Life in the Fast Lane, an Australian Emergency Medicine blog, has been on fire recently with some of the greatest medical posts I've seen in years. Notable recent posts include the worst imaginable complication of chest tube placement -- must be seen to be believed -- and an excellent educational post with the most improbable title, "Code Blue in the Mortuary."
Dr Val writes about her father-in-law's ER visit and work-up for chest pain. The ending is a happy one, but Val totally misses the point in her post-event musings:
No, Val, the ER doc was not wrong. You are committing the logical fallacy of ex post facto reasoning. The CT scan was clearly indicated based on the presenting symptoms because the doctor did not yet know there was no dissection. Carl Sagan once wrote of the TV scientist who sadly lamented a "failed experiment" because it did not produce the expected results. That's the exact opposite of science! Any scientific investigation in which the outcome is known in advance is a waste of time. The test was successful because it provided useful information, and while the outcome was negative, the assay was by no means a waste.
George was right - he was getting old. The nurse was right - there was nothing emergent going on.
The ER doc was wrong - George didn’t have an aortic dissection. And I was wrong - there was nothing actively wrong with his heart.I feel badly that I contributed to a waste of healthcare resources.
Dr Rob writes that he's also struggling with real life, and we're all hoping that he gets distracted right back into blogging soon. Until then, I have dibs on the Llamas!
Dr Bryan Vartabedian writes at Better Health about doctors blogging anonymously:
Anonymity is a fantasy. It’s remarkably difficult to achieve. With small thoughts you can hide – in fact, no one cares who you are. If you offer anything worth hearing people will ultimately find out who you are.So terribly true. I was amazed, the first time I got picked up on Reddit, how quickly some clever commenters were able to figure out my identity. Since then, I've only kept up a very slight fiction of anonymity, all the more transparent when I got cited under my real name in some national publications. The only qualification I would add to this is that I keep my name and that of my hospitals off the blog, since I don't want patients to Google me after seeing me in the ER and immediately find the blog at the top of the search list. Not that it'd be hard to make the connection, but I don't want patients I have cared for to find the blog and have the fear that "he's going to write about me." And yes, I do fictionalize every patient story on this blog extensively. Bottom line: don't post anything on line that you'd be uncomfortable listing on your CV!
Speaking of patient stories, there is a promising new ER blogger in town: StorytellERDoc. I like what I've read so far very much, and will be watching eagerly to see if he can keep up the challenging pace he's set for himself.
One another note, I liked Roger Ebert's cranky and petulant rant in the Sun Times about politicians inserting non-science-based beliefs into their public policy positions. I'd complain about the tone of the piece, but Ebert's clearly on the side of the angels on this matter, so I'll let it be. Hmm. That "angels" metaphor doesn't really work in this context, does it?
OK, gotta pick up #2 son from school now. More real medicine stuff coming soon, I promise.