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.

Paging Miss Pollard

Yes but, no but, Dr, what you see was...






Dr Dork: I notice in your file here you’ve had some heart trouble ?

Patient: No, never gave me any problems.

Dr Dork : Oh. It says here that you had a triple CABG 5 years ago ?

Patient: Oh. Yeah, that. I went to see my local doc about my indigestion. My indigestion was really giving me grief. And I was feeling dizzy.

Dr Dork: So…you had the operation on your heart and it fixed that ?

Patient: Yes. But I never had any angina, any heart pain, no.

Dr Dork: Okay. So, things were good until last year, then ?

Patient: Yep.

Dr Dork: When you had the stent…

Patient: Yep.

Dr Dork: Was it chest pain, angina, that lead to the stent being put in ?

Patient: No. Never had any chest pain.

Dr Dork: So what led to the stent being done ?

Patient: I was having this pain in my neck. I just wanted the pain in my neck to go away.

So they put the stent in to fix it. Which it did, it went away.

...

Dr Dork: Any angina after the new stent ?

Patient: No. Never had angina doc. Never had any problems with my heart.

Dr Dork:













Heart disease is no laughing matter. It is our biggest killer in the developed world. It seems to get a fraction of the press of more fashionable but rarer conditions. As our population ages demographically, and our adults and children balloon into obesity, it is unlikely to diminish in impact in coming decades.

Heart disease is often treatable. Even better - it is largely preventable.

Dr Dork recommends discussing how best to reduce your own risk of heart disease with your friendly local medico.

Heart Foundation of Australia
British Heart Foundation
American Heart Association

Blogger Bug

Dr Dork has encountered a lot of problems over the latter part of this week with accessing many of the multitude of blogs he endeavours to keep up with.

Some sites would simply not load, others seemed mainly to have problems with the comments.



Dr Dork apologises for any inconvience to his readers. Whatever the problem, it seems to have been rectified now by the good people at Blogger.

Like many Dr Dork is appreciative of the Blogger service. It is free, it is not encumbered by garish advertising, and it is fairly easy to use, even for us technical dummkopfs.

It is a bit temperamental at times, but you get what you pay for.

Get well soon, Blogger.

Dork Unveiled

As Dr Dork was afraid might happen, someone remembered his promise to post a picture as an incentive to encourage voting in one of the blog awards, prior to his defection from the Sith.

Well, one must be true to their word.

Click here, if you dare.

Dr Dork quite likes this new portrait. Perhaps he might even replace his old pic. Any thoughts ?

Auscultating Joy

Dr Dork is excited.

He bought himself a new toy today. A new stethoscope. The first one in a decade.


When Dr Dork was a medical student, he spent the equivalent of many weeks wages at his part-time job on a swish stethoscope that would purportedly stop him from misdiagnosing things like death and dextrocardia.

He used this until fairly recently.

However - Dr Dork also received a free "cheapo" stethoscope as a medical student. A Rappaport-Sprague* (double lumen) type.

Dr Dork also made much use of this "cheapo" stethoscope. And found it much easier to use than his swish mucho dinero version, more sensitive in particular.

Today, Dr Dork compared the "cheapo" double lumen versions with the "swish" stethoscopes, the latter costing several times the former.

He still prefers the double lumens to the fancy ones.

Dr Dork is interested in the preferences of others, if anyone would care to share.



*Maurice Rappaport and Howard Sprague invented this type of stethoscope in the 1940's. It is a style of stethoscope, not a specific manufacturer or brand.

Nice summary of the history of stethoscopes here.