Reviewing the 2013 EP Board Review Course

This past week I sat for my third board review course in anticipation of my upcoming third EP board recertification. It was a well attended event of about 150-160 electrophysiologists, some from as far away as Alaska. That, I suppose, is one of the attractions of having this course in a city like Chicago: it's a major central airport hub and has plenty to see and do for those hearty and financially solvent enough to spend the evenings out at a nice restaurant or club. For me, a native of the Chicago area, I was lucky enough to stay in my own home and just had to brave the traffic and $35-a-day parking fees. Others from out of town bore a much larger expense in terms of lost days from work, hotel and transportation fees. The meeting was held at the Marriott Renaissance Hotel on 1 Wacker Drive in Chicago, just a few blocks from Michigan Avenue's shopping district downtown - not the cheapest hotel in Chicago, nor the most expensive. Perhaps it was held there for the comfort of the rooms, the size of the lecture hall, or a need to provide a central Chicago location, but given the amount of time we spent in the lecture room and the social life of most serious electrophysiologists I know, I wondered why it wasn't held somewhere less expensive. After all, cost remains a huge concern (if not overriding one) for doctors attending these courses.

The course began Thursday afternoon at 1pm and went until 8:30 pm Thursday, 7:45am-5:30 pm Friday and Saturday, and concluded Sunday with a rushed morning review of pacing principles from 07:45 am to 12:30pm. (Completing the course on time was critical for those who had to catch planes home on Sunday)

I paid the extra money for attending a maintenance of certification test session before the main session began to earn a few points. This clearly was not worth the extra money in my view, as it was just an extra Workshop that included a bunch of typical board-style questions with the answers in the back of the book. My recommendation would be to save your money and take the online versions that come with one's recertification fee. It just seemed to be another cash cow for the ABIM and HRS.

The course materials were printed, and the majority of doctors polled (75%) preferred their materials this way, despite the Heart Rhythm Society (HRS) clearly leaning to providing the material electronically on a thumb drive. They also offered (with a $1300 discount if you attended the session) the full lectures (with audio and slides) to members who wanted to cough up even more money so they could review the materials at another time. (I passed).

The main course was taught by established names in EP and the Heart Rhythm Society: Ken Ellenbogen, N.A. Mark Estes, David Haines, Fred Morady, William Stevenson, among others. These are guys that taught me, they've been doing it a while, and they're good at what they do. As such, the lectures were paired down to the essential principles and generally well-organized with good audiovisuals and sound, but were peppered the same pimp items that you'll still have to memorize despite our new era of Google. I suppose having these things pass your cortex once so the recognition of these syndromes might be realized in one's practice, but in this era of Google whether memorization is really necessary is another matter.

But did I learn anything? Okay, I have to admit I did. New things I learned included a few pearls about Early Repolarization Syndrome (and is probably fair game for boards), the genetics of plenty of obscure diseases, and about how many ways a doctor can get pimped on a cleverly written examination. Given these realizations, I hope my chances for passing my board certification were improved as a result of attending this course. We'll see.

It was kind of sad (yet psychologically affirming) to see Sonny Jackman, an icon of accessory pathway ablation and EP, in the audience with me. It was particularly entertaining when he had to hop up and explain a tracing to the audience on behalf of the lecturer (truly a highlight). But I also wondered why Dr. Jackman was there. Sadly, I knew the answer: he's no different than the rest of us now and understands that it won't be long before the bureaucratic machine called medicine will require passing an irrelavent test to practice medicine.

It was this last issue that was most relevant and prescient. Mark Estes (someone who has sat on the test-writing committee in the past) tried to explain how the ABIM decides how many recertifying doctors ultimately pass their examination. "This is a sensitive and unpopular issue for EPs in practice," he said quietly. You could see people agreeing. But as he explained how the ABIM determines how many recertifying EPs pass the recertification exam he admitted, "I really have no idea how they decide." He continued, "But when we look at the trend line for the percent passing from prior years, you can see that last year's percentage was down a bit." He then showed the trend line.

Think about that. No one has an idea what consitutes the criteria for a "passing" grade for recertification, yet here we are spending too much money on a process that has little to no proven patient care benefit in terms of quality care. This non-transparent scoring criteria adds to the problems with recertification in my view, since it would not be difficult to think that granting of a passing grade for re-certification could be used against certain subspecialites for any number of obscure reasons (eg., the desire to downsize the specialty, political differences, etc.) One only has to consider how the IRS was used against non-profit political organizations to get my paranoid drift in the era of medical cost conservation here. Perhaps this is a bit overdramatic, but it makes you wonder, doesn't it?

So I'm back in the salt mine of everyday practice now. Hopefully the course helped and will prove itself valuable for me in the future. Honestly, every effort was made to make the sessions tolerable and informative, I just wish I understood why the re-certifiers needed to be there. But I'm trying to cope with the reality of the times and I just hope the ABIM won't decide not to pass me for what I've said here.

-Wes

Shadow Puppet: An App That Lets iPhone Pictures Tell a Story

They say a picture is worth that thousand words, but nowhere is this more true than with a new, free, iPhone app called Shadow Puppet that lets you turn selected photographs on your iPhone into a narrated video storyline.

I saw this app reviewed over at Techcrunch and immediately saw its potential as a teaching aid.  The app allows you to pick a series of iPhone photos from your camera roll, order them, and then record a narrative about your pictures.  What is unique is that you can zoom or move between photos as you tell your story, annotating them by touching areas on the photo that you are discussing as it records the video.  (Very cool).

Here's my very first video I made with the app describing the new Zio XT patch monitor that records 14-days of a patient's heart rhythm that we've been using in our clinic.  Simply made, these video clips are easily shared via email, Facebook or Twitter.  For this particular video, I still had to edit portions of the patient's report on Photoshop, then sent the images to my iPhone but, still, that was easily done.

Want to teach a fellow how to implant a pacemaker?  Take some photos and show them!  Have an EKG that has a finding that you're not sure about?  Snap a picture (without patient identifying information, of course) , annotate it with your question and send it to your EP!  Simple, elegant, and who knows, maybe even life-saving.

-Wes

For Medicine: Go Slow

Three years ago, in the midst of all that was happening with health care reform, I thought about if I'd ever recommend medicine to my daughter.  I thought and thought about that issue and looked deep inside myself for reasons one might still choose this profession, then penned "The Top Ten Reasons to Be a Doctor."  It is, by far, the most popular post on this blog, having been read by more people than any other I've written.

But little did I think my youngest might heed this advice.  Unknown to me, she left for college as an environmental studies/economics major, to abruptly decide one week later after some soul-searching of her own to consider a pre-med curriculum.  I couldn't help but feel a rush of pride, but also a huge amount of concern, for no one can tell anyone else what this path is like until it's been traveled.  One thing I know: it she wants it, she's very capable of doing it.

And as part of her growing enthusiasm for this field and (I suspect) recent rewarding experiences she had as a lifeguard at our public beach this past summer, she's even thinking about training to become an EMT while studying at college.

My first thought, of course, was "Heck ya!  Dive in! You'll love that!  What a great skill to have!"  But after a night of rest and reconsideration, I have another piece of advice for her.

Go slow.

You see there's a little secret every doctor lives with throughout their career and never talk about: their closet.  We've all got one and we use it sparingly, and you don't want to fill it up too soon because it has to last your entire medical career.

You see, your closet is where you store life's experiences that are so horrible, so painful, so shocking, that you can never tell anyone (except, perhaps, another doctor) about them.  It is the place where you put the images you see that you'd really rather never talk about.  Ever.  Really: the gross stuff: the gross images, the gross sounds, and the gross smells.  Things so bad I can't even write them here.  That stuff.   And I know EMTs, like doctors, have a closet of their own.

You'll be surprised how dark that closet is and how fast it can fill.

But you also need to know that the closet exists, it is real, and how to clean that closet when considering the path toward becoming a doctor.  This is probably one of the most important skills outside of medicine that a doctor can muster.  So, I'll ask that my daughter to reconsider the EMT class for now and do something entirely, crazily, stupidly different and fun. (Whether she'll do this or not remains to be seen.)  For this is how we have to learn to clean a bit of our closet, or at the very least, make it a little bigger.  Use this precious time before all of the isolation of studying and commitment that medicine requires to expand yourself.  Learn to play badminton, to paint, to play a guitar, to debate, to sing, to ballroom dance, to fly or just to love and appreciate what's out there.  What ever.  The point is this: learn to do other things besides medicine that will engage your brain, hold you firm, and make you happy.  Because medicine's a long haul: a lifelong haul that never keeps adding to that secret closet.

As a student of medicine, your job, throughout all that lies ahead, is it to make sure you always have the renewable resources to get outside medicine so life stays rich and medicine remains, net sum, rewarding. Because as as rewarding as medicine can be at first, it can wear you down unless you always know how to properly size (and maybe even start to empty) a bit of that secret closet that doctors all share.

-Wes

"Emptying the Closet"
Oil on Canvass, 36" x 24"

HRS2013 Pre-meeting Reflections

This morning I sit quietly in my hotel room, contemplating the day ahead at the 2013 Heart Rhythm Society Scientific Sessions in Denver.  Emotions clash.

On one hand, it will be great to see old friends an colleagues, to be spoon-fed information, and to relax.  On the other hand, I find myself in an electrophysiologic angst:  how I can spend the time upbeat knowing that the relative value of the work that heart rhythm specialists do was cut at least 30% on 1 January 2013, thanks to new billing codes that bundled multiple codes into one?

Can I afford to be here?

I do not say this lightly.  Our first quarter's pay this year compared to last year was recently disclosed and the results were striking. Guys like me who have devoted years to our training, stood at bedsides for countless hours, and endured training that finally ended at age 36 (counting a brief two-year hiatus for a general medical officer stint as an ER physician for the US Navy), got a whopping 30% cut from CMS for the much of the procedure work we do, stealthy cloaked in codes.

It is real.  It has happened.  And its effects are being felt by many, real time, even now, at #HRS2013.

I realize in these economic times that many professions are feeling similar pressures.  I am not here to lament nor ask for pity, but rather to describe.  In many ways, I am lucky: lucky to have good friends, a fascinating skill, and wonderful colleagues and support staff to work with.  But I wonder, how all of this will change things. 

Certainly, we tabled our plans to hire another EP.  No wonder EP fellows are finding it tough to get a job.   Hospitals are not hiring.  Wards are being consolidated.  Pennies are being pinched, and so are staff.  Patients are waiting more to see guys like me.  Attendance at continuing education conferences is falling.  While the effect on physician care "quality" are probably uncertain at best, but it is becoming quite obvious that "innovation" in my field of medicine as we've known it is stagnating or moving overseas.

It is all change - I get that - part of the Great Experiment of our nation's health care reformation project that is moving fast and furious to places unknown.  But change is difficult.  It shakes things up.  Anxiety and restlessness at times like these can consume a psyche or, in ideal circumstances, lead to something new, something liberating, something better.

So off I go to the 2013 Heart Rhythm Scientific Sessions, hoping to keep my chin up, my ear to the ground, and my eyes open.

You never know what you might learn.

-Wes

Physician Blogger Insights On Social Media

A recent e-mail exchange between myself (WGF) and fellow-physician bloggers John M. Mandrola MD (JMM), Edward J Schloss MD (EJS)  and Ves Dimov MD (VDMD) resulted in some interesting insights about how physicians are using social media tools today.  The following is a lightly edited version of the thread (used with permission). It began with an e-mail from Dr. Mandrola:

JMM: "In prep for our Social Media session at HRS2103. I was just wondering…

Do you guys keep a list of favorites on Twitter? I have lists--but they aren't very effective logistically. I was wondering if I designed a list--say the Mandrola-twenty--of folks I did not want to miss, I might be able to use a column on TweetDeck. Right now, I follow 350 people--and it's unwieldy. But yet I have trouble parsing because I'll look at an acct and say to myself, "this one's pretty good; I don't want to unfollow." Also, I find TweetDeck sometimes intrusive. I use the reg Twitter app and often post with Hootsuite--because it allows me to link to 4 social networks at once--LinkedIn, FB, Twitter etc.

What Twitter app do you all use on Computer? On smartphone?

Do you have thoughts on Facebook (FB)? I see from the WSJ they are making a comeback so to speak. For a while there, I thought they might be dead.

Do you agree that Twitter seems more amendable to professional needs--the sort we all use it for: things like links, communication with colleagues, filtering of important medical news. I tend to use FB, the little that I do, for real life things like family, in-real-life friends and cycling stuff, for instance. I wonder whether this is a correct distinction, as most of the major journals and medical society have a FB presence. And likewise, Twitter has plenty of willy-nilly stuff like Hollywood, Athletes etc. The young people I know use Twitter more like I use FB."

* * *

EJS: "I also use Twitter almost strictly for professional stuff, especially my posts. I follow a few non-professional accounts, but am really choosy in general about followers. For my own posts, I try to picture someone looking down my timeline and trying to decide whether I'm worth their time to follow. If I put a bunch of cr*p up, I figure they'd move on. Twitter is also the predominant source of my online persona, and I'm really careful about maintaining this.

Right now I follow 239 accounts and not all are terribly active. That keeps the stream manageable. I actually get a popup on the laptop for every thing that posts to my timeline. Because I use my laptop for all hospital charting, this means I see A LOT of tweets. That setup is clearly not for everyone, but I've gotten good at just glancing up to see who is posting before I commit to reading. The tweets fill the dead and mindless spaces we get during EHR data entry (which are a lot). At any given time I'll also have 5 or 6 searches running that also generate popups. Right now these include meaningfuluse, St Jude Riata, Barry Meier, EHR, @burbdoc, #HRS2013 among others. All of these also generate popups.

If you want to filter down you list to highlight your most important accounts, you can set up a list in Tweetdeck (and I'm sure in the other clients, as well). That will become a column, and you could turn on alerts for just this stuff if you're not at ADD as me. I have a friends/family list that shows up on my front page so I can quickly see if I missed anything good without having to obsessively scroll back through everything.

On the laptop, I use Tweetdeck. The old version before Twitter bought it is the best, but will stop working in a few days. I've put up the new version, but don't like it as much. The biggest drawback is not having the profile photo on the popups. With the old Tweetdeck, it was easier to see who was posting with just peripheral vision.

On the iPhone and iPad I use Tweetbot. It's really good and worth the few bucks it costs.
I'd tell any cardiologist starting on twitter to follow a bunch of health care journalists, along with you guys. The interactions you get with the journalists are really rewarding, and truly are a two way street.

I really don't see much professional purpose for Facebook for an EP doc. If you were a plastic surgeon or ortho, maybe there would be a role. I'm actually trying not to market directly to patients, given the nature of my practice. Maybe you could pick up some AF that way, but I suspect a lot of nervous people with sinus tach or PACs would clog up your office if you did that.

* * *

VDMD: Hi John and colleagues,

Here are my answers:
re: "Do you guys keep a list of favorites on Twitter?" -- yes, I have 2 lists - 1. list of favorite tweets that I use as bookmark, 2. list of "allergists on Twitter".

re: "Mandrola-twenty--of folks I did not want to miss" - yes, KevinMD has that - top 20 Twitters he doesn't want to miss. I follow few people - less than 100, I think, and only 50 of them tweet regularly.

re: "What Twitter app do you all use on Computer? On smartphone?" - I use TweetDeck on my home PC, HootSuite at work (TweetDeck is blocked), and mobile Twitter on my Android phone. I "favorite"/bookmark the links I want to check later.

re: "Do you have thoughts on Facebook?" - Facebook (FB) is here to stay - until a new network replaces it. You have to use it to stay relevant if you have a blog. In addition, people look at the number of your likes to see how large a following you have as a blogger. FB has limitations and can be annoying but Google Plus is not a replacement yet. FB will evolve for sure, they are a young, aggressive company, and will keep searching for ways to combat "user fatigue".

These are some quick thoughts. Please let me know if you would like me to expand on any of these.

* * *

WGF: "Twitter is for the person with ADHD while blogs are for the obessive compulsive.

Twitter, by its very nature, has a low barrier for entry and can serve as an information "gatherer" initially. I'd encourage people to LURK first. It's easy to use and feeds lots of information of interest quickly to docs. As a "MUST HAVE" for doctors, they should follow the journals they subscribe to: Heart Rhythm, NEJM, Circulation, JACC, etc, as well as major news orgs: WSJ, CNN breaking news, local newsorgs or radios, etc. I also follow Steve Colbert for a laugh once in a while.

Twitter is also VERY useful for collaboration (as we have seen) and for "hunters" of information by using your network. I especially encourage follows of docs of the same subspeciality.

Facebook is for family/personal friends for me. No patients there. I find it's the best way to stay connected with my kids after they're out of the house.

As far as lists are concerned: I think they're a waste of time. I tried it, but since you cant send a targeted message or "tweet" to a list, it's only a way to group accounts.

I use Echofon on my iPhone (like it better than Hootsuite) - easy user interface and free. I use Tweetdeck on my PC and MAC.

I follow 446 people - probably too many - but it's a broad group that includes right and left-wing health care thinkers, IT nerds, politicians, bloggers, and you guys, and Steve Colbert. :)

Perhaps the most amazing use for Twitter (recently) was the immediacy of info provided there during the Boston bombings. It was unbelieveable how quickly updates happened and totally smoked the main news organizations. Imagine if doctors had a similar network at times of crisis! That's why I think it would be VERY cool to push that concept with our audience. Consider, for example, the need to get an EKG interpretation immediately (check my recent Twitter stream to see an example of just that) - lots of folks weighed in with ideas - some good - some bad - but in the end it was vetted pretty well.

Looking forward to this..."

* * *

VDMD: re: Journals on Twitter - I'm not a big fan of these. It's mostly the administrative staff pushing some articles they have picked. RSS feeds for the journals are much better, in my opinion. They save time and include most (all) articles of each issue.

So there you have it.  A sneek peak behiund the social media physician curtain on their take of current software, apps, and uses they find for social media in health care today.

For those attending the 2013 Heart Rhythm Society Scientific Sessions in Denver, CO next week, Drs. Schloss, Mandrola and myself (as well as Robert Coffield, Esq. of the Health Care Law Blog fame) will be speaking at the Rhythm Theatre at 3:15pm on 10 May 2013 on Physicians in Social Media.

Hope to see you there!

-Wes

PS: For doctors considering the leap to social media, here's a basic Twitter Primer.

Our Fascination with TEDMED

I've been following the Twitter stream regarding TEDMED 2013 with interest this year, mainly because I recognized and "know" (virtually, mind you) one of the participants this year, @Zdoggmd.  Seems he knocked his talk on empathy out of the park and received a large, booming standing ovation after his talk.  Too bad I wasn't there to witness it.  I could only see a snippet so far and it looked great, but ...

... I had to work.

I love innovation in medicine.  I'm a technology junkie, I like to think of myself as an early adopter, and even though I am a "seasoned veteran" in medicine, I still think I keep reasonably up to date.  So it comes as no surprise that I find myself, admittedly, jeolous that I can't be there to hear the inspirational talks and leave feeling better about myself and the state of medicine.   After all, there is still so much to like about our profession, despite what we hear and what I sometimes write on this blog.

But I also love and respect the science of medicine, and this is the part that bothers me about TEDMED.

TEDMED isn't science.  TEDMED is show: really, really beautiful, articulate, polished, high-definition-brought-from-a thousand-angles-of-view, show.  We are wowed.  We wish we could speak like that.  We cherish the graphics that are shown.  We are taken places where we haven't gone before.  We see the 62,253,416 impressions, 21,023 tweets via 4,420 tweeps and weep.  We see cool things and hear cool stories while doing other things on our computer.  "God, it's beautiful man!"

And we are shown, convincingly, "The Way," through marketing. 

Do not ask.  Do not dare question.  Listen.  Accept. 

Then, while you're there, hob nob with the intellectual hoi polloi.  They are the "influencers."  You are, for that moment and for many thousands of dollars, in the inner circle: an intellectual elite.

It's addicting.  It's so easy:  an aphrodisiac for the tired medical soul.  Seriously, what's not to like?

But real scientific inquiry and discovery takes cynics, doubting Thomases, and critics, not just ideas and stage shows.  Medicine isn't practiced in corporate suites or in front of a computer (despite what others think), it's practiced at the bedside.  It is practiced face-to-face.  So while bringing great ideas together to brainstorm for "breakthroughs" is fine and dandy (even, as they say, "magical"), it is a very corporate way to think. 

But real, lasting ideas that work in medicine require more than just show and entry fees; they require inquiry, critique, testing, critical appraisal, buy-in, and most of all, action. 

Buy-in is tough if ideas are top down.  Buy-in is tough if only certain ideas are amplified by unknown "idea curators" while others are tossed aside too quickly.  Buy-in is impossible if ideas aren't responsibly vetted for they might be incorrect or dangerous.  Buy-in won't happen if leaders don't lead and are different from their followers.  And followers won't implement ideas if they think they are contrived.

So we should watch TEDMED for what it is - entertainment - and for what it's not.  THEN we can keep an appropriate perspective to what we need as we get back to the real work at medicine.

After all, our patients in this troubled medical system still need us firmly based in science and reality.

-Wes

Social Media and the Challenge of Overcoming Intellectual Complacency

They lined the walls in a warm room as far from the central table as possible. They had come to learn about EKG's. Residents of at varying years of training sat amongst the interns, much the same way as the Democrats sat amongst the Republican's at the recent presidential State-of-the-Union address: cordial - not too aloof.

I was fortunate to be the lucky guy to teach them that day. I have always enjoyed this opportunity and generally the lectures seem to be well-received and attended. This was lecture toward the latter part of the year, so things were not the chip-shot tracings that most learn in ACLS. Still, we always harken back to the fundamentals of reading tracings to help us understand new concepts, but I encountered a strange silence when I discussed the EKG's of patients with pacemakers:

"We all hear the phrase "He's got a DDD pacemaker," right?

They all uniformly nodded they'd heard the phrase, so I asked further:

"What do the letters in the term 'DDD pacemaker' mean?"

Silence overcame the room.

Perhaps I had caught them off guard. Many of their eyes fell to the floor. Some smiled but failed to answer. Some were clearly unnerved by the question as they shifted in their seats. A cough could be heard in the corner - it might as well have been a pin dropping. In the back right-hand corner a pager sounded. Everyone turned to the lucky contestant who was saved by the beep. Finally, somewhere toward the opposite corner of the room came a faint suggestion:

"Isn't one of them mean which chamber is paced?"

Relieved, you could see a few heads nodding now.

"Which letter of the three represents that?"

Again, the room fell silent.

Needless to say, we moved on from there after a quick basic review of pacing terminology, but his got me thinking: where have we failed to teach our medical students and residents such fairly basic clinical concepts and vernacular we use every day? Are we spending too much time on the Krebs cycle and not enough time on clinically relevant concepts in medical school and internship? How do we get them to remember?

So I had an idea: what if I used social media?

We all know that every medical student and resident (and doctor and patient, for that matter) has a cell phone. Might we use Twitter to try to teach small snippets of information to our trainees? Obviously they would have to have a Twitter account. Also, not all concepts lend themselves to this appraoch very well, but it might be worth a trial.

Soooooo, look for an occassional Electrophysiology Quiz via Twitter from yours truly. (Others with ideas for ultra-short cardiac electrophysiology quizes are welcome to join in the fun, just use the hashtag '#epquiz' in your tweet.)

Soon, there might be an entire library of fun questions and answers for all to enjoy on Twitter that are easy to catalog! And who knows? Maybe some of our more engaged students, interns, and residents on social media just might remember a thing or two while contributing to the fun.

-Wes

For Your Cardiology Powerpoint Presentations

Dress up your Powerpoint presentations with these animated Powerpoint templates.

Personally, I prefer a minimalist, less distracting approach with lots of real life pictures - unless I'm talking to administrators - they seem to like these nerdly backgrounds. But $30?

Nah. I'll keep it simple, stupid.

-Wes

Could This Be the ACC Meeting of the Future?

Click image to enlarge

I couldn't help but notice the "Heart Hub" at the American College of Cardiology Meeting this year, pictured above. There were doctors nicely nuzzled up to a bar in a relaxed atmosphere where a bartender served cranberry juice, soft drinks and perhaps a small snack, as doctors watched and interacted with any of four talks occurring simultaneously at the meeting. Some were interesting case discussions with a question and answer format where you could text message your answer to a multiple-choice question on your cell phone and, like American Idol, the results would be instantly displayed on the screen for the audience to view before the correct answer was given.

Which made one wonder, with all the concern about industry influence that was aired publicly at the meeting with gargantuan corporate displays that stretched 25-30 feet in the air for over a quarter of a mile in the display hall as a backdrop, might his be a better way to provide education for tomorrow's doctors?

But there was only one problem:

This is very expensive to produce. Who the heck would pay for it?

-Wes

A Cardiology Website to Bookmark

Whether you're a medical student, resident, fellow, or staff cardiologist, once in a while you need a simple, succinct reference for a talk on the basics of cardiovascular disease. Who knew it would come from a radiologist:

LearningRadiology.com was conceived, designed, developed, is published, managed and maintained and its content is produced in its entirety by William Herring, MD, FACR. Dr. Herring is the Vice-Chairman and Radiology Residency Program Director at Albert Einstein Medical Center in Philadelphia, Pennsylvania, where he has been the Radiology Residency Program Director for over 25 years.

All material on the site, except for the Faculty lectures by other members of the staff at Einstein, was produced by Dr. Herring. Started in June of 2002, the site was originally intended to replace the handout notes that accompanied lectures for the residents and medical students at Albert Einstein Medical Center. It now contains over 20,000 pages of content, and has grown in popularity so that currently over 9 thousand unique visitors access the site every day. Visitors access over 20 million pages of content every year.

The site has been, and continues to be, free to use. It requires no registration, no sign-in, no fee and is commercial-free.

Kudos to Dr. Herring.

-Wes

h/t: Dr. S. Venkatesan, MD.

Are We Seeing the Death Spiral of Conventional Medical Conferences?

I think so.

It was apparent to me at the Heart Rhythm Society Scientific Sessions meeting and now a similar trend was noticed by Dr. Steven Sedlis at this year's American Heart Association meeting:

It felt like a ghost town. I ran into Ira Schulman, my medicine resident at Bellevue when I was a third year medical student; we looked at one another and simultaneously blurted out “where is everybody?”
. . .

There are probably numerous reasons for plummeting attendance at AHA. The economy, the on-line publication of trial results prior to presentation, the ubiquity of conference calls, e-mail strings and yes blogs that keep one in regular contact with colleagues throughout the country and the world without the need for face-to-face encounters are just some of the obvious causes.

The scaling back of industry support may be another major factor at play here. Certainly there are fewer exhibitors and the exhibits are far less lavish. As Muhamed Saric pointed out when I met him on the floor of the exhibit hall there were no Siemens or Philips exhibits, and in fact I could not find any cath lab manufacturers presenting their products at the AHA. The need to diminish the influence of industry on the medical profession and the need to avoid conflicts of interest were brought up at many of the presentations at the session by leaders of the AHA and other thought leaders in academic medicine, but one unintended consequence of this well-intentioned effort seems to be less financial support for the meeting itself.

I've always enjoyed the socialization and camaraderie that comes with medical conferences, but with the uncertainty of the current health care climate for doctors, the rising costs of these conferences for attendees, and the increased comfort doctors have for receiving medical information via the internet and social media, the need for traveling to medical conferences has quickly become obsolete. While medical device company or pharmaceutical reps might still find these venues moderately entertaining, without their ultimate customers in attendance, the medical scientific session conference marketing circuit will slowly fade away.

-Wes

No More Goodies?

Sorry doctors, we will no longer will be bringing branded trinkets to your office. You know, our new policy states "the changes prohibit gifts of any type, including all non-educational branded promotional items, regardless of value."

Instead, we'll just bring our truck and park it in your lot:

Click image to enlarge

After all, it's all about education.

With love,

AdvaMed

-Wes

Addendum 05 Feb 6:50 AM CST: Background from the FDA Law Blog

Education Time

Dr. Wes will be attending the Boston Atrial Fibrillation Symposium for the next few days (weather permitting), so blogging might suffer a bit. Since my early AM flight has already been cancelled and rescheduled for later in the day (thanks to the gorgeous *cough* weather at O'Hare Airport), I hope I can make enough of the conference to make the costs worthwhile.

It feels like that ol' Visa tag line:

Registration fee: $675
Airline Ticket: $310
Hotel: $400
Transport to/from the airports: $100
Chance to learn something new: priceless?

We'll see.

-Wes

Now You's Gettin' Smarter

A young medical student walks into a store advertising "Smart Pills." His exams are in two weeks and he decides, "Hmmm, maybe I should give those a try."

So he goes into the store. The store owner, seeing the desperate shape of the med student, smiled politely.

"How are you?"

"Oh, just fine. I'd like to get some of those smart pills, please. What's in them?"

The crafty old store owner leans forward and whispers, "It's special and top secret. But they really work!

The med student looked at the sign, advertising 30 pills for $19.99. He figured, what can he lose (except $20)? So he paid the man.

The store owner diasspeared into the back storage room where his small pet rabbit was caged. He placed 30 of the rabbit pellets in the bottle and placed the top on the container, then reappeared to the front counter and handed to the med student.

"Here ya go! Just take one of 'deez every night before studying and I'll guarentee you'll gets smarter and smarter, ya hear?"

So the med student went home, eager to try them out. He had tons to study for his microbiology, pathology and histology exams were coming up in the same week. He took one of the pills as the store owner suggested.

Just then, this huge wave of nausea overtook him.

"What the ...?? These taste like rabbit sheiiit!" He was furious and stormed back to the store.

He barged in and said, "Hey buddy, these so-called Smart Pills - they taste like rabbit sheeiit!"

To which the store owner smiled and replied: "Now, you's gettin' smarter."

***
So why the story? Well, just to remind us that there's a lot more to medical school than just what's taught in books. And the thought that Canada wants to correct their doctor shortage by returning to three-year medical school curricula because doctors can be trained faster and it's less expensive, well I say, why not give the med students up there some "Smart Pills," too.

-Wes

Med Schools Fail at the Business of Medicine

I have the pleasure each year of interviewing some of the brighest individuals applying to our categorical and transitional medicine residency programs. So far, I have asked each of 9 interview candidates to answer this question at the end of their interview:

"What do the numbers 99233 or 99244 mean to you?"

Without exception, each of them sat dazed.

Then I asked them, "What's the difference between an ICD-9 code and a CPT code?"

"It has something to do with billing," most said but not one knew the difference between the two.

Is this acceptable? Is it responsible to leave our medical students so woefully unprepared to enter the big wide world of medicine as it exists today?

Each of the students got an "A" for their efforts and idealism, but the programs from which they came received an "F" in teaching the business of medicine.

-Wes

Image reference.

With Cigarettes: Men Suck

My job is secure.

I was awestruck by a Center for Disease Control (CDC) report yesterday that demonstrated that, on average, one of five people over the age of 18 still smoke.

More importantly, the prevalence (at least in Illinois) is even higher for younger adults ages 18-35: one in four. And we're not talking about just casual smokers who later quit. No, we're talking about people who have already smoked over 100 cigarettes in their lifetime and say they currently smoke every day or some days. If true, these data are remarkably concerning and mean that we've got a lot to learn about how to implement public health policy on a grass roots level. It also speaks to how little the recent $200 billion tobacco settlement did for protecting our youth.

But then came the next remarkable statistic from this data that missed the headlines: men sucked more (on cigarettes, that is).

Without exception, the prevelence of men smoking exceeded that of women in every state. Why was this? Does testosterone combined with nictotine have a differential addictive effect? Or are we just more gullible to the influence of advertisers? Or is it because men don't seek health care as often as women and hence aren't reminded as often about the adverse effects of smoking? Who knows, maybe this is the reason guys have a consistently shorter longevity than gals.

Or is it because men are less educated than women? Fewer and fewer men are entering college now, relative to women. The educational system in America, with its unchecked growth in costs (especially in colleges) stays clear of this issue because it's not politically correct. And college admissions officers have admitted that acceptance standards are lower for men than women. But even from pre-college days, an increasing population of male children are failing to excel in grade school and high school relative to women. It's as though the old ways of teaching with bland coarse curriculae and drum-beat learning exercises has failed in comparison to the draws of action-packed video games (like the record-breaking Halo 3) that suck time from the active pursuit of learning and fail to engage our young men and boys. Many a child (mine included) have fettered away ridiculous amounts of time on these games to find themselves coming up short on tomorrow's exam.

This is not to blame the video game industry for the demise of male education in America. The problem is much more deep-seated than that. Attracting male educators to serve as role models to our education system is rarely discussed, but the need is keen, especially in early childhood education. Reworking our curriculae to stay in touch with the ever-rapid expansion of information and information delivery while "un-plugging" our families from the incessant influx of media influences might help too.

Certainly, I am not a specialist in education, but an educator and a guy who thinks about health. And there is a clear connection between the quality (and quantity) of education and the influence of public health initiatives - like smoking cessation - and we we'll never fix one problem without fixing them both.

-Wes