, I’d get more dressed than usual and split off from my inpatient team around noon to go see patients in another building, outside of the hospital.

flickr image, HikingArtist

Today, I’m reminded of a man I saw there and treated for two years. His name was Mr. Sunshine.* The first time I met him, it was in the midst of a noisy, crowded and windowless waiting room.

“Mr. Sunshine?” I called out, as loudly as I could from the receptionists’ desk. I’d skimmed through his chart including partial notes of a recent hospitalization. It was 1988, long before we stopped calling patients by their names in public areas. He stood up and greeted me with a broad smile. He shook my hand before I guided him to a smaller, quieter windowless room for his examination. He carried a medium-sized suitcase.

Mr. Sunshine had heart disease, kidney disease, diabetes, and peripheral vascular disease. He’d had a heart attack or two, and possibly a stroke. He was a large man. As I recall, he came from North Carolina but had lived most of his life in Brooklyn. After some brief, standard but sincere chit-chat about who we each were, I asked him why he was there in the clinic. “I’m sick,” he said. “I think maybe I should be in the hospital.” That was, essentially, his chief complaint.

Being the diligent resident that I was, I attempted to get through a review of systems (ROS) – the drill by which doctors run through a lot of questions as fast as possible, starting like this: “Do you get headaches, earaches, have trouble hearing, double vision, blurred vision, sinus congestion, a runny nose, frequent sore throats, swollen glands, cough, pain on swallowing…” Keep in mind, this was before most doctors had sheets for patients to answer these questions in advance, on a checklist, or NPs to ask the questions for them. If you were lucky, and smooth, and the patient wasn’t “difficult” – or really sick, you could get through a complete ROS in under 1.5 minutes.

Mr. Sunshine said he was tired and short of breath most of the time. He pulled from his suitcase a crumpled, large brown bag with more than 20 medication vials and vitamins. There was a set of pajamas inside, and other stuff including a toothbrush.

I didn’t admit Mr. Sunshine to the hospital that day, but we bonded. He stayed as my patient in the clinic for two years, always treating me with respect while I adjusted and tried to reduce his meds.

Once he asked me if he might ask me a question.

“Sure,” I told him.

“Are you Jewish?” he asked.

“Yes, I am.”

He nodded.  I lacked the nerve to ask him why he wanted to know. He told me he sang at his church.

When I moved on to become a fellow in hematology and oncology, Mr. Sunshine asked if he could still be my patient. I told him that in my new position I’d be working in another clinic, and only with patients who had either cancer or serious blood disease. He didn’t have cancer, or sickle cell anemia, or anything like that.

“If I get leukemia, will you be my doctor?” he asked me.

“Yes,” I told him. “But it’s a good thing you don’t have that now,” I said, adding: “I wish you the best, Mr. Sunshine.”

(*The patient’s name was not Mr. Sunshine, but it was equally evocative of his disposition.)

I’ve been thinking lately, what makes you recall some patients. I hope he’s doing OK, wherever he is now. Same for all my patients, really. I wish I could tell them.

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The NBCC Holds Annual Summit and Pushes for Deadline 2020

Last week the National Breast Cancer Coalition (NBCC) held its annual summit. The meeting drew over 600 women to its opening rally in a Crystal City ballroom on Saturday, along with students who participated in sessions for Emerging Leaders, and a few men who joined in lectures and panels, and lobbied on Tuesday on Capitol Hill.

The NBCC aims to get HR 3067, the Accelerating the End of Breast Cancer Act, passed by the House of Representatives and, ultimately, into law. The bill ties in with Deadline 2020 and with the conference theme: “It’s Time.”

The opening rally, organized in the style of a political convention, was lively. When I entered, participants – or “activists,” as they might be called – were rocking to Three Dog Night’s Joy to the World. Attendees congregated by state and region. Most wore festive garments and signs over black tee shirts carrying the Deadline logo: women from Maine wore floppy red lobster hats; a contingent from Pennsylvania held brightly-decorated kite-posters; a group from Oregon played kazoos (to We’re Not Gonna Take It) and supported multicolored umbrellas over their heads; members of the CBCC lifted Rosie the Riveter boards proclaiming: “We Can Do It!” Each region offered a progress report. In videos, these demonstrated a mix of activism (“waving breast cancer goodbye” on a Rhode Island beach) and seriousness (scientist in a lab, explaining why the research matters).

Fun aside – the meeting’s mood was overwhelmingly serious. Each day’s session opened with a moment of silence to recall women who have died from breast cancer. There were plenary lectures, and smaller educational meetings on topics like “A Critical Review of New Therapies for Metastatic Breast Cancer,” “Estrogen Exposure throughout the Life Cycle,” “Nuts and Bolts of Congress,” “and “The Environment and Breast Cancer.” Many of the women there have metastatic cancer, or had cancer. I had lunch one day with a woman whose early-stage cancer came back after 15 years. Many of the college-age people attending have moms with advanced disease or who died from that. There were young people who’d had breast cancer – some under 30 years old. The few men I spoke with were affected by their wives and mothers’ illnesses. You couldn’t walk a few feet without hearing a sad tale, or seeing the outcome of loss, in motivating people to take action.

In her remarks, Fran Visco, the NBCC Founder and leader, reminded the group that breast cancer remains a leading cause of cancer deaths. Each day, on average, 110 women die in the U.S. from breast cancer. That’s the equivalent of a woman dying every 14 minutes from the disease, she explained. “This should not be considered success, or even meaningful progress.”

“We need to take a less comfortable approach,” she said. “The system rewards safe ideas. We need to take risks.” She spoke of the Artemis project, an NBCC-supported research program to develop a preventive breast cancer vaccine. “There’s a moral imperative to do these trials,” she said. “We’ll get scientists to form new collaborations, to change their focus not on the next grant, or publication, but on the real goal, which is saving patients’ lives.”

In the 20 years since NBCC was founded there’s been progress, she said. “But we’re nowhere near close enough.” She referred to Dr. Jonas Salk, whose polio vaccine came through after just seven years in the lab, and – as did others at the same meeting – to JFK’s 1961 promise to put a man on the moon. That seemingly impossible mission got done in less than nine years. The idea of the Accelerating the End of Breast Cancer Act is to leverage our nation’s prior investment in biotechnology, and to use that work – including much research already done – to end to breast cancer and stop metastases. Visco hopes to deliver a petition to the President on inauguration day in January, 2013.

Through the meeting, I gained a better sense of the organization and Deadline’s purpose. In the words of Senator Kirsten Gillebrand, who met with a delegation from New York on Tuesday: “It creates an urgency about the issue.”

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