Monthly Archives: October 2010

Grand Rounds

I’m proud to be included in this week’s education edition of Grand Rounds. Thanks to Spice Island!

http://notesfromspiceisland.blogspot.com/2010/10/grand-rounds-volume-7-no5-lessons.html

Foodie Friday: Korean

I never thought I’d have have a reason to visit South Korea, but there I was, wedged into the back row middle seat of a Korean Air flight to Seoul to visit a family member working and living there. The heart of a culture may be its food, and Korea is no exception. Now, I wouldn’t exactly call myself an adventurous eater. If you’ve read prior “Foodie Friday” posts, you’ll see that I nearly always choose the sweet option, even in savory dishes, and while I do enjoy occasional fish and shellfish, other ocean crawlies and seaweed are pretty much never on my menu. It’s not that I don’t want to like these things. My palate does not really enjoy strongly salty, vinegary tastes. The shellfish may be a texture thing. It’s not for lack of opportunity. Raw oysters and lobster rolls are an integral part of my family’s summer shopping list. I’ve just been the odd man out. I look at gorgeous pink shrimp or colorful sushi rolls and WANT to like them. Maybe if I keep trying it one day I will.

View of a residential part of central Seoul and the surrounding mountains.

Anyway, back to Korea. I was a little nervous about my food options, given the very seafood-centric diet and the ubiquitous spicy fermented vegetables, kimchi. In my travels around the city I saw lots of this:

I didn’t want to be that person. That American who turns up her nose at the local delicacies. That’s no way to visit a place and no way to act when going out to eat with locals. Fortunately, I found plenty of things I LOVED. Big pots of steaming chicken and noodle soups, the barbequed beef you roll up in a huge leaf (not lettuce, I forget what kind now) with some of the kimchi and sauces, porridge called juk (may also be known as congee) of many flavors. We found it interesting that many restaurants are known for one single type of food. For example, there may be a restaurant that just does soups, or just does barbequed duck. It’s that specific.  I also had to get used to the fact that sweets are markedly less sweet than we are used to and, in fact, dessert is most often a small cup of some warm fruit tea or maybe orange slices. Overall quite a healthy diet. Aside from, I think, once to a Coffee Bean and Tea Leaf, we didn’t go to any chain or fast food places.

I am brought back to the tastes, sights and smells of that trip each time I visit one of the local Korean restaurants around greater Boston. Last weekend I dined on dolsotbibimbap, or rice and vegetables served in a sizziling hot pot. I usually have mine vegetarian with tofu and I’m a wimp, adding only in a few drops of chili paste. We had a scallion pancake just like the ones I ate from street vendors in Seoul. I missed the acorn jelly side dish, but some sweet and spicy cucumber was amazing. It’s always a nice way to bring back a memory. I’d love to hear your favorite Korean menu options!

Enjoying the many side dishes that come with the meal.

A doctor’s fashion emergency!

PRIVATE PRACTICE - "Know When to Fold" - Charlotte's rival practice, Pacific Wellcare, opens its doors and the competition with Oceanside Wellness begins, as Sam and Pete steal one of their clients, a favorite patient of Addison's goes to a Pacific Wellcare doctor for a second opinion, and Dell proposes the creation of an in-house adoption program, on "Private Practice," WEDNESDAY, DECEMBER 10 (9:00-10:01 p.m., ET) on the ABC Television Network. (ABC/MICHAEL DESMOND)KADEE STRICKLAND, AMY BRENNEMAN, KATE WALSH, AUDRA MCDONALD

The fashionable lady docs from abc's "Private Practice"

Doctors are not typically known as fashion icons. In fact, let’s just get this out of the way. Most doctors are actually not fashionable at all. Yes, I’m sure you can tell me about Dr. So-and-so who always looks like an arrival from fashion week, who teeters around the hospital in heels, whose tie collection is legendary (let’s include the men, too). There are also the TV shows where the ultra-modern medical office is nothing but an arena for sex, drama and incredible dresses! (For the record I’ve long been a junkie for these shows). But for every shining star of the medical runway, I bet you can find more than a few pants of questionable length (and decade), polyester skirt suits worn with sensible shoes, sweat-stained shirts long since ready for the trash. Even those of us who fancy ourselves au courant just might have in the closet a few donation-worthy gems that come out into the workday rotation from time to time. As I once tweeted, “A long white coat hides many a fashion don’t.”

I’ve been thinking about fashion a lot lately for a few reasons. First, the change of seasons means examining the under bed bins packed with fall and winter woolens (at least here in New England) and switching over the closet space. Also, a friend of mine recently hired one of those clothing consultants who go through your closet and help decide what to keep, what else you should buy and how to make new outfits from your old pieces. As I contemplated this service, I concluded she’d be done with my closet in about 10 minutes. I love clothes and fashion, but my job doesn’t exactly demand my style be cutting-edge. Why?

  •  It’s not expected. I’m actually surprised at how many studies on this topic have been published. You can read about patients’ preferences and attitudes regarding doctors’ appearances. Generally surveys of patients indicate a more conservative appearance is preferred. Nothing wild, nothing provocative, no crazy hair colors. Some organizations may have rules about visible tattoos and piercings. Open-toed shoes aren’t allowed in clinical settings, limiting a lot of summer shoe options. That’s not to say we should be boring, but most patients aren’t here to check out what new clothes the doc is wearing. Our wardrobe must be neat, clean and not distracting.
  • We don’t have time to shop. We’re busy. That pair of pants may have been great in the 90’s but they still fit and, well, what’s wrong with them? We have other things to think about, like stamping out disease, getting CMEs and doing insurance preauthorizations. We’re more likely to read NEJM than Vogue. We’re also goal-oriented. “I need a new blue shirt and a pair of grey pants.” We run into the mall, find our items, run out. You think I’m kidding? I have more than a few doctor friends with this mindset! I know, I can’t believe it either!
  • Comfort! We got used to wearing pajamas at work. I’m jealous of anesthesiologists and ER docs. Remember as a resident, wearing scrubs all the time? If we were doing an inpatient rotation, we were allowed to wear scrubs on call and post-call days but weren’t allowed to wear scrubs to the clinic. It’s kind of like school uniforms. It used to be so easy! We like our comfort. Take the prevalence of Dansko clogs. Oh so comfortable and oh so clunky. I love ‘em! My above-mentioned fashionable friend begs me not to leave the house with them on my feet! Once I was all dressed up in my “lady shoes” (what I call heels, dress shoes, anything not flats or clogs) for a presentation and a podiatrist said to me, “Keep wearing shoes like that and you’ll be seeing me soon!”
  • It might be OK to wear theme clothes. I’m not around pediatricians much these days. Do you still wear “fun” clothes? Is a teddy bear sweater appropriate anywhere else but peds clinic or a preschool classroom? What about holiday pins? Don’t forget to take off your spooky ghost Halloween pin and earrings before going to that dinner meeting!
  • Work can be messy. I’ve had to throw some things out due to workplace contamination – and this is Rheumatology! Granted, a business person or attorney might spill coffee or lunch or ink on a nice suit, but not blood or sputum or vomit! (Usually). Trying to move limbs and position patients is hard to do in shorter skirts. The white coat is protective, but also hot. Heavier sweaters, anything with embellishments/bows, longer necklaces and more are all hidden behind the coat. Granted, there are many docs who don’t wear a white coat. I just can’t figure out where to put my pen and stethoscope! Men have the ease of a sport coat. I’m jealous again!
  • We’re nerds. Admit it. Just a little? How’d you get to and through med school without being a little bit of a science nerd? Hey, it’s OK! You can even claim “geek chic” if you want. Dress codes are quite, er, relaxed when it comes to spending a lot of time in the lab. Part of being a little nerdy is there can actually be some self-confidence with it. “I like what I like, I wear what I want to wear and what’s it to you” kind of thing. We’ve had to be nonconformists to get here and if that extends to our fashion choices, so be it!

Now, if you’ll excuse me, I have to dive back into my closet and reconsider those yellow faux snakeskin clogs I thought were “fun” and “different” and try on that skirt I distinctly recall wearing on my medical school surgery rotation!

(Photo Source)

Foodie Friday: When in Rome

Did you think I was going to talk about Italian food? My wonderful trip to Rome? Nope. Never been. But I DID follow the “When in Rome . . . ” rule and ordered the house specialty cheeseburger at the famous Shady Glen! You may have seen it on travel or food TV shows or heard about it, as I did, on the Road Food segment on NPR’s The Splendid Table. Fortunately, it is just a mere 90 minute drive and, fortunately again, I had SIX other family members who wanted to make a pilgrimage.

When you’re stuffed full of fried cheese, onion rings, crinkle cut fries and almond joy milkshakes, what should you do next? If you have a strong stomach, you should drive the windy backroads to East Haddam, CT, and tour the beautiful and unusual Gillette Castle. Our group was initially disappointed that there were no free razor samples (The castle was designed by William Gillette, an actor who brought the Sherlock Holmes character to the stage around 1900, no relation to the razors or Gillette Stadium). However, we all enjoyed hearing about Mr. Gillette’s life and, er, eccentricities, and soaking up the fall sunshine overlooking the Connecticut River. If you need to quickly get back to the interstate, you can take the Chester-Hadlyme Ferry!

Hope you have a reason to enjoy this south/central Connecticut day trip!

A Love Letter to Primary Care

Faneuil Hall, Boston

Living in a major metropolitan area means taking a lot of things for granted. Especially here in the Boston area, with its many renowned hospitals and universities, one can find physicians practicing and conducting research in specialties within specialties. Nothing seems too far out of reach. However, this city mouse recently traveled down the Blue Ridge Parkway for some R&R and to learn how the country mice work and play.

My FP friend's happy old horse

I was thrilled to meet up with a medical school friend who practices family medicine in a rural area a bit further south. We spent a lot of time catching up and reminiscing, of course, but we also did a fair amount of “shop talk.” Touring her office space, she shared with me some examples of what her typical day might be like. The pride in her voice was evident as she talked about what it means to be a family doctor. I was surprised to hear about all the office procedures done on site, as I think locally a lot of procedures here in the city are referred out to specialists. We hear so much about how medical students these days don’t want to go into primary care. Maybe they need to spend more time seeing what it truly means to be someone’s family doctor. Through blogging I’ve been touched by the words of some fantastic doctors who are living and sharing this life, but it was also wonderful to hear about the struggles and inspirations from my friend over lunch. “You know what I wish,” she said, “That people didn’t think you only go into primary care if you’re not smart enough to specialize.”

Barn cat

Maybe this sounds strange coming from a specialist, but I couldn’t be a bigger advocate of primary care. And the further I get away from my general internal medicine training, the more I’m struck by just how hard it is to have to keep up to date with ALL the body systems! Not only do I value the teamwork and co-management of the primary care providers I work with, but I want my OWN doctor too. Everyone is a patient, and don’t we all want someone to call “my doctor?” Having gone to medical school at an institution with a strong primary care commitment, I don’t think this value has ever been far from my mind. In fact, of my group of close friends from medical school, the majority are family doctors, one is a pediatric specialist and one is an internal medicine hospitalist. Then there’s me, in rheumatology, which I do love for the multi-system nature of many of the conditions I see.

Some medical student blogs I follow occasionally talk about “specialty bashing” or how residents and attendings they encounter put down other areas of medicine. Some have said, “Oh, I could never be a XXX doctor. How boring! What torture!” (Well, more colorful language may have been used, but you get the picture). I’m GLAD we all find some things boring and some things exciting. What if every medical student in the world wanted to practice in the same field? That wouldn’t work at all. This post didn’t start out as a love letter to primary care. My original intent was just to say thanks to my good friend for the visit and share some photos. But after thinking about it, I want to also say thanks to all the primary care internists and family docs for what they do. Thanks for inspiring my friends and colleagues, who will hopefully be able to inspire today’s medical students to follow in their footsteps.

Hospital Manners

My 93 year-old grandma always has a story to tell. A few weeks ago when I visited her, she wanted to show me a greeting card she found in a box of old photos. I snapped a few photos of the pages – here’s just a couple. Maybe I’ll post the others later. It’s VERY sexist and talks a lot about how to behave when the nurse comes to give a sponge bath or an enema. I don’t know if you want to see it. I’m not sure I really understand the page with all the fill in the blanks and smiley faces. The date inside is 1930!!

1st Blogaversary!

While I was on hiatus, my blog celebrated its first birthday. I may not have attended the party, but I’m still cleaning cake and frosting from various corners of the blog. Sounds like it had fun celebrating. As many others with “blogaversaries” do, I thought I’d reflect on the last year of social media experimentation. Bad or good first? Hmmm, let’s do the good.

What I liked about blogging/social media over the past year:

  1. Learning something new. It was very exciting this time last year to learn some new technology and play around on the computer, albeit just a wordpress.com blog without bells and whistles. I got to learn a little bit of new vocabulary. I started reading tech forums. I went to a conference for bloggers (not medically related).
  2. “Meeting” new people. Making connections. Sometimes hard to do when you’re in an office not connected to a hospital, not inside a university. I love having contacts in many different fields and geographical areas.
  3. Looking at medical information in new ways. For example, this week a few docs I follow on Twitter are posting lots of tidbits about the EM meeting they’re attending. Where but social media would I have the chance to learn this kind of stuff outside of my own specialty? Also following blogs and Twitter accounts for medical societies and journals is much more interactive than sitting down with a paper copy. I’m more likely to learn that way.
  4. Being one of the few blogging Rheumatologists and trying to be an ambassador for social media in medicine when interacting with friends and colleagues.

What I found challenging or frustrating about blogging and social media:

  1. Finding my “voice.” I’m not comfortable sharing patient stories except as a very vague jumping off point to spark a discussion. I’m not very political and I don’t have much experience with the business of medicine. What’s left? Discussing medical conditions? Well, there are already many reputable sites people can visit for health information. My personal life? I’m interested in food, healthy cooking and exercise and hopefully I’ve shared that over the past year.
  2. Negativity. Every once in a while I’m overwhelmed by the negativity in the medical blogosphere. Much of this, of course, has to do with the payment system and the business side of things, government, etc, etc. Sometimes continually reading that the sky is falling makes me start to believe it.
  3. Technology. For example, a few months ago Picapp photos just stopped showing up. There’s some glitch where the photos only show up as a red X in the corner of a blank box. I’ve joined a help thread and they say it’s working but I just tried it to get a birthday cake photo and it’s not. I don’t HAVE to have stock photos but I liked putting them in. Sometimes I want to put in videos and I don’t know how. I’d like pretty badges and buttons on the side but I guess you can’t have those on wordpress.com or I don’t know how to add them.  I don’t really have the knowledge to deal with this. I don’t have enough of a readership to make it worthwhile to hire someone to help me with technology.

Bottom line, I’m blogging for fun because I love writing, it keeps me up to date with current medical literature and news and I have had a great time “meeting” and interacting with other bloggers. The technology part is fixable if I decide I really need it and the problem finding my voice hopefully will evolve as I continue to write and participate in the community. It’s good to be back from hiatus.

Some of my favorite posts from the past year:

Food: I really can’t choose, but I do love these – The world’s best beef stew. Making mini donuts.

Exercise: How a non-athlete exercises.

My work day: What do I do at work, anyway?

My perspective: Dr. Fix-It.