Not Drowning, Waving

I haven't posted anything for a long time, so please bear with me.

I'm not even going to pretend any pertinence to clinical medicine, nor any forays into Dorksome jocularity. I shall refrain from the third person self-referencing for a change, as well.

Firstly, an apology to all my intertubes comrades, friends and acquaintances, who felt excluded by this blog 'going all private'. With my rudimentary understanding of Blogger, my decision to close the blog in May seemed to present only two options - make it "private", or delete it completely, which I wasn't quite prepared to do.

I have eschewed my dorkdr@gmail address until now, and regret any hurt feelings, as I wade through a great backlog of email tonight, to those who might take umbrage at any perceived exclusion from a "private blog". It was simply easier for me, at the time, to close the blog and avoid the brief flurry of kind email inquiries. The blog was not so much private, as in a state of pre-deletion.

I have started lurking about again of late, and note that many other health blogs, some of my favourites included, have shuffled off as well, pro tempore or otherwise. As others have discussed with far more perspicacity, perhaps this is simply the nature of the beast.

Why did I vanish ? Let me count the ways...

1. Ill health. Improving now.

2. Copyright concerns. I have developed further some of the nascent scribblings I occasionally posted, and as posting on Blogger legally counts as "publishing" in most regards. I have had to remove most of my creative work that I am compiling or submitting elsewhere, unfortunately.

3. Privacy. I don't write about my patients in any way that could be potentially identifiable. This is a Hippocratic fundamental, in my opinion. However, I have chosen to bare my personal foibles and failings in this blog. Others have suffered for similar disclosure, possessed of far greater altruism than I. Whilst hosting Grand Rounds was a privilege and a pleasure, the consequent huge surge in site visits was worrisome for me. I much prefer peeping out (and piping up occasionally), snug beneath my warm little rock, to the glare of the hot sun.

I am of the opinion that, particularly with my personal spectrum of illness, this fractured window may have been, and still could be, of use to someone, somewhere, sometime. When traversing one's own dark night of the soul, a single kindred spirit is of much value, wherever and however found.

So the blog archive is back, in part. Not that there is much of it, in retrospect. At least for now.

It is a pleasure to read the words of others, especially those who have lingered long. It is a pleasure to be read.

Yours occasionally,

Dork

In Absentia

Waiting Room

Long story short: Dr Dork is on hiatus. For salubrious and salacious medical writing, please explore the blogroll.

Disgruntled patients

Grand Rounds Vol 3, No.30

Grand Rounds now available at Fat Doctors.

Archives and upcoming schedule here.

Another nonsensical bout of self-absorbed whimsy

Irrelevant and irreverent descent into mirth and whimsy has been just about the only output from Dr Dork of late.

Apart from Grand Rounds, of course - which was not as time-consuming as Dr Dork thought it might be. Dr Dork reads most of the blogs which submitted anyway - his Bloglines feed count stands at 205...and counting.

Dr Dork is perhaps showing his age by divulging his love of cheesy Creature Features. An excellent way to while away a few hours of insomnia.

So here we have a Godzilla dancing extravaganza, produced by Daniel, a 15 year old in San Jose.

Don't know the music, but the combination is much fun.




Dr Dork is thinking he will finally bestow a first name on himself, for a trial run.

Until next time,

Dr Tom F. Dork

The Magick of Iridology

Mr Odd : My back feels completely fine. But I still see the chiropractor every 3 weeks, of course.

Dr Dork: Of course. Do the wrists give you much trouble after the operations ?

Mr O: None at all, doc.

Dr D: Great! Good for you. How has the drinking been going ?

Mr O : I drink a bottle and a half each night, but I took out the unhealthy stuff from the mix.

Dr D: Meaning...?

Mr O: I saw my iridologist just after the operations. He told me to cut down on the Coca-Cola.

Now I mix my bourbon with ice-water.

Only smoke light cigarettes as well.

Dr D: OK. *takes a sip from diet cola*

Mr O: The phosphates in that will kill you, you know...

Grand Rounds Vol 3, No.29

G'day and welcome to this weeks edition of Grand Rounds. Dr Dork is pleased and honoured to host your journey through some highlights of this weeks medical blogging.

No time to shave today

Dr Dork has elected to follow the early tradition of Grand Rounds, as established and maintained by Nick Genes, venerable beyond his years in this regard. To elucidate, a few posts that have stood out, in this editor's opinion, have been selected for each category, to keep this edition of Grand Rounds to a readable size.

There were roughly quadruple the number of submissions for the (arbitrarily) designated size of this edition. Many quality submissions were regrettably left out this week, apologies to all. Dr Dork wouldn't have made the cut himself amongst the field of entries this week.

For those with particular preferences and predilections, the 30 selections for this week have been compiled into the following categories:

1. Rants
2. In Practice
3. Of Patients and for Patients
4. Education
5. Research and Advances
6. Healthcare Policy and Reform
7. Medicine in the Media
8. Miscellany and Mirth

Lastly, In Parting, we have a bittersweet farewell from the greatly admired Barbados Butterfly.


Rants



Fallen Angels rants on discourtesy in the healthcare blogosphere in Doctor Bloggers

Dr Dino berates the local lawmakers for the misguided enforcement of BMI Measurement in Schools.

Susan Palwick of Rickety Contrivances of Doing Good (perhaps the tongue-twistiest healthcare blog title) shares her anger at observing abusive behaviour towards an ED "frequent flyer".

In Practice

Dr Kenneth F. Trofatter discusses the evaluation of Recurrent Early Pregnancy Loss as part of an ongoing series on the topic. An increasing problem, one presumes, as many elect to become parents later and later, it seems.

Fat Doctor shares a moral dilemma as an overzealous schoolteacher almost berates her into support of developing SuperBugs.

Azygos shares a poignant tale of a patient's death from Multiple Sclerosis, and touches on the dangers of a fragmented care system in Paul

Signout, in the midst of a trying cardiology rotation, is touched by the power of a simple gesture of thanks in What we're supposed to do.

Dr Shazam of Mr Hassle's Long Underpants (still one of the best blog names, period) shares the electricity, and the enervation, of emergency room codes in Fallen Star.

Of Patients and For Patients

Dr Rima Bishara gives a comprehensive summary for parents, examining sports injuries in children.

Adam of Daylight Atheism gives a disturbing account of the situation faced by those in the Congo, where a single, lone psychiatrist, Dr Alain Mouanga, struggles to turn the tide of abuse inflicted upon the mentally ill.

The Bohemian Road Nurse shares her deeply personal experiences of battling alcoholism, a common affliction throughout the healthcare professions.

ChronicBabe shares some advice on time management for those struggling with their health...advice which we could all heed, irregardless.

Education

The inimitable Orac looks in detail at the subtleties of early cancer detection, particularly in regards to breast cancer in a highly informative two-part post.

Vitum medicinus shares a compendium of people he admires most in his class at medical school. Reminds one of the different paths many of us walk to the same destination.

Research and Advances

GrrlScientist identifies a major flaw in the much lauded "treatment" for ABO blood type incompatibility which has been bandied about in recent weeks.

Docinthemachine blogs on new developments in genetic pap smears which could lead us one step closer to eradicating some common STDs.

Dr Domenico Savatta looks at surgical options, including some recent research of his own, in treating prostate cancer. Very relevant to us old codgers.

Dr Charles revisits some of Kinseys ground-breaking and controversial work with a "Kinsey-style" sex survey of the health blogosphere. Go on. Be honest!

Healthcare Policy / Reform

Australian Parliamentary Debate

Dr Kevin takes a break from his frenetic link-blogging to give us a thoughtful and considered discussion of the growing problem of defensive medical practice.

Amy at Diabetes Mine previews Michael Moore's much anticipated "sicko" documentary. Even those of us on the other side of the globe will be interested in his take on the American system.


Medicine in the Media

N=1 from Universal Health berates the New York Times in Heart Disease, Treatment and Thrills for a recurring debasement of the nursing role.

Kerri at Six Until Me considers from the perspective of a diabetes sufferer the recent macing of a Mr Universe whilst hypoglycaemic in Doug Burns, Maced ?

Walter at HighlightHealth examines an inflammatory television "investigation" of pharmaceutical dispensing errors.

Jon Schnaars at Anxiety, Addiction and Depression Treatments comments on recent research looking at the questionable use of "check-list" questionnaires in psychiatric diagnosis and arbitrary exclusion criteria in Checklists Often Fail to Address Important Aspects of Depression Diagnosis. Dr Anonymous takes another look in is depression really depression ?


Miscellany and Mirth

Aaaaaah...Dr ? Are you Ok ?

Dancing Bare gives us a taste of Gilbert and Sullivan with an ode to Dr. Mom.

Roy of Shrink Rap gives an emotive, heartwarming view of the necessity of humour in preserving sanity in the face of tragedy in laughter is a drug. Dr Dork couldn't agree more. Ijeoma Eleazu reminds us that April is national humour month for American readers.

Dr Karen Little, a South African intern, of Just Up the Dose, shares with us some stomach churning experiences in a post succinctly titled ew.

Dr J of Northmed does some brain-twisting with medical acronymony

Nurse Ratched shares with us some outstanding additions to her vast collection of medical pulp fiction. Ah, those were the days....

What ? Time for my sponge bath already ?

In Parting

Charity Doc shares an ode dedicated to the much admired Barbados Butterfly whose wings have been sadly clipped.

It is common knowledge, after some dubious leakage to a major Australian newspaper, that Dr Barb was (in this Dork's, and many others opinions) inappropriately reprimanded by her hospital administration. Dr Dork recalls his many 100+ hour weeks from his hospital training days. Even back then many administrators preferred to deny the ridiculously unsafe hours many doctors worked. Unsafe for patients and doctors both. Dr Dork suspects this is what got Dr Barb in trouble...but we will, sadly, possibly never know.

Dr Dork has badgered Dr Barb into providing an "approved statement", which follows.


BARB BUTTERFLY STATEMENT APPROVED FOR RELEASE
=============================================
Dear Blogosphere,

Thanks to everyone for your well wishes, kind words, expressions of concern
and thoughtful tributes in recent weeks – I was amazed to realise the extent
to which the Barbados Butterfly blog had touched and inspired others since
its beginning in 2005. As the blogosphere has reported, the BB blog has been down since March 15th 2007.

The 2006 post “Tips For Surgical Intern #1” stated that in a bad situation
you can either leave it, reframe it, accept it or change it. In some
situations change is the only option. It may be daunting and difficult, but
that must not dissuade us from trying. Surgical training is necessarily
hard, but there are some paths that trainees should not have to walk. Long
term readers will recall my Darker Days series:

“I do know that as a profession we need to do better. We need to promote a
culture of safety. We need humane leaders - both clinicians and
administrators. We need to value our colleagues and create work environments
that we feel confident about and excited to be a part of.”

I am grateful that there are people who are both willing to accept the need
for change and willing to act. My blog is down and I shall miss sharing my
stories with you, but I sleep restfully (my pager notwithstanding!) and
continue to wield my scalpel with a smile. We live in exciting times.

“If nothing ever changed, there would be no butterflies.” – Anonymous.

Best wishes and much love to all,
Barbados Butterfly


That's all for this week. Next weeks edition of Grand Rounds will be hosted by The Fat Doctor.

Addendum: the pre-emptively curmudgeonly Dr Nick Genes interviewed Dr Dork for Medscape Pre-Rounds here.

Can I have some more, Sir ?

Just a reminder.

Grand Rounds here this coming Tuesday. All are welcome.

Submissions to dorkdr@gmail.com

Low Expectations

Pip and Miss Havisham

The key to enjoying modern cinema, perhaps.


Dr Dork is aware of the detriment that the culture of merit-free celebrity has upon civilised society. He tries to avoid TV...apart from Dorky things.

Dr Dork occasionally, for various and variable reasons, inflicts aspects of his musical or literary tastes upon his readers. He has only - indirectly - referenced contemporary cinema once before.

Tonight's Film at Château Dork: Little Miss Sunshine (LMS)


Dr Dork loathes formulaic film. Dr Dork enjoys films that break the mold. Or is that mould ? Unlike much of the current commercial cause célèbre, such can still, at times, be considered an art form.

Dr Dork had been recommended LMS by a few members of his desiccated gene pool, and had read a few rave reviews.

Rave reviews are usually the kiss of death at Château Dork. However...Dr Dork needed an extra movie to complete his VideoStoreCheapoDeal today. LMS effectively cost a dollar. Expectations were low.

Expectations were surpassed.

Conflict of interests should be identified:

1. Dr Dork has had a schoolboy crush on Toni Collette since Muriel's Wedding.

2. Dr Dork perhaps sees too much of himself in Steve Carrell's previous roles.


Dr Dork enjoys ice cream. French vanilla, preferably. Enough said.

Pageants debase and demean humanity. Enough said.

Urostream Grand Rounds, and holler for submissions

Grand Rounds are up at UroStream.

Dr Dork thinks Dr Keagirl (seen here:)
has the most amusing and apt blogheader of all medical bloggers, but he can't work out how to display it...so you'll have to go see for yourself !

Dr Dork will have the pleasure of hosting Grand Rounds next week. Please make your submissions to dorkdr(AT)gmail(DOT)com.

Curfew will be lunchtime Monday your local time, after which the CHUDs will be released.

Grand Rounds will be following the traditional format as per Nick Genes guidelines from the early days of the tubal interweb, with a selection of highlights from the week.


Addendum: You can find Dr Keagirls Pre-Rounds Medscape interview with Dr Nick Genes* here.



*Grand Rounds founder/co-ordinator/eternal slave to the beast he has created

Centennial Rounds

Dr Rosendo Ribeiro, and his trusty zebra, Kenya, 1907

Dr Dork, whilst briefly logging on the intertubes to upload his typically belated Grand Rounds notification, noticed that this is also his hundredth post.

Dr Dork can almost hear the tumultuous response from the medical blogosphere :

"Whoop-di-do."

"Tell someone who gives a rat's derrière."

Dr Dork has wrestled since beginning to blog with a multiplicity of goals to the endeavour. Overarching all of these, of course, is the primary reason why he came into existence.

Like many of his medical brethren, Dr Dork has a propensity towards perfectionism and distinct obsessive traits. "Best to do something well, or not at all," he recalls Dork Sr advising.

Dr Dork suspects his psychologically savvy colleagues might suggest this "everything or nothing" style of thinking is a recipe for disaster.

There are a lot of medical blogs out there. Dr Dork has lost count of the number he is now subscribed to. Many of the consistently productive ones seem to focus on a particular modality or two of blogging only:

Politics of healthcare. The particular speciality of the writer: Surgeons to shrinks. Emergency medicine to General Practice. Little people to even littler people. Tickers to tubing. Debunking quackery. Collating medical news. The history of nursing caps and dodgy romance novels. Medical literature. Doctor as patient.

Just to name a few.

Dr Dork is fragmented. He produces random output in at least 5 different modalities. Choosing to avoid his particular speciality field (which may or may not have been touched on at some point) is quite limiting.

Anyway.The loperamide appears to be kicking in, so enough verbal diarrhoea for now.

Suffice it to say Dr Dork is contemplating whether he might get more out (ie. put more in) if he chose a particular modality on which to focus. We'll see.

A trace of ennui intrudes at present, and output shall continue scarcely. This appears the eternal nature of the Dork, to spew forth at random intervals in random amounts. So be it - like it or lump it...Ha!

The main point of this post, before Dr Dork become absorbed in the wonders of navel gazing, is that Grand Rounds is up at Medviews.



Medviews is written by Dr Stuart Henochowicz, an Allergist/Immunologist at Georgetown with an impressive breadth of credentials.

Grand Rounds and Dorkish Humour

Dr Dork is aware Grand Rounds was posted several days ago. Better late than never.

Dr Sam Blackman is a paediatric haematologist/oncologist from the US who is the host of Grand Rounds this week.

For any non-medical readers paed/haem/onc = little kiddies with cancer.

Tough gig.

Dr Blackman touches on the role of humour in grand rounds, and Dr Dork thinks this a salient point. In a similar vein, CodeBlog has made impressive use of limericks in this weeks
Change of Shift.

Humour is a useful tool in medical teaching, and in medical practice. From his psychiatry days, Dr Dork recalls it as a critical element of assessing a mental state properly.

Humour is, of course, a therapeutic tool in and of itself. Although Dr Hunter "Patch" Adams is a controversial figure, and Dr Dork disagrees to some extent with his extremely anti- “conventional” psychiatry stance, the message that humour does us good is beyond reproach.

In this spirit, Dr Dork would like to share some of his favourite humour sites. Please note, some are at times crude. In the tradition of FARK, the NSFW (not safe for work) tag will be applied for these, for those of you reading from a work computer.

Dork Humour

Dr McNinja – yes, it is a comic strip about a Ninja Doctor. Seriously. The premise : a kindly physician is infected with a virus which bestows ninja powers. The current story, with guest (ie. shoddy) artwork is average, but the archives are very entertaining.

Amateur Transplants – by Dr Suman who is a British anaesthetics trainee. The highlight is the section of mp3s, which are very funny.

Chaser – largely political Australian humour, possibly nonsensical to those outside Oz.

Comics curmudgeon – dissects humorously various daily comic strips

The Daily Show – you can’t get the show clips via Youtube anymore due to Viacom getting all "sue-y", but they are posted here at ifilm. The Chappelle Show archive is also recommended. Sometimes NSFW

Dilbert – probably the funniest comic around at present, given that Patterson and Larson
have effectively retired.

Dr Rob – arguably the funniest medical blogger around, at least to Dr Dork's mind, although there is some stiff competition about.

The Onion

The Overheard series. NSFW

Reasons you will hate me. A sometimes raunchy blog with much political humour, by a 30-something author/screenwriter/ex-child actress that is especially entertaining if familiar with Melbourne. Very NSFW

And last but not least, Red Meat, Medium Large and The Perry Bible Fellowship are three irreverently funny web comics. Often NSFW

Well, all that should keep some of you out of mischief for awhile.

Dr Dork is a bit tied up at present, hence Chateau Dork might be a tad quiet over the next week or two. He also apologises for being rather tardy in replying to comments - these will be addressed over the next few days.

Viraemia

Dr Dork generally is wary of "memes", in the same way he doesn't forward chain mail.

Nonetheless, as two health bloggers he holds in high esteem, AngryDoc and JMB, have pointed the bone in regards to suggesting Dr Dork is a "thinking blog"...

Flattery will get you everywhere, Dr Dork thinks.

The requirements of this "meme"

1. Post with links to 5 blogs that make you think.

2. Link to (*original source blog*) which contains advertisements and solicits "donations" to its author. Maybe not.

3. Variation on 2. Definitely not.

Well, if anyone's interested, these are the 5 blogs that make Dr Dork think more than any other:

1. Stranger's Fever

2. NHS Blog Doc

3. Respectful Insolence

4. The Dilbert Blog

5. Intueri

These selections are entirely idiosyncratic, in random order, and Dr Dork also notes that thinking ain't always a good thing. Ha !

Chrysalis

The Bloglines post notifier / reader / thingamajig, which Dr Dork opens even before his email nowadays when cranking up Old Rusty^TM , his venerable PC, is temperamental at best.

Oftentimes, little red exclamation points appear next to various blogs Dr Dork subscribes to. Usually, this is a transient software glitch. Going directly to a blog / site address bypasses such RSS or similar problems.

Today, Barbados Butterfly (link now inactive) was “flagged” in this manner.

Dr Dork had some trouble accessing the site, and presumed a glitch or gremlin was at play until just now reading this.

Dr Dork is very sad tonight.

As he has mentioned elsewhere, Dr Dork has been reading weblogs of non-medical nature for years, but only really began to appreciate the burgeoning of medical blogging in late 2005, not long before dipping his own toe sporadically into this great ocean of data.

Although the *cough* “honour” was never requested, this dork has long considered Dr Barb as one of his “blogparents”…whatever that means. If nothing else – it is a token of respect and admiration.

Dr Dork is hoping against hope this heralds a necessary pupation, and that Dr Barb will one day return.

Grand Rounds

Grand Rounds are up at ScienceRoll which is a blog by an Hungarian medical student.

Interspersed this week with lots of Monty Python videos.

Ni !

Wordsmith of the Week

Dr Dork (to waiting room):
Mr Simia ?

Mr Simia stands. They enter office.

Dr Dork:
Hello, Mr Simia. Have a seat.

How are you today ?

Mr Simia:
G’day doc. F***ing al’right. Not too f***ing bad. F***ing hot, ‘ay ?

Dr Dork:
Boiling, isn’t it ? So, tell me about…..

(later)

Dr Dork:
And what operations have you had before ?

Mr Simia:
Couple ‘a things. My knee was f***ed for years.

Dr Dork:
….

Mr Simia:
Then Dr Amazing fixed it. ACL. Better than ever. It was f***ing f***ed for years before. He is absolutely f***ing amazing. Best f***ing doctor ever. Does all the footy players. Really f***ing good.

Dr Dork:
…

Mr Simia:
F*** oath. Good job, mate.

Dr Dork:
…

Dr Dork:
…and the other operation ?

Mr Simia:
Opened up me f***ing guts and ripped me appendix out. F***ing ripped it out.

Dr Dork:
OK then…

Uh..by the way...you know your appendix didn’t do you any good, anyway ? So no harm in losing it.

Mr Simia:
Well, why the f*** is it there then ? What f***ing good ?

Dr Dork:
Some people would say it is a vestigial evolutionary remnant. Of something useful at an earlier stage..

Mr Simia:
F***ing evolution ? What about that s*** anyway ? What f***ing proof ? Eh ? Why’s it there then if there’s evolution. Why we f***ing evolve it if it's no f***ing good ?

Dr Dork:
Fair enough...now, back to.....


Dr Dork avoids imposing his religious or other world views on his patients. He believes it unethical to do so. This was an attempt to reassure gone horribly wrong. Mr S was raring to go for a philosophical debate. Which would have been interesting.

Dr Dork is trying to figure out how to write dialogue effectively. You have been warned.

Mateship and Rapport

Old Slim

"Mate" is a non specific greeting used between Australians. Of both genders in certain regions. It is usually of a positive connotation.

As with much Australian vernacular, subtleties of inflection and context can produce a great variety of meanings.

"Maaaaaaaaaaaate", as a drawn out drawl, accompanied usually by a half-smile and a knuckle-crunching handshake, is the traditional greeting of the Australian male in the wild.

"G'day, mate!" is often used as a general, friendly greeting to an unknown person, especially of the male persuasion. The equivalent of "Good afternoon, sir", "Bonjour, monsieur".

"Mate" can also be used in a derogatory context just as easily and this is what led Dr Dork to consider the topic today.

Whilst sauntering down the street in the vague direction of his morning bus, Dr Dork was nearly cleaned up by a cyclist who barrelled past without warning. A near collision...and partially Dr Dorks fault, as he tends to meander along a circuitous path, especially when his mind is 90% elsewhere...as it often is. The words that leapt to Dr Dorks lips, albeit unspoken: "Use your *(edited)* bell, mate!".

Dr Dork sometimes refers to his male patients as "mate".

On his new patient registration forms the only option available is Mr for males.

Being of a certain age, Dr Dork still refers to new older male patients as "sir", unless or until they clearly indicate a preference otherwise. Younger males are usually "mate" or addressed by first name.

This seems to assist in rapport building with younger males, in particular. It is a gesture of camaraderie, of casual "blokiness" that makes the staid old Dr Dork seem less intimidating to a young 'un, perhaps.

Females may select Ms, Miss or Mrs, and are addressed according to their preference. No grey areas.

On the whole, Dr Dork finds it often takes longer to develop rapport with female patients. He is a dork, and thus the instinctive female repugnance to Homo Dorkus Sapiens (and his negative evolutionary corollaries) must be gradually overcome.

The greater flexibility he has in addressing his male patients seems to further facilitate rapport. More scope to tailor to the individual, less possibility of inadvertent offence.

Dr Dork works only in adult medicine. Kiddie rapport is a whole other kettle of fish. Ask Dr Flea.

Children are evil, and should stay off the lawn, anyway.

Grand Rounds

Grand Rounds are now up at Grunt Doc.

Grand Rounds

Grand Rounds for this week are up at one of Dr Dork's favourite reads, Musings of a Dinosaur.

Next week they will be hosted at GruntDoc.

Stasis

This isn't a post of any substance, beyond self-indulgence, so feel free to skip over it.

The BritMeds are worth a read if seeking proper medical blogging.

Dr Dork is mildly concerned that he is violating a Dinosaur rule or two today.

Well, not that concerned, really.

He is going to talk about blogging, as a doctor, and any feedback, scathing or otherwise, is welcome.

Dr Dork has waffled on previously as to his personal motivations for blogging. He enjoys, most of all, blogs of those driven by similar motivations.

Yet once one has established a 'presence', however limited, however brief, one cannot help but feel an expectation to pander, to please an invisible audience. This is the kiss of death for a blogger such as Dr Dork. This explains his reticence about participating in certain annual events. Not to imply that there is anything wrong with these - far from it. Simply that Dr Dork considers such contrary to his personal blogging motivations, as he is one who blogs anonymously for his own edification, ventilation and amusement.

Dr Dork is new to medical weblogs, only having really discovered them in late 2005, but has been present, under a different pseudonym, in a couple of non-medical online forums, for several years. He was once asked to contribute, a few years ago, a regular 'column' to a popular non-medical Australian website, and did so for awhile, before finding that it was sapping his creative impetus, and found his interest and output soon waning.

It would be interesting to hear what Dr Dorks colleagues in supratentorial pathology think of this propensity. Conversely, Dr Dork in his "non-creative" life as a medico is driven to work harder by increased demand. In practical and technical matters, his output increases with increasing demand.

This has led Dr Dork to the conclusion....that Sloth is his muse.

Absent poetry

In Dreams

Dr Dork has been thinking about his own history of challenges with Hypnos in light of some recent discussions such as this.


Sleep difficulties are rarely not a major component of depression - indeed, of most if not all psychiatric illness, it could be argued. The classic problem in depression being early morning wakening, considered one of the core physiological shift symptoms.

In the hour before the dawn,
When darkest thought is often born.
It seems to me my head is shorn
And that I sleep on frigid steel.

It's not fun to await the day, when your mood, your perspective, your world... are all bottoming out together in the diurnal trough.

Dr Dork has previously suffered from what is nowadays termed PTSD, as well as wrestling with the Black Dog since a young whippersnapper. He has run the full gamut of sleep dysfunction at one time or another.

Dr Dork also often advises his patients on improving sleep.

If there is a physical cause, such as pain or obstructive sleep apnoea, it needs to be treated.

Sedatives - anxiolytics and hypnotics - are, to Dr Dorks mind, best avoided if possible. Used briefly if necessary. They are only ever a short-term bandaid solution, and can exacerbate the problem(s) in the longer term.

Benzodiazepines are addictive. They also have a depressant effect on the CNS. Even a 'pure hypnotic' like zolpidem is at the very least psychologically habit forming.



Persistent insomnia is enervating. Exhausting.

The first goal is to treat the cause, whatever it may be, if it is identifiable.

The second goal is to promote sleep hygiene. This is not referring to clean pyjamas. In summary, this entails several principles, which the Dork endeavours to practice as well as preach, including:

1. Get a routine and stick to it. Always get up at the same time. As much as possible turn in at the same time.

2. Maintain a comfortable sleep environment. Not too hot, not too cold. Quiet. Dark. Wear earplugs if you have to.

3. Your bed is for two things. One of these is sleep. The other is not eating, reading, or watching television.

4. Limit caffeine. The half-life of caffeine is at least a few hours. Dr Dork religiously avoids caffeine after 3pm. Or maybe 4pm.

5. Alcohol. Many think alcohol helps them sleep. This is bollocks. It can induce sleep initiation, but stops you entering the 4th/dreaming phase of sleep, and leads to less restful, poor quality sleep.

6. If you're a Nana-napper, limit to 20-40 minutes.

7. Exercise. Doing so in the mid-afternoon / early evening has been shown to promote improved sleep. If Dr Dork wasn't nodding off, he'd source a reference....*Yawn*.


Sweet Dreams.

Grand Rounds

Grand Rounds for this week are now up at Pure Pedantry.

It is themed, the topic being 'The Oscars'.



Dr Dork is not sure, but thinks this is some type of Bollywood ceremony.

Political Banter

Dr Dork is feeling a mite repetitious of late, what with returning yet again to the contentious theme of healthcare funding in his last post.

One last parting shot over the bow that Dr Dork especially recommends for any medicos or medical students out there : No Free Lunch.

As per usual, the BritMeds are up at NHSBlogDoc.

Dr Crippen continues to impress with his prolific yet thoughtful output.

A matter of considerable debate in the BritMeds this week. A link was originally included that went to a particular racist/xenophobic/extremist right wing political party in the UK. Albeit this appeared to be in a derisory, derogatory fashion there was nonetheless an outcry amongst NHSBlogDoc's copiously commenting community. Such that the link was withdrawn.

Dr Dork leans towards the justification Dr Crippen put forth in the comments on this post, to whit:

"Better to get them out in the open and put the case against. I fear that by advocating censorship as you appear to do, you achieve the opposite effect to the one you intend. If that guy is so wrong (and I think he is too) why not demolish his arguments rationally, rather than saying he should be suppressed? If you take the latter course, people will say you cannot demolish his arguments and that therefore he must be right."

To borrow a Respectfully Insolent^TM term, such Wingnuts are only a danger to the ignorant and iniquitous. It is better to expose such idiocy, stamp it out like a bug skittering from under a rock, than to allow it to fester and grow in a darkened corner.

Dr Dork disagrees not infrquently with some of the health bloggers he regularly reads, and holds in high regard...irregardless.

Debate and discussion amongst those with dissimilar viewpoints is one of the ways in which we grow as human beings.

"Ooh - an eclipse !"

Two Tiers Part III

It is interesting to observe, from this sequestered shore, the seemingly perennial debate over the growth and evolution of further two-tiered systems akin to that found downunder.

In particular, the heated debates arising amongst and between the principle sources of health bloggers : the UK and the US.

Although at present they appear at extremes in their philosophy of healthcare delivery - and funding thereof - they appear, from afar, to be gravitating towards each other.

Dr Dork knows little of fiscal matters, but it seems that in the UK, in essence, there is fairly heavy taxation with the resultant expectation of (amongst other public services) quality, accessible public healthcare. In the US, there is perhaps less taxation, certainly less public funding for healthcare, and more of a “user-pays” or privatised system.

In Australia, we have been under the sway of a rightward leaning government for a decade, and whilst for many years prior healthcare has been an admixture of public and private, the pendulum has swung increasingly moreso towards the latter.

In theory, we have public hospitals and a fully government funded Medicare system to provide inpatient and outpatient care to all.

Australians, for the most part it seems, still subscribe to the ideology of providing healthcare to all – irrespective of income, employment status, or ability to pay.

Dr Dork disagrees profoundly with the viewpoint that access to basic healthcare is not a right, as some have suggested. Healthcare is a fundamental right common to all humanity. It is inhumane to deny treatment to those who cannot pay – directly or indirectly – just as it is inhumane to deny the starving food and water.

For many reasons healthcare costs will only continue to grow. As science advances, we live longer, and consume more health resources. We expect not just greater longevity, but greater quality of life.

What we gain in mortality, we lose in morbidity.

Our public healthcare system in Australia is increasingly struggling to keep up. The cracks are perhaps not as wide as in parts of the NHS, but one supposes this has much to do with such being papered over by a parallel private system which is inexorably growing. Many doctors choose to practice only within the private system. They are not necessarily better skilled or qualified than those remaining largely in the public sector, but it is almost inevitable that the overall standard of care is often better in the ‘private’ system.

Like 40% of Australians, Dr Dork has chosen to pay for private health cover. It is silly not to, with our current system, if one can afford it.

If one can afford it.

Housekeeping

Dr Dork is finding his internet niche increasingly cluttered and cumbersome.


Some renovations are underway.


One thing that has been particularly time consuming is attempting to maintain a collection of medical links organised by specialty. It is increasingly hard to keep up with the growing number of such contributors, and occasionally superlative blogs are missed for a long time. Dr Dork suspects he inadvertently classified some bloggers into inappropriate categories, as well, at times. Apologies.

To allow more time for blogging, and reading other blogs, all are now combined into a Blogroll of sites Dr Dork peruses. This is recommended as an excellent, free, time-saving option for others struggling to keep links up to date. User friendly and no annoying advertisements.

Dr Dork recently discovered the wonders of RSS as well, and finds Bloglines an easy way to keep up to date with blogs, without having to keep checking constantly if sites are updated. In the spirit of this phenomenon, Dr Dork foisted links to several RSS/feed/thingamajig services upon his sidebar, but is worried they look a mite gaudy, so has recommended they take administrative leave of absence.

Dr Dork only views his site via his venerable PC at Chateau Dork, hence is rather ignorant of any display errors or similar gremlins on other systems. Any feedback on layout, links, archives, load time, doohickies, thingamajigs...positive or negative ...is appreciated.

Rounding Off

Grand Rounds for the week are now up at Chronic Babe. There is a theme: 'give me some sugar', perhaps in honour of the Hallmark/Cadbury Annual Celebration of Commerce.







Paediatric grand rounds are up at Awesome Mom. Or Awesome Mum, in the local vernacular.




The Brit Meds are up at NHSBlogDoc also, and is quite an interesting collection yet again.



Image courtesy National Library of Medicine

Hyppocrates

Dr Dork has found it highly disturbing in recent years to note an increasing trend whereby doctors are appearing in television advertisements. Often extolling the wondrous virtues of certain competing "over the counter" analgesics.

As reported here and supported by the AMA, the Federal government has acted to close a loophole in TGA regulations whereby a few shonky medicos had been rather lax in recalling the recommendations of this old Greek chap.






Dr Dork was frankly surprised, and disappointed, when these ads started appearing a couple of years back. He is uncomfortable enough with the marketing of pharmaceuticals as it is.

Thankfully direct to consumer advertising of prescription medication is not permitted here, as it is similarly banned in most of the developed world - the only exceptions being the US and our Kiwi neighbours.

Dr Dork is of the opinion that to nonspecifically promote one specific treatment, therapy or medication to the general public, when it is not always the best option, and there is furthermore a risk of harm, is a gross violation of rudimentary medical ethics. Especially when one is being paid to lie.

A lie of omission, rather than commission, perhaps, but a lie nonetheless.

Fortunately, at least one of the offenders listened to Mr Cricket after all.



This type of behaviour should never have been allowed in the first place. It indirectly violates primum non nocere. It harms the therapeutic nature of the doctor-patient relationship in general for all who see it, and demeans the profession as a whole in that the public observes the lack of any consequences for these unscrupulous bad apples.





Time for a cuppa and a lie down again.

Grand and Other Rounds

Grand Rounds for this week are up at Tales of the Emergency Room and Beyond.

A themed collection (albeit fairly nonspecific) regarding "Medical Professionals as People".

nb: I think Dorks are higher order primates, but we don't get voting rights, and communicate via jumbled screechings. Dorkus Australopithecus, perhaps ?

Dr Dork did submit this week anyway, as the 'topic' correlated with an already planned proctological post. Rather than bemoan theming ad nauseam, Dr Dork has put his hand up to offer to host a future version to briefly appease the Dork and his fellow curmudgeons.

The BritMeds are also up at NHSBlogDoctor.

Updated: Nurse Ratched's Place is hosting Change of Shift this week.