I've temporarily put up a PacMan gadget up on my 'Links' page. PacMan is a little before my time; I grew up in the 8-bit graphics era of Nintendo. Also popular around this time were: slap bracelets, Teenage Mutant Ninja Turtles and Vanilla Ice.
I encourage you to play and to relive your childhood as I have been doing for the past 17 hours, or so. Whether I am having a true insight, or whether it is the onset of video game-induced delirium, I find myself seeing many parallels between the plight of our PacMan hero and the plight of the primary care physician. Thus, I have compiled the following top 10 list:
Top Ten reasons why PacMan would make an excellent physician:
Hunger - PacMan is hungry. Likewise, the excellent physician should never lose his hunger for knowledge.
Confidence - A physician can cause harm to his patient by second guessing himself. Sometimes, suboptimal management given in a timely manner can be better than optimal management given after a delay or hesitancy. PacMan has to be sure of his ability to eat all the dots. If he goes for all the power pellets right away, not sure of his ability to effectively evade the ghosts, he will be in trouble later on when all the power pellets are gone.
Risk vs. benefit - PacMan is the foremost authority on risk-benefit analysis. Each ghost he eats is worth more than the previous one. If he eats just one ghost that's 200 pts., but if he eats all four that's 3000 pts! However, each additional ghost he eats confers an added risk of getting killed or of not being able to eat all the dots. PacMan must carefully balance all of these opposing factors.
Self direction - PacMan must guide himself through a tricky maze. Staying in one place for too long spells certain death for PacMan as it does for the physician who is not self-directed and self-motivated in his continuing education.
Yellow - PacMan is bright and colorful and would nicely complement the decor in a pediatrician's office.
Flexibility and adaptability - PacMan, if he had them, would be constantly required to think on his feet. Just as the same management protocol is not appropriate for every patient, PacMan cannot eat all the dots and navigate the maze in the same way every time. He has to be constantly changing his plan of attack in order to avoid the ghosts.
Expediency - PacMan is always in a hurry! And, given today's culture of managed care and the 15 minute office visit, PacMan knows how to eat all those dots in the most efficient manner possible.
Two-dimensional - Ok, maybe this isn't really an advantage per se. But, hey, at least he's not one dimensional!
Anticipatory - PacMan must always anticipate where the ghosts might go in order to avoid them. And he must have a plan in place in case they go somewhere other than where he expects them to go.
Round - PacMan is circular, like the excellent, well-rounded physician who has ideas and interests and partakes of activities outside the medical world.
If you don't believe me, play the game for yourself!
I'm back home for a few days and went with my family to see the most recent in the film adaptation of C.S. Lewis's "The Chronicles of Narnia," Prince Caspian. It's been a very long time since I read the book, so I can't really speak as to how faithful the movie is. The plot involves our heroes, Peter, Susan, Edmund and Lucy, getting called back to Narnia by Prince Caspian (the rightful heir to the Telmarine throne) in order to defeat his evil uncle, Miraz, who intends to have Prince Caspian murdered and to usurp the throne for himself.
The action is passably good, if rather tame. Like good Christians, the Pevensey children, along with Prince Caspian, turn the other cheek, do unto their enemies as they would have done unto them and work out a diplomatic solution to the "succession to the throne" issue involving a power-sharing agreement between Caspian and Miraz that... Oh, no wait a second - nope none of that actually happened. What actually happens is that, like good Christians, Caspian and the Pevensey children preemptively attack their enemies and bravely slaughter them in battle. In fact, given that the mortality rate in this movie rivals The Lord of the Rings: The Two Towers it was quite a feat for the producers to come away with a PG rating.
Another interesting decision on the part of the producers of this movie was to give Caspian and the Telmarines Spanish accents. The back story here is that the Telmarines are descended from pirates and, many centuries ago, accidentally came upon some kind of wormhole that brought them to Narnia. Then, instead of behaving like good houseguests, they proceeded to rape and pillage everything in sight. The Telmarines are eventually undone while pursuing our heroes across a river which Aslan (the God figure) then causes to rise up and swallow them. The evil Miraz now defeated, Aslan then goes on to make an offer to the Telmarines, "You may live with us in peace or, more preferably, you may walk through this door I have made in the air and end up some place...else. Someplace where we will never have to see you again." Hmmmm, sound at all familiar? Large numbers of hispanic looking and sounding people, trying to cross a river into unwelcome territory and subsequently being deported to another realm? Does The Chronicles of Narnia: Prince Caspian have a political agenda? I'll let you decide.
I'm studying for Step III using USMLE world and I get the following question:
22 year old pregnant female in her second trimester is brought to the emergency room by her boyfriend because she's threatening to commit suicide. On initial evaluation, she exhibits clear, unmistakable signs of a manic episode and a clear intent to kill herself. What is the appropriate management? (I'm paraphrasing to respect USMLE World copywright)
A. hospitalize and give prozac
B. ask to speak to the boyfriend privately and find out what he did to make her so crazy
C. grab her by the shoulders, shake vigorously and tell her to calm down already
D. hospitalize and give ECT (electroconvulsive therapy)
E. reassurance and discharge home
In real life, when this lady shows up to OB triage, the correct answer is: consult and let them deal with it - she has no OB issue. Unfortunately, the USMLE examiners operate under the assumption that the only doctor available is YOU. The scary thing about this question, however, is that one of the above answers is not made up. Think you know which one?
The the not-made-up, and apparently correct, answer is D - electroconvulsive (shock) therapy. Yeah, I have some misgivings about that answer. As an OB resident, we used to work very hard and even give potentially toxic medications to pregnant women in order to prevent seizures. It seems pretty counterintuitive to me that you'd want to induce a seizure in a pregnant woman. I understand that there's lots of literature on ECT. Proponents will cite its superb effectiveness. And, I have no argument there. ECT is very effective treatment. But, I always thought that "effective" kind of misses the point when your talking about ECT. I mean, a foot amputation is a pretty "effective" treatment for toenail fungus but, Jesus Christ, man - you're causing a seizure! I mean seizure - like on those medical shows when the camera starts moving around all fast, and the patient is foaming at the mouth and monitors are going off and everyone's yelling at each other; you're creating this situation intentionally.
Marketingservicestalk blog recently published some statistics on how bloggers perceive themselves with respect to the news media. According to a report from a legal services organization called DLA Piper, "Only 5 per cent of internet users are clear on their legal rights and responsibilities when posting comment online." Their research also showed that, while 42 per cent of internet users believe that bloggers should be held to the same standards as journalists, only 27 per cent of actual bloggers agreed.
I'm not particularly hung up on whether or not bloggers are journalists - logging into their free account a few times a week in order to commit random acts of journalism. Certainly, very few of them are good journalists. And virtually none of them are engaged in anything remotely resembling real, investigative reporting - something that is slowing going the way of the dodo in today's media markets.
I do truly applaud the men and women on the ground with real jobs, earning real salaries, with real professional standards, who keep me informed about what's actually going on in the world. However, I am not one of them. We at jamesloganmd.com are not journalists. We do not report news, nor do we hold ourselves to any standards whatsoever. Anything you read here has equal chances of being either real or fictional, truth or falsehood, fact or opinion. The author of what you read here may be James Logan, M.D., or it may be someone else. Or it may be no one at all! We cannot verify any facts or claims made or not made herein; neither can we verify the existence of jamesloganmd.com nor its readers.
During my workout today, I listened to Sanjay Gupta talk to Wolf Blitzer about Ted Kennedy's newly found brain tumor for a good seven or eight minutes without ever learning what the actual diagnosis was - other than "malignant brain tumor." The News Hour With Jim Lehrer rarely lets me down and somebody had apparently informed the UCSF neuro-oncologist they interviewed, Susan Chang, of the diagnosis - malignant glioma. Everyone seems to be dancing around the prognosis; suffice it to say, the prognosis is poor. According to my own bit of cursory research, 80% of people in senator Kennedy's age bracket can expect to be dead in about a year with almost none surviving past 3 years. On a tangential note, I was very impressed to see that, at the time of the writing of this article, someone had already updated Ted Kennedy's wikipedia entry to reflect the diagnosis which was only made public earlier today.
The point that I want to get at - and, I realize this is going to sound callous - is that I think that this is one of the best things that could have happened to Obama's campaign. Kennedy is one of Obama's most prominent supporters. And when someone that close to you, with that degree of popularity, has been diagnosed with a fatal illness...it's gold! Even McCain was choked up today:
"I have described Ted Kennedy as the last lion in the Senate," a tearful McCain said on his campaign bus in Florida. "And I have held that view because he remains the single most effective member of the Senate."
Remember when Elizabeth Edwards was diagnosed with a recurrence of breast cancer back in March 2007? Unfortunately, breast cancer is just way too curable and any momentum that this may have provided the Edwards campaign had pretty much fizzled by primary season. But, what if it had been ovarian cancer? And what if she had died in January 2008? Edwards would have been UNSTOPPABLE! There would have been such an outpouring of sympathy and support for this brave man who carries on despite this terrible tragedy; he would've rolled right into the democratic nomination. If Ted Kennedy (heaven forbid) doesn't make it to November 4th, it will unite the Democratic Party behind Obama like nothing else. How could one not pay tribute to one of the most influential senators who ever lived by voting for the candidate whom he had endorsed?
Therefore, any conceivable path to victory for John McCain includes the following two things that must necessarily happen before the election 1) Kennedy must stay alive, 2) they need to find Bin Laden.
I missed the season finale of Law and Order SVU because I was watching the Frontline documentary: Storm Over Everest. But I quite enjoyed the previous episode called "Authority," in which Robin Williams plays a disgruntled sound engineer who expresses his years of stored guilt and rage by tricking gullable people into doing things that they wouldn't otherwise do. He does so under the guise of a fictional character named, Miilgram; the name is a reference to the famous "Milgram Experiment" (footage below) in which subjects were asked to administer what they believed to be real electric shocks of increasing voltage to paid volunteers. The shocks, of course, were not real; the subjects who were allegedly being shocked were confederates. The purpose of the experiment was to study the degree to which individuals would blindly follow authority.
Though it produced some very interesting results, today the expirement is widely considered to have been unethical. I, personally, am a strong beliver in informed consent and I don't necessarily think such an experiment is unethical so long as adequate informed consent is obtained (though, this very issue often presents a problem for psychological experiments, in general).
For fun, I included some actual footage from the Milgram experiemnt:
I love the new incarnation of American Gladiators almost as much as the 1990's original. But, to the AG producers, please indulge me as I voice one small bit of constructive criticism. Your female gladiators - Jet, Venom, Phoenix, Siren - all get to wear dead sexy outfits that expose lots of abs and are tight enough to give us all the information we need about the size and contours of their thighs and of their respective gluteal regions. So, what's the deal with Helga's outfit?
Helga is your HOTTEST gladiator! And just like in all the later seasons of Xena, Warrior Princess (the ones where Xena was really buff), she has to completely cover up the midriff and she has to hide her legs and butt with some frilly skirt-like thingy. American Gladiator producers, take my advice; put the skirt on Jet - she's an amateur and there isn't much there anyway. If there's anyone whose costume should come in two pieces, it's Helga. You guys clearly are not shy about showing off the human form; let's see Helga's beautiful physique!
My girlfriend and I went to see Iron Man last night. The new glut of superhero movies that began around 1998 makes me wish that I had picked up a Marvel comic book or two as a kid instead of all those "outdoor activities" my parents made me partake in - which seemed like a good idea at the time.
We both really enjoyed it. One of the most refreshing aspects of the movie, is that it successfully avoids the trap which so many post-cgi revolution comic book movies fall into. That is, they don't rely on the cgi too much. Or maybe they do, but cgi has improved to the point where I can't tell the diferrence. That point is that, with few exceptions, the movie never looks like a cartoon. There are many fantastic close-ups of "Iron Man" (which Downey's character builds in the basement of his house in Malibu) with relatively few fast-paced, out-of-focus, night-time action sequences. And I never get tired of Stan Lee's principle theme, no matter how many different ways he packages it: that with the power and gifts we are given comes the responsibility to use them for good.
It was a good time. And it also brought home another point I think worth mentioning: "why will congress not authorize the funding to provide our young men and women in Iraq with the robotic, armor-plated, bullet-proof, rocket-propelled, weaponized suits they need? So many brave soldiers risk their lives every day in the name of freedom and justice and everything that America stands for. And yet the democrats in congress want to deny our troops in harms way the armored, nuclear-powered rocket-suits that they so desperately require. The world changed on 9/11..."
-Ugh. I'm having flashbacks to the nightmare that was 2004. I probably have a little PTSD.
And not to worry, this movie is fun without being a flag-waver (which doesn't seem as fashionable as it used to be anyhow). The thinly veiled representations of Al-Qeda terrorists turn out to be victims - not innocent victims, but victims nonetheless - pawns in the game of an American rogue arms dealer, played by Jeff Bridges. The real enemy, as it is an all good superhero stories, is hubris. For it is hubris that was ultimately responsible for the downfall of, among others: Doctor Frankenstein, Morbius (Forbidden Planet), the first two Spider-Man villans, and of course, the Bush administration.
I hadn't eaten at McDonald's for several months, I have lost 20lbs in the past seven weeks; I decided yesterday that I had earned myself the privelage of a one cheesburger meal for lunch. Not a two cheeseburger meal, not a big mac + a chocolate shake meal - a ONE cheeseburger meal. My girlfriend and I pull up to the drive thru where we are accosted with a $1 menu that includes a double cheeseburger. "That's cool," I think to myself. "Double cheeseburger only costs $1. Therefore a single cheeseburger must cost..." (scanning menu, scanning menu) "ALSO $1?!"
"(static)Good afternoon, McDonald's. Can I take your order?(static)"
"Hi, I think there might be some mistake on your menu out here. How much is your cheeseburger?"
"(static)$1.(static)"
"And your double cheeseburger is also $1?"
"(static)Cheeseburger and a double cheeseburger are the same price.(static)"
Well, paint me green and call me gumby. A cheeseburger and a double cheeseburger are the same price. I spent a minute or two trying to justify to myself how I might decide to get just a cheeseburger. But, in the end, it simply didn't make economic <groan>cents</groan>. Twice as much meat for the same price? I had no alternative but to go with the doublecheeseburger.
Now, I'll be the first to admit that I'm no economics expert. In fact, econ 101 was the only class in which I received below a 'B' throughout my 4 years of college. But, I really think this warrants some further study. If we could only figure out what economic principle is operating here, we could kick this recession once and for good. Clearly there is something far more complex that just ordinary 'supply and demand' at work. If we could only harness that power - just imagine the newscasts...
"The price of crude oil held steady today at $114 a barrel. However, thanks to the administration's bold, new economic initiatives in recent months, the price of two barrel's of crude oil also held steady at $114 a barrel. As a result, gas prices held steady at $4.09 a gallon or $4.09 for two gallons. While the price of a ton of rice in the third world continues to soar, overall food shortages have been greatly aleviated as the price of two tons of rice is now at an all time low. Gwen Ifill reports..."
You've probably seen Digene's new ad for their HPV test with the tagline, "take the test, not the risk." I'm flabbergasted that this commercial hasn't been taken off the air, for it completely misrepresents what the test is meant for. The commercial clearly makes the implication that the life of Jodi, "whose story every woman should hear" was saved because her positive HPV test allowed her doctor to catch her disease before it became cancer. THIS IS COMPLETELY FALSE. A positive test is only useful if your pap smear is equivocal. Otherwise, a negative test along with a normal pap smear can reassure you that your cervix is fine and doesn't need to be checked on again for three years (instead of the standard 1 year). The reason they don't recommend the test for women under 30 is because around 60% of sexually active women in the under 30 age range are positive for a high risk strain of the HPV virus anyway. We want those women to come back yearly for their paps regardless of what Digene says about their HPV status. Jodi's pap was normal, but she was HPV positive. All this means is that she had a normal pap smear and an unnecessary test and would have to come back again the following year for another pap smear - which, apparently, "showed that she had cervical disease." But, if she'd never taken the test, her doctor would have told her to come back in a year for another pap smear ANYWAY. Therefore, Jodi, "whose story every woman should hear" is exactly the person for whom the HPV test is of no value whatsoever!
Take home message = please help do your part to help in not contributing to the high cost of healthcare by not asking your doctor for an unnecessary test unless you are a) over 30 and b) are not engaged in any high risk behavior. Second take home message = please don't engage in any high risk behavior.
I've temporarily put up a PacMan gadget up on my 'Links' page. PacMan is a little before my time; I grew up in the 8-bit graphics era of Nintendo. Also popular around this time were: slap bracelets, Teenage Mutant Ninja Turtles and Vanilla Ice. 
