Discussion forums, part 2

Not so long ago I hade some thoughts about a common discussion forum for emergency physicians all around the world. The idea came more from the need than "just because I can do it".

Emergency medicine is a very young specialty in Scandinavia and as such we have a lot to learn and discover. Although my ED can proudly claim to be one of the first and most developed in Scandinavia - we still are no more than 30 or so young and enthusiastic residents but without the backup of emergency medicine specialists who've been there for ages and "seen it all". So we have many questions and ponders over clinical and practical aspects of the ED which require that extra experience and cannot be answered internally. Comparison of treatment methods or approach, types and use of ultrasound devices, prehospital involvement just to name a few examples - a discussion forum would be truly useful for sharing thoughts with colleges abroad and having those special questions answered or at least discussed.

Some might have thought Facebook is all we need and surely it would be sufficient if everyone was familiar and comfortable with it's privacy hassle. It turns out doctors are paranoid as cats in the bathtub and I've never been able to engage projects with FB because of this, frustrating as it is. Twitter is another option and with the use of a selected hash-tag, say #em-forum, it should be easy to setup a centralized, simple to use platform. But tweets are limited to 140 characters only and discussions are open to the whole Internet. And then too many doctors don't even have a Twitter account, except for Dr. Bailey who just jumped onboard.

I exchanged my thoughts with the ever hyperproductive LITFL guys and they reminded me of http://www.doctors.net.uk which is essentially a social network (Facebook like) platform where registration is moderated so that there are only doctors signed in. I must admit, I haven't been there for a while but the mere idea of persuading thousands of emergency physicians to register and try it out gives me chills all the way from brainstem down to cauda equina. I actually tried once using the free-and-easy-to-use Ning social-networking platform to engage my colleges - they liked the idea but signup/login treshold and a miniscule learning curve was still enough to kill it in birth. Doctors are busy, conservative (just a polite way of saying IT-lazy) and generally exhausted - everything new needs to be dead simple, easy, ready-to-use and again; dead simple.

That leaves us with only one option, email. Every doctor has an email and reads it on a daily basis or so. A server backup-ed, email based postlist system with functions to moderate content and members would be absolutely necessary. Members would want to have an option to login to change their profile and settings (receive immediately or digested content) and even go back in time and read older posts in the archive. Members should be able to see each others and even contact them individually. The system should still be closed for the public, that is - open for special registration/invitation only.
Is this starting to sound like Google Groups? Well, it is. GG is the only system I have managed to use to successfully get together a group of doctors and believe me, I've tried a lot of platforms.


Besides being a tip for you if you wan't to engage your colleges at work for off-work discussions, this will be my attempt to make a unified discussion platform for enthusiastic and alike emergency physicians all around the world. Now that I have colleges in USA, Australia, Iceland, Sweden and UK - this surely has a potential for multicultural emergency medicine discussions. So if you feel interested please feel free to invite yourself at
 https://groups.google.com/group/em-physicians

We'll see what this expirement leads to!

Dr. Bailey does the Twitter

My wife told me yesterday about an interesting scene in the last episode of Grey's anatomy. It turns out Dr. Bailey was Twittering in the OR for the sake of getting assistance from her social-network. As expected she was met with sceptism and disbelief from the chief who finally though got the catch and accepted this new technology. This short clip says all there is to say about Twitter - and social networking in general. It is bound to make a HUGE impact on the way we practice!


I wonder if the script was based on a true story where a college had difficulties with a patient in severe hypertensive crisis but got help from Twitter?

Google custom search to search all your blogs and resources

Most doctors have a set of favorite websites they have become familiar with and prefer to search when immersing in a clinical topic or issue. Medscape's Emedicine is one of these, I find my self repeatedly Googling a topic and adding "emedicine" to search their site specifically. As most of you have found out, Googling medical topics commonly leads us to completely irrelevant sites like patient information or even veterinary sites. Just try 'ileus' - you'll get tons of recommendations on how to treat a horse with no bowel sounds!
While everyone of us searches the web for clinical information every day or so I am amazed to see how little physicians bother about the actual search tools or using advanced search queries since these can significantly alter the results in a positive way. It's pretty much like scavenging the ocean floor when looking for birds.

Google has a special "site:" operator to search a particular webisite (URL) or even part of the site only. This will give us even better results than the above mentioned query;
 "ileus site:emedicine.medscape.com"

will return results only from Emedicine. This way you can use the power of the Google search engine rather than the sites' own.

You can actually add more site:... operators to search a group of websites but that's making things a bit complicated isn't it? So what if you could search a predefined group of sites only?
Well, Google custom search is exactly that and even more. It's one of the excellent Google tools and as such free and uses your Google account to store your predefined sets of selected searches. Yes, you can define not only one set but as many as you wish. I have been using a "medical community" group where I search my favourite emergency medicine blogs (the 'blogosphere'), perfect for finding my colleges' personal experience and opinions or even updates on clinical matters. Then I have a "basic medical resources" where I have included Emedicine, "Merck manual" and similar webs when I want to do some "back to basics" digging into the medical knowledge.

What a wonderful (IT) world

Last night I lay comfortably in my bed, not being able to sleep. I plugged the miniature headphones to my Android and listened to Scott Weingart's EMCrit podcasts on treating the severe asthma patient. After that Amal Mattu's EM Cast about a 2 year old lethargic child with fever and that's when I Mr. Mattu started to echo and I found my self drifting away into the world of jumping sheep.

Earlier this week I was asked to have a short clinical case for my colleges in the hospital and as preparation time was essentially none I picked three excellent 5-minute videos from HQMedEd, all presenting a clinical scenario where the ultrasound in the ED saved the patients life (walkin and talkin!). I had even prepared to show Vanderbuilt's ultrasound video collection to show my ED colleges that learning to use ultrasound in year 2010 doesn't require an expensive international course - just a comfortable sofa with your laptop/mobile and some interest in the field!

Then, preparing for an exam next week - the insanely great Lifeinthefastlane has provided me with invaluable texts on everything I ever wanted to know about ECG, arrhythmias, electrolyte disorders (and other lab-abberancies), intoxications and ED medicines like Magnesium in acute asthma. It's so much more than just a blog. Of course I have my dear Tintinalli resting quietly in the book-shelf, just in case - but LITFL has simply provided me with everything I need to know. It's a true emergency medicine website; written by emergency physicians for emergency physicians - just the facts. The cream of the cake. The brass of the music.
With all this knowledge at the top of my cortex I was prepared for that unconscious patient the other day presenting with a new LBBB which I correctly diagnosed as hyper-K induced. After some insulin+glucose, a new ECG revealed a normal sinus rythm and a resource-draining trip to the angio-lab was spared.


And I haven't told you all the useful things I've learned by reading through my RSS subscriptions... oh my oh my...

Saint's triad

An interesting little thing to remind us of the possibility that a patient can have more than one diagnosis at presentation - something every emergency physician should be aware of! Saint's triad is the simultaneous diagnosis of cholelithiasis, hiatal hernia and diverticulitis:

Saint's triad is named after the British surgeon Prof C.F.M.Saint, the term's eponym, who established the first school of surgery in South Africa. He emphasized the importance of considering the possibility of multiple separate diseases in a patient whenever his or her history and the results of the physical examination were atypical of any single condition.[1] Traditionally, there is thought to be no pathophysiological basis for the coexistence of these three diseases. Saint emphasized that more than one disease may be responsible for a patient's clinical signs and symptoms, and his Triad provides a counterexample to the commonly used diagnostic principle that "the explanation of any phenomenon should make as few assumptions as possible," also known as Occam's Razor .[2] The principle underlying Saint's triad is also expressed as Hickam's dictum.

Source: Wikipedia