Eye of Science: Life in the microcosmic world.

Eye of Science

01. Medical science: skin, lateral cut
Electron microscopy

A section through human skin. The skin layers, from top to bottom, are the stratum corneum (flaky, brown), composed of flattened, dead skin cells that form the surface of the skin.

The dead cells from this layer are continuously being shed and replaced by cells from the living epidermal layer below (red) The lowest layer seen here is the dermis (grey-brown, lower centre), a thick layer of fibrous connective tissue that supports and nourishes the epidermis. In the middle, a sweat gland can be seen. Coloured scanning electron micrograph, Magnification: x50.

Medical illustrations & animations: The inner life of a cell.

The Inner Life of a Cell: Watch the video here.

The Inner Life of a Cell, an eight-minute animation created in NewTek LightWave 3D and Adobe After Effects for Harvard biology students, the animation illustrates unseen molecular mechanisms and the ones they trigger, specifically how white blood cells sense and respond to their surroundings and external stimuli.

Sermo: Physician 'MySpace'.

MySpace for physicians

...challenge or corroborate each others opinions, accelerating the emergence of trends and new insights on medications, devices and treatments. You can then apply the collective knowledge to achieve better outcomes for your patients.

Med Spa Burnout? Be happy you're not a urologist?

A day in the life of a urologist. Sometimes everyones just on a different page.

Via UroStream: The setting is a medical examining room. List of characters includes a physician and a patient. The action is all undertaken by the patient while the physician is present. Which of the following scenario would you consider rude?

• Playing games on your cell phone
• Answering above mentioned cell phone
• Clipping your nails
• Chewing gum
• Being drunk
• Being drunk and asking for pain meds
• Being drunk, asking for pain meds and blaming lack of pain meds for being drunk.
• Eating a yogurt
• Eating and then spilling your yogurt on the floor, and having the physician clean it up.
• Pooping in the uroflow machine (device to measure your urinary flow and NOT designed for BMs)

It was a very long week....

The Uninsured Patient Experiment

It appears that hospitals are a hit and miss proposition with elective procedures. From the Healthcare Advocate Blog.

The Uninsured Patient Experiment:

• The list price varies by 75% ($1,013 to $3,970).
• The best uninsured price varies by 92% ($204 to $2,600).
• List price discounts range from 0% to 86%.
• To get many of the discounts hospitals offer the balance needs to be paid in full at the time of service or a large down payment made, to receive it.
• Some hospitals are unwilling to divulge the price over the phone and others will not call back.

Dr. Charles Book: Legends of the Examining Room.

From The Examining Room of Dr. Charles. A young family physician's attempt to say something pithy. Some stories loosely based on real experience. All characters, however, are fictional. Copyright the author 2006.

Presenting Legends of the Examining Room, a collection of the best stories I had to offer from the first year of this blog, in addition to many pages of never before published writings.

The book is available in paperback and PDF/eBook versions, makes for a unique gift, and helps me donate a portion of the proceeds to The American Red Cross. You can read the 1st chapter here.

Reviews

Dr. Nicholas Genes, writing for Medscape from WebMD, states: "He senses a patient's grace in times of vulnerability and appreciates the privilege of helping them... the book reads like a window into the office of an observant, engaging physician."

Dr. Clifton Meador, author of several books including Symptoms of Unknown Origin writes: "Aidan Charles, in his 'Legends of the Examining Room,' demonstrates an extraordinary ability to see and hear the human condition. This talent would be extraordinary alone but he reports his observations in prose that is often poetic. If these writings come from his first year of practice, we can hardly wait for what he might see and write in the next few years."

Leigh Hopper, a writer for The Houston Chronicle, comments: "The days of medical professionals are full of great stories. But it takes something special to turn that material into something worth reading."

Marianne Szegedy-Maszak, special to The LA Times summed up this blog quite well: For all their dissatisfaction with medicine today, blogs offer doctors a hopeful place to feel unconstrained about their profession, to feel a bracing sense of possibility. As Dr. Charles put it in his first posting: "You almost feel as if you are putting a message in the bottle across the sea, across the world. And you wonder, is this a narcissistic shout or the first living synapse?"

My agent certainly helped my ego: "After reading your blog "The Examining Room Of Doctor Charles," I am thoroughly convinced that your writing will do for medicine what James Herriot did for the veterinary profession. I was thoroughly impressed with your style and touched by the gravity and wit you bring to the most delicate of human circumstance. As the founder of one of New York's leading literary agencies, it is my commitment to identify outstanding individuals with your caliber of writing talent who have fascinating individual stories to be told and celebrated."

The Angry Physician Syndrome: Hostile MDs entering cosmetic medicine.

Hostile doctors and the clinics they run.

Having consulted with many physicians about incorporating some form of cosmetic practice into their clinic, I've noticed that one of the biggest problems that these physicians have is changing the way they 'think' of medicine. (Noticed is something of a simplification since 'beaten over the heat' is a more accurate description.)

Cosmetic medicine is a new world for doctors who are used to third party reimbursement, nasty collections letters, physician referrals and seeing 30 or more patients a day. Docs today are angry; Irritated by long hours, pissed at malpractice premiums, feeling unappreciated and defensive.

Dr. Charles is Hostile:

There's no justice in Germany either. A German court ordered an OB/GYN doctor to pay $769 a month in CHILD SUPPORT to one of his former patients - a woman who got pregnant despite the IUD (contraceptive device) he inserted. This is horrendous. Sue your doctor if you get pregnant? An unintended yet healthy baby is evidence of bodily harm? No contraceptive is 100% accurate! The article says that "the implant could no longer be found in the woman's body." This does not mean it was the doctor's fault. IUD's fall out in up to 7% of women in the first year of use. That's part of the reason they have a string that dangles out of the cervix into the vagina, meant to be checked on a regular basis by the woman to ensure proper placement. This is totally outrageous, uncivilized, and another reason why it takes serious courage to try to help anyone in this world of blame.
[update - thanks to the correction of a German commenter, it was not an IUD that failed but another device, probably like Implanon but I don't know what's available in Germany. The underlying principle is still unbelievable. Overlawyered has some more links to this, and a decent discussion starting in the commentary.]

The Trial Lawyers Association is changing its name to the American Association for Justice. George Orwell is smiling somewhere, the skies are getting clearer every day, and no child is being left behind.

A doctor acquaintance of mine just got destroyed with a $20,000,000 jury award in a bogus malpractice case. I typed it into google and found this page, which is unrelated. I felt nauseous reading the top guy's credentials. The best thing he's done is apparently winning "the largest medical malpractice verdict ever won in the District of Columbia ($24 Million), (which was) reported by USA Today, Dateline NBC, Jet Magazine, the Washington Post, the Baltimore Sun and affiliates of ABC, CBS and NBC." Way to go! I bet his pockets were full after that one! Those doctors on the other end deserved utter destruction, all those years they spent working 120 hours a week for $30,000 a year, all those hopes they had of helping people, of making a difference. All those efforts pale in comparison to the $24,000,000 he got the jury to cough up.

Dr. Charles is right.

But... cosmetic medicine is a different animal and angry docs fare poorly when the anger they have towards the system spills over into their interaction with patients and staff. (Yes, I know angry docs fare poorly everywhere.)

Whenever I'm interviewing a physician I ask myself if they're an angry doc. If I think they are, it's a non-starter. I can work with a lot but can't change the way that someone fundamentally views the world and their situation. I can't change the way that an angry physician deals with patients, staff, and me. It just doesn't work. It's true that there are lots of angry docs out there and you might know some that you think are successful and that the fact that they're angry doesn't hurt them as a business. I don't.

If you're thinking about entering cosmetic medicine because you're angry and think that someone owes you, get ready for more of the same. In cosmetics as in regular medicine, it's still all about them.

Update on 2006-11-21 00:56 by Medical Spa MD

Follow-up: Dr Charles sent me a very nice email that included the following:

"...Although you said "I'm right", I did find your post kind of annoying, labeling me as an "angry MD."  There is so much more than that unipolarity in defining my approach to medicine, but at times we all get angry."

I did not mean to apply a blanket angry label to Dr. Charles. In fact, he seems to be a well read and thoughtful physician with a respected blog. My apologies to Dr. C. Nothing at all personal intended.

This post, and other I'm sure I will write, are meant to delineate the difference between general and cosmetic medicine for docs looking to make a change or choice. 

Of course anger is not only confined to physicians, pharmacists have it too. 

Family Doctors, 8 Laws of Medicine

Solo Family Doctor: Laws of Medicine 

#1 Dinosaur offers these truisms for docs.

• First Law: The Art of Medicine consists of amusing the patient while nature takes its course.
• Second Law: It is impossible to make an asymptomatic patient feel better.
• Third Law: The urgency of the test is inversely proportional to the IQ of the insurance company preauthorization clerk.
• Fourth Law: No good deed goes unpunished.
• Fifth Law: A patient's acceptance of a screening test is inversely proportional to its necessity for that particular patient.
• Sixth Law: Trauma survival is inversely related to the patient's value to society.
• Seventh Law: Fertility is inversely proportional to intelligence.
• Eighth Law: The better the surgeon, the more reluctant s/he is to operate.