Semi-Public Announcement: seeking pre-alpha comments on "Medics and Magics"

I posted on G+ under "Fantasy Writing/World Building" and cross-posted on reddit/rational tonight.

http://www.reddit.com/r/rational/comments/2ofzm9/of_medics_and_magics_story_synopsis_for_a_new/

This represents my semi-public announcement for my hobbyist foray into fantasy writing in the style of free web fiction ala "Worm" or "Harry Potter and the Methods of Rationality."

The idea for my alt-blog has been a personal dream to unite all of my loves (science, medicine, and fantasy) into a coherent package that reflects my identity.  That is NOT to say that my characters will be an "author self-insert" or a "podium" to share my personal views on the world.  My main drive is to build a fun cool fantasy world that stimulates my imagination and pushes me to explore our world further in a rational, empirical fashion.

I recently discovered that Diane Duane has continued to publish books for her Young Wizards series that I read in elementary school with the first book: "So You Want to be a Wizard."  Duane comments that the more fantasy writers mix truth in with a lie, the stronger it gets.

http://en.m.wikipedia.org/wiki/Young_Wizards

https://www.goodreads.com/author/quotes/11761.Diane_Duane

'Tis my goal to strengthen Iatropia to a fun new level for fantasy fiction.  I'm trying to set myself up for success, so please check out the link above and comment!

Further Blogging Musings

I started off one of my Family Medicine interviews in a very interesting way.

"I noticed you were a blogger and I must say, I was disappointed." He paused to drink in my reaction and his eyebrows furrowed as he continued in a very somber tone. "You haven't blogged in a few months!"

"Well, I have been busy interviewing," I confessed. "Plus, I would not want to blog about a specific program only to have it come back to me in a bad way."

"Exactly. I thought that I could comment on your thoughts about interviews in the hopes of bringing up a point of awkwardness."

I thought to congratulate him on doing just that, but we moved forward from that point... but he did make me think more about the frequency of my posts as well as the content itself.

One of the things that has made blogging difficult for me has been the way I have spent my free time.
My blogging dropped off precipitously when I started a relationship with a special someone (with a p-value of <0.0001! I like to joke) and when I decided to blog, it quite often turned out to be "catching up on blogs" rather than "writing cool and fun content for my own blog." Sadly, my comments on other blogs dropped off with the exclusive use of Google Reader for my blogging needs. It does a splendid job of offering me text content, but a terrible job in helping me reach out and become a part of a virtual community. I put myself in the position of observer alone, having all of these amazing bloggers teach me about fascinating clinical cases.

I have been afraid to post things of personal interest.
My posts of late have adopted more of a neutral tone and lacked personality. Tossing back the curtain of "pseudoanonymity" by attaching my Real Name to this blog and revealing its presence to ALL of my potential residency programs made me meek. I have been afraid to say anything that may offend, provoke or be of any real interest, to be quite frank. This has made me think of the Happy Hospitalist and his "crap or not, here it comes" attitude to posting. Despite the fact that I often disagree with his philosophy and politics, he does occasionally have an excellent pearl or two to share... the rest are just his opinions.

And I certainly do not live up to my pseudonym if I am afraid to offer up opinions of my own, as ill-informed, naive, idealistic, fluffy bulshytt as they may be.

Writings and Ramblings

January 1st is a time of reflection on the past year as well as a time to resolve to make changes.

There's a few things that I want to do differently in the year 2010 and beyond.

I want to complete the 100 pushups workout. This is something that I think will be achievable by March.

I want to Blog more. Technically, this is something that I have accomplished with the simple exercise of writing this post! More specifically, I want to blog daily. There are a lot of things that go unwritten that I might find of relevance at a later date.

Recently, during a resident dinner, I found myself making two quite random non-sequitors on the subjects of urushiol and polydactyly -- subjects I fancied enough to blog about in the past. I found it quite striking that these topics bubbled up from my subconscious and became somewhat relevant!

One of my favorite interviews (at my favorite residency program) included a discussion on blogging. Indeed, said interviewer encouraged resident blogging as a way of reflecting on issues that came up!
There was a suggestion to ask yourself three questions:

What?
So what?
Now what?

What: Subject of discussion
So What: WHY is this of importance to you (the writer) and me (the reader?)
Now What: Conclude with something of significance.

So there. I've come up with a new method for generating blogging content that hopefully will me more entertaining and engaging than recent posts (that have been so dry that I bored myself writing them) and hopefully I can find a way to blog more often.

Cheers!

"For the Life of Me" and "Depression Too is a Type of Fire" by Taylor Mali

Love and loss.

Taylor Mali is a poet and a teacher and a true inspiration of the Word. He is best known for "What Teachers Make."

I wish that I could speak with the eloquence and gravitas that Mali has at his command. These two poems hit a particular chord in me that continues to hum. There is so much of me that I wish I could share with the world, but my idle thoughts lie unpolished and forgotten in some unexpressed corner of my mind. I find myself wishing that I had more time to compose myself in a manner worthwhile, yet when I do have time, I spend it appreciating only the works of others. I feel a sense of love and loss, but it is more of a manner of withdrawing into my own little safe world of medical facts to protect myself from the real world's imagined(?) horrors and disappointments.

Every once and a while, I find moments. I live moments of love. The smile of a patient at the end of a visit -- "you'll make a great doctor someday." "good luck to you." "it was a pleasure meeting you." "thank you, doctor." "Student doctor," I respond. A warmth creeps into my body, a smile uncurls naturally onto my face. Small moments in which the connections I find myself wondering if I could ever make with another person -- are precisely the things I do every day. I know there is a division between professional and personal life. I wonder if these friendships are worth the lonely nights and weekends spent studying dry facts and memorizing the latest evidence-based guidelines. Am I merely an algorithmic medical computer?

No.

The satisfaction I feel at the end of the day does not stem from the recognition of a particular diagnosis or a particularly clever question I ask. It comes from the bond I forge with my patients. Is it worth the sacrifice of a more social life? For now, yes. However, I don't think it is selfish to want something more.

whoa!

to those of you who might have subscribed to my feed and have noticed the sudden influx of posts... from a blogger you thought was dead and gone... hello!

I'm going to do the awful thing of meta-blogging, a self-serving, useless and noisy post that amounts to nothing in the greater blogosphere. However, talking about relevant and poignant posts will be precisely my goal for this meta-blog entry.

First up on the point of news, I've moved to Maui for 5 months where I will be finishing up my third year of medical school. I completed 6 months of inpatient rotations on Oahu in Queens, Kapiolani and Kuakini hospital. As a member of the third-year longitudinal program, I have the distinct pleasure of getting to live on a neighbor island, get to know a community and precept in several clinics.

Second up on the point of news, my girlfriend broke up with me three weeks ago. It was difficult to spend time with her in the initial part of the third year and we both recognized how much harder things would get. Our paths converged for a wonderful 3 months and then a subsequent sometimes frustrating/content/puzzling 3 months... but now our paths have diverged. I'm trying to have the insight and wisdom not to dwell on it too much while taking the best of it, learning and moving on.

Both of these bits of news mean that I am now going to resume my devotions to blogging. I have kept up reading other blogs, but when it came to the creation of my own material, often the only things I found worthwhile preserving out in cyberspace were a list of mnemonics I found helpful on my journey to the MD.

I recently divulged my true name onto the site of this blog. Frankly, this idea terrified me. I had a lot of great lessons to share and stories to tell from my hospital experiences, but I didn't want to have a repeat of an experience like this; where my pseudonymity betrayed me. Hopefully the passage of time has colored these experiences and I can share some of the details without violating anyone's right to privacy or bad-mouthing any particular resident or attending. I will be scheduling many of my posts which should help with the release times (and in case any of my patients check out my blog, they would be hard pressed to recognize themselves or anyone they know in my stories.

woot! new blog format up.

A friend told me that she lost the link to my blog a while back and that's why she stopped commenting. A few new people stumbled upon my blog somehow and one of them even offered to interview me!

Wow, it's nice to have that sort of attention. :)

After two months of puttering around with some minor changes, I decided to clean house and unveil my new blog. ta da! It probably looks the same as always. Perhaps the most important change I made was a mental one.

I reviewed some of the questions on Y.S.'s blog. It made me think about my motivations for blogging and what I had hoped to gain from all of this extra work. My biggest reason for blogging was for self-reflection. To think about the things I've done and form opinions about them. Somewhat ironically, I picked the name "Not My Second Opinion" as if I had some outrageous and strong opinions about subjects, like the folks at MDOD. I'm actually quite conservative (not in the political way) and I'd hate to be caught in the middle of a flame-war.

Let me tell you about my biggest fear with this blog though. I was afraid that someday I would get hauled into the Office where an Administrator would pull out my blog and list the violations I made to their Honor code and the privacy violations I made to HIPAA. The infractions would be minor, like mentioning a neat fact I learned from a case on that particular day, except it gives away the diagnosis of the case. Since the first two years of JABSOM is based on these cases, it constitutes cheating to provide this information to students. Arrgghhh!

There's been a lot of times where I wanted to share some things, but decided against it, erring on the side of caution. I've been burned before.

Still, I'd like to throw back the curtains of anonymity. Hello World! My name is Clinton. I'm a second year med student currently going to JABSOM, Hawaii's medical school. I love it. It's a strong cooperative place and my classmates are the best friends a guy could have. I'd like to start sharing my experiences with you as I move into my Board studies and prepare for my third year of school... that exciting, sleepless time filled with great stories and interesting patients.

I'd like to begin blogging fearlessly and passionately once again. After all, it's personality, not really content that drives Blogs. Otherwise they'd just be called websites with regular updates.

Healthcare Blogger Code of Ethics

I just came across this concept through Nick Gene's Pre-Rounds Interview with Dr. Lei of Eye on DNA.
Med Blogger Code of Ethics:

1. Clear representation of perspective - readers must understand the training and overall perspective of the author of a blog. Certainly bloggers can have opinions on subjects outside of their training, and these opinions may be true, but readers must have a place to look on a blog to get an idea of where this author is coming from. This also encompasses the idea of the distinction between advertisement and content. This does not preclude anonymous blogging, but it asks that even anonymous bloggers share the professional perspective from which they are blogging.
2. Confidentiality - Bloggers must respect the nature of the relationship between patient and medical professionals and the clear need for confidentiality. All discussions of patients must be done in a way in which patients’ identity cannot be inferred.
3. Commercial Disclosure - the presence or absence of commercial ties of the author must be made clear for the readers. If the author is using their blog to pitch a product, it must be clear that they are doing that. Any ties to device manufacturer and/or pharmaceutical company ties must be clearly stated.
4. Reliability of Information - citing sources when appropriate and changing inaccuracies when they are pointed out
5. Courtesy - Bloggers should not engage in personal attacks, nor should they allow their commenters to do so. Debate and discussion of ideas is one of the major purposes of blogging. While the ideas people hold should be criticized and even confronted, the overall purpose is a discussion of ideas, not those who hold ideas.

I agree with these ideas, especially those about Reliability of Information. There's so much garbage out on the internet that obscures the truth... it's important for health professionals to ensure that they are providing a refuge from this refuse!

"Flea" Bite

A while ago, I started to read the posts of "Flea," a pediatrician blogger so named by snarky surgeons who call pediatricians "fleas."

He took to his pseudonym well, offering biting commentary in the medical field, often offering harsher truths than I thought appropriate, as evidenced in my response to his entry on Lavender Essence and vaccines. A doctor has a position of high responsibility and respect and it requires a certain amount of professionalism... which apparently, extends to blogs. You cannot let your guard down, even when you use a blog as an outlet for something as frustrating as a malpractice lawsuit.

Flea's posts became irregular and more and more of them cited an ongoing court case he was involved in. I thought that this was a risky thing to do and as many speculated when his blog was completely erased -- it did not bode well for the outcome of his trial.

Indeed, he was featured on the FRONT PAGE of the Boston Globe just a few days ago! That's crazy scary. I would not want something like that to happen to me.

Worried about how a blog might affect your career and your reputation if you should be discovered? Clinical Cases and Images offers a few pieces of advice: write as if your patients and your boss reads your blog everyday. Conform to HIPPA. I added a disclaimer to my sidebar, but I don't have the traffic/notoriety/fame that Flea, Respectful Insolence or Dr. Dimov have to warrant full disclosure.

Kevin, M.D. offers his own comments and summarizes the responses in the blogosphere.
Eric Turkewitz, personal injury lawyer provides some links to the ongoing story.

Blogging & Clinical Cases

DB's Medical Rants had a podcast reflecting on his one millionth hit. He talked about writing -- how his blog initially started off as a way to become a better writer and express himself, but he eventually found more and more people visiting his site. He had a few tips for fledgling bloggers and I found myself thinking about my own blog and motives.

Have I been focusing too much on the audience and the reader and not enough on myself and my own thoughts? What is my purpose for writing?

I haven't been posting as much as I intended to when I first started Not My Second Opinion. There are a number of reasons for this... I initially wanted to share my philosophical musings about various ethical topics in medicine, but I've regrettably found myself with very little time and energy to post on such topics in a meaningful way. My interest in posting something drastically wanes within the first few days... sometimes I get bored with the idea or I no longer think it is postworthy. Perhaps I have high standards of what a medblog constitutes after perusing the quality of my favorite blogs. Most of all, I'm worried about being held accountable for what I say -- which I find highly ironic considering the name i had settled on for this blog.

For the new year of 2007, I am going to make a few changes to my writing tone and style to reflect more of my deeper thoughts. It will be more unvarnished and more rough around the edges, but I hope that this bluntness will encourage more discussion (and be less taxing on the small portion of my brain dedicated to being sagely and wise.)

I'm going to start a new series of entries, inspired by clinicalcases.org. Every week, I will present a case that I've seen in the hospital. It will focus mainly on the clinical aspects of differential diagnosis and reasoning through the physical exam, but I will add my own personal thoughts in at the end as an emphasis for humanism in medicine.


One of my New Year's Resolutions is to devote a few more hours a week to writing. Not necessarily here for you, but for myself as well.

The Seal of NMSO

As if this site needs an Official NMSO seal... but here it is anyway!

Get your own free personalized seal here:
http://www.says-it.com/seal/index.php
Make it as funny or as professional as you'd like!

via Aetiology

Why I'd like to maintain my Pseudonymity.

The time was a year and a half ago, a week after spring break. I got an urgent phone call from the Biology Dept asking that I make an appointment with the dean ASAP. I received a merit scholarship award a few months earlier and they didn't even bother to call me about that, so I was a little bit concerned. I went in to see the dean that afternoon and he started asking me some odd questions.

"Have you ever seen a Dr. Nx?"
"Do you have a personal blog where you made any negative comments about him?"
"He's accusing you of slander, for painting him as an inconsiderate, tardy doctor."

BWA? Sure. However, this was an event that was a year old and I had gone on a trip for spring break to shadow some doctors with a club. A bunch of doctors had agreed to let the pre-meds follow them around in various parts of the hospital and clinic. I was just commenting on my experiences and I mentioned that "Dr. Nx left me sitting around for half an hour, then when he got to work, he left me sitting around for another half hour so I ended up following another doctor around." It was just a sentence in a long reflection entry. This was on a blog entry that I had made "private", but unbeknownst to me, Google had a cached version of the entry.

The dean believed me and told me that he thought the doctor was on pretty thin ice to get me on academic probation for libel, especially if the incident was well over a year ago and no longer "public." I was given the doc's phone number so I could call him to apologize.

I swallowed my emotions and I called up Dr. Nx. He seemed very upset, but he tried to talk to me in a reasonable manner, telling me how "I screwed him over." He calmly explained how easy it would be for someone to Google his name for a job interview only to see my little careless blurb about his tardiness that stains his reputation as a doctor. Then he proceeded to give me his excuse/explanation for why he was late and why he ignored me when he arrived.

Okay, I can see how unprofessional it would be to be googled and have these negative impressions pop up #7 of maybe 20 sites. I didn't write with the intent to upset anyone; I just wanted to say "oh, I had a fun trip, except for a few rare instances."

Then, he dropped the bomb.
"If I weren't such a nice guy, I could call up your medical school and .... talk with Dr. Sx, your medical school interviewer, right? I could tell them that you slandered me. I could make sure you wash test tubes for the rest of your life."

This certainly implied that he had been reading through my entries since the event.

I thanked him for being a nice guy. I promised to "contact Google to get rid of its Google cache of my personal blog site." They were both lies, but they placated Dr. X... and that was sufficient. My Undergrad School had their "formal record" of the story from both sides and received no further complaints from Dr. Nx.

This was an eye-opening experience for me. This will be the ONE and ONLY time I will make negative comments about anyone on NotMySecondOpinion. I've learned that casual comments on the internet can last forever... luckily for me, there weren't any regrettable consequences from my harrowing experience.

Hm... blogging is hard!

Well, I started medical school recently. I've been busy studying and working on small group presentations. It is good that I've been learning a lot, getting to know my classmates, having a lot of fun in the sliver of summer break that everyone else still has left... but I haven't been devoting the sort time to this blog that I really wanted to. I intended to use this as a place of reflection on my experiences, to make sure that I maintain my balance -- to learn about ethical, philosophical and spiritual issues alongside the biological and clinical lessons that I am taught in school.

The thing is, ethical issues are HUGE. I feel like I don't give the time they really deserve if I poke in and comment on the few issues that crop up day by day.

Philosophical entries are monstrous as well. I love thinking about these things, but it is difficult to trim down my thoughts into a coherent essay -- a recreational essay at that -- and give it a solid opening and closing.

So, I'm going to change my focus a bit. My other goal of this blog, educating the public (read: you!) about health and social issues, has been much more successful. I think that the addition of the mnemonics section to my themes will give you new entries to check out on a daily basis. Mnemonics and news are just short little clips that I can pop out with next to no effort or thought.

Unfortunately, next-to-no-thought is not what I want this blog to be about. Weekends will give me the time to compose myself and write the better entries that I have been stewing in my mind that I have not had the time to write during the week.

Post Structure

Just a few more notes (mostly for my sake) before this blog fully gets going.

Each entry will follow a certain theme across the span of a week. This will keep the content cycling on a regular basis in a manner that I hope will keep things interesting and fresh. The subjects that I am mainly interested in discussing are:

• Philosophy/Ethics
• My ruminations on life, ethical inconsiderations and neigh-un-informed politics will fall under this category. I want to cultivate of a greater sense of my psychological and spiritual self and reflect on how this affects other people.
  
• Education
• I strongly believe that our society will succeed if we emphasize two things: healthcare and education. I will strive to teach and inform on medical matters in particular (with citations as necessary) to further these two objectives. This will range from mnemonics for med students to interesting trivia that everyone should know about their biological selves.
  
• Technology
• I am fascinated with the advances of science and I like knowing what is going on. I will try to find the most quirky inventions, the nifty gadgets that have transformed our healthcare system and promising new concepts.
• News
• I anticipate that I will be busy studying... a lot. In lieu of my own thoughts on days when I am preoccupied, I will link you up with news articles that I think are significant points of discussion.
  
• MD Life
• Funny anecdotes of my life in medical school, my shout-outs to fellow med bloggers and other such social "pimpnetworking" will go under this category.
• Pre-Med
• Just in case pre-meds stumble in here looking for guidance and advice, I will stuff my thoughts, tips and tricks in here.
• Mnemonics (added 8/3/06)
  
• I'll put up a few mnemonics a week to fill in the gaps in my own knowledge. Sounds like a lot of fun... but not many medblogs are doing this for some reason.
  

Hello, World!

"Hello, World" is a phrase familiar to many computer programmers. One of their first lessons in coding involves the creation of a short application with one purpose -- it prints out "Hello World" -- thus announcing itself proudly as the beginning of something new.

This proclamation is relevant to this blog as well. I am a novice in coding and a novice in medicine. As time goes on, my proficiency in both will be demonstrated here, as I reflect on my daily experiences and their greater relevance to the world. After I recently discovered (much to my relief and those of my parents) that I will be a part of my state's medical school, I decided that I would document my progress so others may learn with me as well.

I hope to share my insight, my humor and my nonsense with you all.

Enjoy!