19 July 2010

Finding the right tone

Dr Wes has a timely post today which reflects something I also have been struggling with of late. I get disheartened, sometimes, sifting through the dark swamp that is the med-blogosphere.  A substantial fraction of physicians' blogs, especially some of the emergency physicians' blogs, are unpleasant to read.  Which is not to say that they are wrong about things, or that their politics are simply opposed to mine or that their perspectives are not valid.  It's just that there is, for some, a toxicity: anger and resentment, inchoate but always present, in so many blogs. 

The ones that I simply cannot stand are the ones which are hostile or disrespectful towards patients.  I get it -- the ER is an incredibly effective bottom filter for society.  We see the weirdest things, we see people when they are at their worst. I've been known to marvel at the things that come through the door from time to time.  I try, maybe with imperfect success, to be respectful of patients' dignity and humanity.  Yes, you shake you head and wonder what the hell they were thinking.  When it's funny you can't help but laugh. Amid it all, though, I always try to remember that these poor souls are here for my help (whether I can help them or not) and that it's an utter betrayal of my raison d'etre to belittle or attack them.  There was an ER blog a few years ago which commonly used the acronym "WPOS" to describe patients they didn't like -- "Worthless Piece of Shit."  That's the sort of thing that gets me.

Some ER docs also use their blogs to vent about their challenging patients. That also bothers me. Again, I get it -- ER patients can be really nasty characters sometimes, and FSM knows I don't like all of my patients. They are frustrating and maddening sometimes. Venting can feel therapeutic. Whether it's appropriate o not, I will leave to the ethical censors of the internet, but for myself I feel uncomfortable reading physicians rant about how pissed off they are at their patients, with venom in their tone.

And then there's politics. This has nothing to do with Right or Left, but with rage. There's such a stark divide between the cool dispassion of the health policy blogs and the anger that wells up from doctors when they discuss the system we work in. There's a fair argument that if you are not angry then you are not paying attention, and that it's a maddening system to work in.  But who wants to be around someone who is spitting mad all the time, who seizes on every new bit of information with an aggrieved and indignant voice?  Some folks cherish their anger and stoke it carefully to maintain their fever pitch of righteous fury.  Which is their right, of course. I'm just tired of reading it.

So for me the solution is obvious.  I culled my reader list aggressively (a difficult task for the information omnivore that I am) to reflect the blogs that are written by someone I feel like I would like to sit down and have a beer with. And rather than spending a whole post bemoaning the negatives, I thought I would take a few moments to highlight a few doctors' blogs which I very much enjoy reading.  This is very much not a comprehensive list:

ER docs:
Life in the Fast Lane
The best EM blog on the net, in my opinion.  These Aussies (and at least one Kiwi) have a blog which is educational and fun to read. I admit that I don't always "get" their "humor" which includes a set of obtuse specialty societies such as the UCEM (Utopian College of Emergency Medicine) and the Society for the Prevention of Surgery, but if you chalk it up to living in a culture which produced the didgeridoo and Yahoo Serious, it kind of makes sense.  They don't do patient stories or cases per se, but have lots of actual teaching content and if you're not careful you might learn something.  I have resisted that urge thus far.


Could be viewed as a companion to LITFL. While they are highly academic, StorytellERdoc strives to depict the humanistic and literary side of Emergency Medicine. Seems like a really nice guy who cares about his patients.

I only put him on the list because I'm afraid he'd shoot me if I didn't. I hear he's becoming quite the marksman.
GD no longer writes much about life in the ER, but he's been around since before electricity and we've had many an engaging conversation. If I ever stop over in DFW I'll let him take me to the shooting range and we won't talk politics.

Other specialties:
Dr Rob
There's something seriously wrong with his brain, in a good way. He's funny and silly and sounds like the sort of doc I'd want to take care of my kids. Yet he's also a techie and pretty savvy on the business and policy side of medicine, too.  If it weren't for his inadequate appreciation of Apple products I might have a man-crush on him.

other things amanzi
Bongi, a surgeon in South Africa, has a wealth of amazing stories -- some because the humanity or the medicine is simply incredible, some because the practice environment is so otherwordly.  He's a great writer, too, even if he hasn't yet figured out that the "shift" key makes capital letters.  Maybe they don't have "shift" keys in South Africa.  I was terribly bummed not to get to meet him in Vegas last year.

Buckeye Surgeon

As a graduate of Northwestern University with vivid memories of our Wildcats losing 63-0 to the Ohio Buckeyes in football, it's hard for me to say anything nice about a blog so named.  But Jeffrey Parks tells good stories -- great medical cases as well as occasional heart-breaking human tales, interspersed with the occasional political rant.

Suture for a Living

Dr Bates is officially the Nicest Person on the Internet.  Her blog varies between quilting and plastic surgery and linkfests. Every so often I send her pictures of interesting lacerations. Lord knows why I would think she would be interested, but she's always been very polite about it.

Respectful Insolence

Orac is amazing. He really shows the difference between being an amateur and a professional blogger. He's a surgeon, a Primary Investigator medical researcher, and also has 7.7 million hits on his blog.  He writes passionate and meticulously detailed articles debunking anti-vax autism loons and all other sorts of pseudo-scientific charlatanry.  How he does it all I'll never know.

db's Medical Rants
"Dr Bob" aka Robert Centor is an academic internist at the University of Alabama School of Medicine. You can tell he's an internist because he cares about the interpretation and meaning and a mixed acid-base disorder, and will frequently torture quiz readers with electrolyte or blood gas puzzlers.

Musings of a Dinosaur
A Family Practice doc in solo practice, she is among the last of a dying breed.  Skeptical of woo-based medicine, she's fierce in her defense of the family practitioner and also wrote a real honest to goodness book. On paper. Yeah, I know.  Weird.

These are just a few of the blogs I read and really enjoy (I read over a hundred, so please don't feel offended if I left yours out).  When I get kind of down about the nastiness out there it can be helpful to reflect that there are a lot of really cool people out there blogging.


  1. I think you just gave me the most compelling reason to stay clear of Apple products.

    I do very much agree with you (on the other stuff). There is a trust patients put in all of us, and it's part of the reason we get paid like we do. If you read the comments on my latest post about chronic disease you will see the way in which many docs betray that trust.

  2. I found a comic that is relevant.A job for LINK

  3. "Some folks cherish their anger and stoke it carefully to maintain their fever pitch of righteous fury."

    Couldn't be more well said.


  4. what is this shift key you speak of?

  5. I used to read a lot of the political blogs, but the constant anger in people's voices made it a total turn off and a total emotional drain for myself. I am a political junky and it was hard having to cull my daily reading list, but you know what I am glad I don't have their angry words in my life anymore.

    I think that is the hardest thing for folks that devour information. That we are somehow missing something by not reading this or that anymore, but what are you really missing out on. Being a sounding board for someone else's rage?

  6. If you are not careful I am going to have to start listing you with the thoughtful, compelling and literary medical bloggers...a tag the LITFL team have yet to bestow upon your good self.
    Great piece of writing, well developed and including a laudable use of the word inchoate.
    I worry that our subtle antipodean humor may at times be lost as it rises to your fair shores...we will perhaps try to subtitle or caption our posts in the future...

  7. Mate - I've gotta agree with every word, and cannot argue with your great blog recommendations.

    Apologies for the LitFL sense of humo(u)r - to be fair, most of it is way over my head too!

    Look forward to that beer one day in the future - any chance you'll be in San Francisco in November?

    All the best,

  8. Thank you for the nice words. You have included me in some great company. :)

  9. Thanks for including me, and I wouldn't shoot anyone for including me (or excluding me) from a list.

    I just don't like paper, so it gets shot at (humor).

    I don't blog a lot of 'life in the ER' these days, you're right. Partly I've said everything twice, partly the bar to be an 'interesting case' is now so high they're very hard to anonymize, and the more of my work colleagues, staff, etc read it the more circumspect about writing about work I become.

    Nice post.


  10. Replace "the Navy" with "emergency medicine".

    In the common, natural course of events physicians, surgeons and apothecaries are faced with enormous demands for sympathy: they may come into immediate contact with half a dozen deeply distressing cases in a single day. Those who are not saints are in danger of running out of funds and becoming bankrupt, a state which deprives them of a great deal of their humanity. If the man is in private practice he is obliged to utter more or less appropriate words to preserve his connection, his living; and the mere adaption of a compassionate face as you have no doubt observed goes some little way towards producing at least the ghost of pity. But our patients cannot leave us. They have no alternative. We are not required to put on a conciliating expression, for our inhumanity in no way affects our livelihood. We have a monopoly; and I believe that many of us pay a very ugly price for it in the long run. You must already have met a number of callous idle self-important self-indulgent hard-hearted pragmatic brutes wherever the patients have no free choice: and if you remain in the Navy you will meet a great many more.

    --Stephen Maturin, The Nutmeg of Consolation by Patrick O'Brian

  11. I am very pleased to be included on your list of reads. The blogs you have selected are all amazing and I feel honored to be included. Seriously. And I think you are being humble not to put yourself on this list. Finally, as you mentioned, if we ever do meet up for a beer (or two), it's my treat.

    Thanks for the shout-out, friend.

  12. If you find it a bit disturbing as a physician, imagine how a patient feels (I'm sure you can). While I appreciate venting, humor, and all that - it's a bit scary to read some of these blogs, and think "These are the docs I might meet in the ER - and how will they think about/treat me?".

    StorytellERdoc is indeed an exception to the above - I've often noted the compassion and kindness, and thought "If I had to go to an ER, I want THAT doctor".


  13. Great post. I agree with you completely about getting tired of reading annoying stuff, though I keep a couple of them on the list to 1) avoid the trap of reinforcing my biases by just reading stuff I agree with, and 2) keep an eye on them so I can chime in when they get too ridiculous (a "keep your enemies closer" strategy).

    So there I was reading along, nodding in agreement, noting that you were naming all my favorite blogs too (including Dr. Wes and yourself), and lo and behold: the final entry. Thanks for the kind words.

  14. Thanks for the kind words. I do love acid-base and electrolytes, but I love caring for patients even more. We all went into medicine to help people and we are fortunate to have the opportunity to do that.

  15. As a health care consumer, thank you.

  16. Good for you! I read MDOD a few times then read a post by him or her that was vile in its hostility and will never look at it again. There are plenty of humane doctors and nurses who blog.

  17. MDOD is funny though, gotta admit, makes me laugh :)

  18. thanks dude. And it's not the Ohio Buckeyes....it's THE Ohio State University Buckeyes. Take care.


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