The Cloud and Medicine


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I recently finished an elective in pediatric infectious disease elective, and just prior, was gifted an iPad 2. Combined with a portable keyboard, it became one of the most useful tools in my medical arsenal. I was able to type notes and save them with Dropbox, increasing efficiency since I type more quickly (and more legibly) than I write, enhancing note taking during lectures, and allowing me to reference textbooks while discussing a patient.

Many of my colleagues made mock-fun of me, but as Bryan Vartabedian writes on 33charts, the future of medicine is in physicians embracing technology. Another resident on this elective with me does not, using an old Blackberry without any of my “essential” medical applications (such as Medscape), and even he became smitten with using Dropbox to synchronize our notes. As this is a relatively new field, I’ve made sure to attempt to be HIPAA-compliant by only using patient initials and bed numbers in my notes.

Combined with applications like Dragon Dictation (free!), I can see how the old-style dictation into a phone that someone subsequently transcribes and sends back to the hospital will become obsolete. DD is pretty accurate for “regular” speaking, but its attempts at medical-speak are pretty humorous. Radiologists routinely use real-time dictation systems, but I’m sure both of these approaches have a hefty cost associated with them. A relatively small initial investment of an iPad and some as-yet-unwritten medical dictation system could revolutionize things, especially considering all the other functions it can serve.

I love living in the future.

Transcribing dictation with a Dictaphone wax c...
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After Yoga

Two teen monks were playing long flutes in the...
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Just finished a vinyasa workout from Zyrka Landwijt, so relaxing

My body is grounded, my breathing is calm, my thoughts flow easily

Even as I type this, I can still feel a connection to the ages

Almost sleeping, but awake

Just calm and serene, but knowing that I will be up and about in a few minutes

Looking around the room, I have so much clutter, but my mind feels calm and clutter free at the moment

I wish I could stay like this forever

Nothing will stick to me, it bounces off, I can do anything

New Year’s Resolutions… in April

Two New Year's Resolutions postcards
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Today is day 103 =  3-1/2 months = week 15 of this year, and where are we with our previously-new resolutions? My list has been:

  • Study Japanese everyday
  • Go to gym ~3 times a week
  • Do weekly budget
  • Iron clothes
  • Take vitamins

I’ve certainly not studied Japanese everyday, not even close… despite what Khatzumoto has to say about it, I haven’t been able to consistently do it with my work schedule (although that shouldn’t be an excuse).

I’ve intermittently been to the gym, although also not 3 times a week as prescribed, again, secondary to work… but at $500/year, it’s not something I should be ignoring!

I have keep up to date with my budget, with an elaborate spreadsheet for tracking debt/assets and using assiduously.

As far as ironing goes, I do want to look good for work (and play!) and so iron when necessary, but it’s fairly common to see a dozen shirts draped over a chair waiting for the touch of steam. I got a new Rowenta iron (yes, a German-made one) so I’ll try to keep on top of that better.

And vitamins, even though I set an alarm every night to remind me to take them, I just can’t bring myself to pop in the Centrum… and calcium… and vitamin B complex tabs. They’re easy and certainly help since I don’t get any sunlight, and they sit right on my table, but… I have no excuse.

I know it’s a joke to make fun of new year’s resolutions and how no one ever keeps them, but what if we did? Imagine how much healthier a population we’d have, eating well and exercising, not abusing substances, doing jobs we loved, in happy relationships, Getting Things Done, living in clean houses, taking time to play everyday…

Physical Health

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I’ve been using MyPlate from Livestrong for a couple of years now to track my food and exercise intake, and initially saw very impressive results – over about 10 months I dropped from 205 to 168 pounds. I would go to the gym in my apartment to do the elliptical for ~30 minutes three times a week or so and tried to eat as healthily as possible, mostly keeping track of foods and being aware of what I was eating so I would ration my calories (“I could eat this candy but it’s 45 calories and I only have 200 left for today…”).

I certainly didnt’t subscribe to any new fad diet or anything, I basically ate the usual foods but exercised portion control. And as I’m fond of saying, I’ve discovered the secret to weight loss: eat well and exercise. I recently heard of Timothy Ferriss‘ 4-Hour Body and it sounds like an interesting idea, although as an MD myself, I’m certainly skeptical; maybe I’ll give it a read in my spare time.

And despite being a doctor myself, I make sure to have my own primary care physician to make sure I’m getting the necessary “health care maintenance” advice and screening. A few months ago, I had somewhat elevated triglycerides but an otherwise good lipid profile (LDL 70’s and HDL 50’s) and was told to cut out things like pastries and take-out food… not that I have. I recently came across the FitBit and as a gadget-oriented guy, I thought it’d be neat to get one, but just like those fad diets versus eat well and exercise, I feel the $99 price tag is not justified in my case. It’d be just as effective making sure I take time to get to the gym and remain mindful of my eating (and logging it in MyPlate!).

What do you think? How much do you depend on gizmos and gadgets and the latest in weight-loss hardware and software to maintain a healthy lifestyle?

Growing Up Technolog’ed

Tandy 5000 MC
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From as early as I can remember, I had wanted or used a computer. I don’t even remember what the incentive was, but I wanted a computer and for my fourth or fifth Christmas, received a Tandy RL-1000 (the one to the right is clearly a more advanced version). It had this cool drawing program that necessitated the purchase of a mouse (two button or three button? no wheel!) and I think I also had a joystick, although for what, I have no idea. I remember also getting a box with two microchips in it: a RAM upgrade from 256 to 512kb! There was also a dot matrix printer (and eventually a color one) and this neat fluorescent desk lamp. I probably didn’t use the vast majority of what it could do, but I do remember using WordPerfect v5.1 to write up school reports (did my classmates use typewriters?).

In any case, I essentially grew up with computers, having the trusty old Apple ][e at school in kindergarten, IBM PS/2 models through fifth grade for learning touch typing, “Creative Writing”, and “Writing to Write”. I think in junior high we were introduced to “multimedia” with CD-ROMs in those cassette cases and Microsoft Encarta. What a revelation – it was like Wiki before Wiki.

Anyways, I visited my aunt and uncle today who are in their mid-60s and who had recently received one of those digital photo frames. I couldn’t figure out what they were asking me to do until I realized they wanted to put their old printed photos into the frame… it’s possible but in my head, thought it wouldn’t be worth the effort or the cost of someone else doing it for them.

I can’t find the link, but I remember reading something awhile back about how, because we have instant access to information through the Internet and access anywhere via our smartphones, people are becoming stupider: it’s easier to look something up than to remember it. It’s like the phenomenon of looking at your watch and then looking again a second later if someone asks you what time it is: you look first to see if you’re approaching a limit (like whether you have time before a noon meeting) but you don’t really comprehend the time explicitly, so to tell someone the time, you need to look again.

I’m personally very guilty of looking things up on my phone whenever and wherever – and how much do I retain? Probably not much… not to mention the whole distractibility thing and inability to multitask. I’m very fond of saying that “I love living in the future,” especially after discovering something like Google Translate on my iPhone that can translate spoken text (just like Star Trek!) – I’ve always been a sci-fi geek and fantasizing about the future.

What do you think – are today’s children growing up connected from an even earlier age than me at any disadvantage? If so, what would you suggest to today’s parents? If not, what do you think the biggest benefits are.

What do you wish you knew more about?

Steps to knowledge

Prompted by Plinky, I figured it’d be a good marker for the future too (ie, did I actually do any of it???). In no particular order:

  • Meditation and yoga
  • Cooking and baking
  • Relationships
  • Scotch and wine
  • Who I am as a person and what’s important to me
  • What I really want to do when I grow up
  • Anime
  • Japanese
  • Personal finances and investing
  • How to survive the end of the world
  • My career
  • Classic books like The Art of War and the Tao Te Ching
  • Psychology and sociology
  • Men’s style
  • Tae kwon do

There are probably a lot more, but these are a few that I thought of in 10 minutes…