tag:blogger.com,1999:blog-65482461601328600782011-08-15T17:54:49.566-06:00Trying to improve my medical practice. Also, various random thoughts.Kishore Visvanathannoreply@blogger.comBlogger1261100tag:blogger.com,1999:blog-6548246160132860078.post-2976070022399269192011-04-16T15:18:00.000-06:002011-04-16T15:18:02.114-06:00

Thanks for visiting Plain Brown Wrapper! The blogging fun has moved to Adventures in Improving Access. See you there!

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-26847884919555489672010-03-07T13:41:00.003-06:002010-03-08T18:54:13.238-06:00

My HQC blog has moved to Blogger to join Plain Brown Wrapper.The Sask. budget is coming down in a few weeks, and I'm already worried about QI drawing the short straw.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-11017480874335332952009-08-31T14:58:00.012-06:002009-08-31T15:53:14.647-06:00

Hi! Long time, no see.Thanks to Mark Wahba's keen eye for this one:Bright yellow "Sharps" containers are ubiquitous in health care facilities. Pointy, pokey stuff goes in them after it's been used. This reduces the chance of needle-stick injuries. While the containers come in different shapes and sizes, their uniform yellow color is a strong visual cue as to their presence and purpose.

Kishore Visvanathannoreply@blogger.com2tag:blogger.com,1999:blog-6548246160132860078.post-60868992289167551672009-03-19T23:06:00.002-06:002009-03-19T23:19:54.239-06:00

Thanks for coming to my presentation of BOMB! How a (failed) career in standup comedy made me a better surgeon. I look forward to receiving your feedback. Please click here to take the survey. You'll need the password from your souvenir postcard!This survey closes on Tuesday, March 31.P.S. Got time on your hands? Check out "What's wrong with this picture?"

Kishore Visvanathannoreply@blogger.com2tag:blogger.com,1999:blog-6548246160132860078.post-12050903412756568642009-03-19T22:52:00.004-06:002009-03-19T23:06:01.981-06:00

Well, almost. The ever-topical TV show, ER, featured surgical checklists in a recent episode. If that's what it takes to get the momentum going on implementation of checklists, I'm OK with that. Pressure and interest from the public will be a very powerful force to convince recalcitrant OR staff. (And, when I say recalcitrant OR staff, I think you know who I'm talking about.)

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-19008981377499827422009-03-08T22:56:00.004-06:002009-03-09T06:01:01.537-06:00

Last week, I noticed someone had nailed a green doodad onto the door of each operating room.Any guesses what it's for?I suppose this is a trick question "What's wrong with this picture?" because this is really an example of great design. WWWTP is usually about bad design, but I'm going to broaden things a bit to allow for this doodad.It's a room marker in case we have to evacuate the OR because

Kishore Visvanathannoreply@blogger.com4tag:blogger.com,1999:blog-6548246160132860078.post-83826414737576625842009-03-01T22:55:00.003-06:002009-03-01T23:03:30.086-06:00

Want to know what patient-centred/patient-directed care could look like? Read "On being a 'Difficult' Patient" by Michelle Mayer.Then, if you have some time, and a box of Kleenex, go to her blog "Portrait of a Dying Mom".

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-55831567452770220452009-03-01T14:56:00.013-06:002009-03-01T17:12:33.863-06:00

Last month, I made a day trip to Regina on a small, local airline. While I waited for my return flight in their Regina airport lounge, a Canadian Forces aircrew was also waiting. There were about a dozen of them, getting ready to fly out in their huge transport plane. The lounge was small, and the aircrew were quite boisterous, joking and clowning around. What happened next has been on my

Kishore Visvanathannoreply@blogger.com5tag:blogger.com,1999:blog-6548246160132860078.post-59177890402606562582009-02-18T20:08:00.002-06:002009-02-18T20:23:56.865-06:00

Fraser Institute's Nadeem Esmail terrifies Wall Street Journal readers with a chilling tale of socialized health care. And just in case we're deciding public policy by cherry-picking anecdotes of health care systems gone awry, the NY Times makes our blood run cold with some south-of-the-border horror. I guess this Scare Off is a draw.Don't go into the basement without full private insurance

Kishore Visvanathannoreply@blogger.com2tag:blogger.com,1999:blog-6548246160132860078.post-75439450828325982032009-01-29T22:18:00.003-06:002009-01-29T22:40:51.859-06:00

Thank you, Andre Picard, for restating the case for a significant investment in the electronic health record. It can't come soon enough.We (finally!) got the last 3 docs in our clinic on our EHR. Just the fact that our staff don't have to search out paper charts 100's of times a day is a huge bonus. I can hardly wait until the Health Region's lab computer can communicate with our system so

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-10789983635074649442008-12-14T14:14:00.007-06:002008-12-14T15:03:00.676-06:00

Dictating hospital discharge summaries! Aaarrrgh! I don't know a single doctor who enjoys this necessary evil. (For those of you who haven't had the pleasure, a discharge summary is essentially the story of someone's hospital stay.) Not only does it mean 30 minutes of dictating reports, it also means 30 minutes of cranking my neck into an unnatural position to accommodate the terrible

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-83215933010535633852008-12-09T23:41:00.004-06:002008-12-09T23:53:33.834-06:00

Check out US President (not yet, but he might as well be) Obama's video blog of his Economic Recovery Plan. He's going to make sure that all US hospitals and doctors' offices are outfitted with EMRs and are connected to each other (3:50 on the video).EMR and connectivity are part of his core plan. "Cut red tape, prevent medical mistakes and help save billions of dollars each year..." Looks like

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-51304722253618558542008-11-30T19:54:00.002-06:002008-11-30T19:59:22.206-06:00

Dr. Kent Sepkowitz informs Slate readers that doctor review sites aren't helpful for patients. But can they be helpful for doctors? I think so - check out this old post.

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-3840580343382656452008-11-27T21:43:00.002-06:002008-11-27T21:45:56.045-06:00

Here's a recent article from the Prairie Post. 1762 Sask docs listed on RateMD. There is no escape!

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-432706992277733882008-11-18T22:20:00.001-06:002008-11-18T22:23:59.873-06:00

Thanks for coming to my presentation of BOMB! How a (failed) career in standup comedy made me a better surgeon. I look forward to receiving your feedback. Please click here to take the survey. You'll need the password from your souvenir postcard!This survey closes on Thursday, November 27.P.S. Got time on your hands? Check out "What's wrong with this picture?"

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-59708888312764450692008-11-05T22:39:00.002-06:002008-11-05T22:52:03.639-06:00

In this corner, CMA president Robert Ouellet weighs in on how private health care will improve access for Canadians.In this corner, former NEJM editor Marcia Angell, takes a swipe at American-style privatization.Judge's decision: Angell

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-73712296032242736452008-11-01T21:19:00.005-06:002008-11-01T21:46:05.042-06:00

The medical community seem to be committed Mac users.  At our recent Departmental Research Day, several presenters made that clear.  But, in a counter-productive way...The laptop being used for presentations at Research Day was a PC, but several physicians brought their own Mac laptops. Great to see other Mac users promoting the cause, but it turned out to be a distraction. Because they had

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-90354556974761308622008-10-23T22:43:00.002-06:002008-10-23T22:54:06.820-06:00

Having schlepped through more than my usual number of airports this month, I've noticed, and enjoyed, HSBC's ads displayed in various walkways.The ads feature beautifully-photographed images alternately labelled with antonyms, that, well... Check them out for yourself and you'll get the point.

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-51387383231241356812008-09-25T22:31:00.007-06:002008-09-25T23:02:49.611-06:00

Long time, no blog. No excuses, just life.I was reviewing a patient's chart this morning, and several phrases in nursing/physician notes caught my attention: Patient refused breakfast. Patient denies shortness of breath.If you're a hospital caregiver, you've seen similar stuff written on charts. Wording notes this way makes it sound like patients are our adversaries. Like we're suspicious of

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-70803733435928902262008-09-12T19:54:00.003-06:002008-09-12T20:02:50.875-06:00

Thanks for coming to my presentation of BOMB! How a (failed) career in standup comedy made me a better surgeon. I look forward to receiving your feedback. Please click here to take the survey. You'll need the password from your souvenir postcard!This survey closes on Saturday, September 20.P.S. Got time on your hands? Check out "What's wrong with this picture?"

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-14630009652106363652008-08-03T10:43:00.002-06:002008-08-03T10:46:44.663-06:00

Tom Peters (Re-Imagine) is just a little hot about Health Care. Check out his proposed hospital org chart. He gets it.

PBWnoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-19244469836697656862008-07-12T23:43:00.001-06:002008-07-12T23:44:23.176-06:00

Latest Adventures in Improved Access post.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-37238307957660706462008-07-06T13:11:00.001-06:002008-07-06T13:15:00.445-06:00

Here's a news item from CMAJ about US initiatives to free physicians from drug company gifts.

PBWnoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-10283971366854896112008-07-01T11:01:00.005-06:002008-07-01T12:14:17.951-06:00

Dan Walter put a comment on my last post, and it's left me a bit of a dilemma.He comments that he's "off topic", and, after I did a little homework/surfing, I think he's right. In fact, his post is essentially spam to promote his website/agenda. And an angry agenda it is!Dan has left a link to Adventures in Cardiology which is a bitter-voiced (and perhaps rightly so...) personal account of

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-33120201166971958672008-06-27T07:19:00.003-06:002008-06-27T07:35:33.525-06:00

I spent the last week getting hammered by bad Powerpoint.I was at the annual meeting of the Canadian Urological Association. The speakers were all respected experts in their clinical fields, had excellent command of the scientific evidence supporting their arguments, and rigorously adhered to the Bad Powerpoint code of conduct:Pack your slides with text. Read directly from the slide. Graphs

Kishore Visvanathannoreply@blogger.com2tag:blogger.com,1999:blog-6548246160132860078.post-31258667129801178992008-06-09T23:07:00.003-06:002008-06-09T23:34:21.548-06:00

Today, at the hospital, I saw a porter pushing a patient in a wheelchair. She stopped to talk to an acquaintance as they passed in the hallway. Their conversation was loud and of a personal nature. As they talked, the man in the wheelchair fidgeted, obviously uncomfortable with being ignored. It made me think of a recent article "Talking over patients: sTOP" in CMAJ's Salon.sTOP is a

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-64346810697458250262008-06-05T21:34:00.003-06:002008-06-05T21:36:04.628-06:00

You've been keeping up on the latest Advanced Access posts, right?

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-80147311396576221112008-06-04T10:06:00.003-06:002008-06-04T10:13:52.555-06:00

Plain Brown Wrapper is mentioned in this quarter's Strategy, the CMA's financial management magazine. If the Strategy article led you here, thanks for coming. Have a look around the site. I have the most fun with "What's wrong with this picture".Also, I'm very excited about our office's ongoing Advanced Access project (latest post here), chronicled at Health Quality Council's website. We're

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-29905663989075373032008-06-01T18:01:00.003-06:002008-06-01T18:20:48.188-06:00

Remember this post about patient confidentiality on a hospital ward?Well, they fixed the problem!And so simply and elegantly, too. They just turned the req over before clipping it up. Sure, anyone can still take a look at the req, but they have to make an active effort to do so.Well done!I also learned something from this experience. When I had originally noticed this problem, I brought it to

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-38594401187796077842008-05-29T22:04:00.002-06:002008-05-29T22:39:58.401-06:00

As I started reading Atul Gawande's Complications: A Surgeon's Notes on an Imperfect Science, my first reaction was Nooooo! Don't give away the secrets! When relating his first attempts at an invasive procedure (central venous catheter insertion), Gawande is so frank about his uncertainty and shortcomings, that it made me squirm to recall my own similar experiences.All physicians gain

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-83359186270704154312008-05-15T16:49:00.002-06:002008-05-15T16:58:04.720-06:00

An Edmonton urologist has slapped RateMDs with a $12M lawsuit. Apparently he was upset about the "bad publicity" from his RateMDs page.Talk about counterproductive. Now he's got that "bad publicity" all over the papers.

Kishore Visvanathannoreply@blogger.com3tag:blogger.com,1999:blog-6548246160132860078.post-78528561632020890492008-05-04T23:07:00.003-06:002008-05-04T23:12:41.591-06:00

"Friends tell me that I will take naturally to blogging because I am in possession of many poorly considered opinions about issues I understand only marginally."A wry take on blogging, at The Atlantic.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-36511971803396948822008-05-04T22:23:00.004-06:002008-05-04T23:04:45.015-06:00

Some more ideas from Crash and Learn by Jim Smith Jr.Chapter 2 - Room Setup MistakesMy first inclination was to skip this chapter. After all, in most cases, I don't have much say in how a room is set up. Or maybe it doesn't matter to me how the room is setup, as long as everyone is facing the front and can see me. Or maybe I'm not aware of the recent breakthroughs (there must be some!) in

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-13628384845103481462008-04-28T14:30:00.002-06:002008-04-28T14:41:52.392-06:00

Some of my posts on the pharmaceutical industry have been strongly-worded. Or at least I thought so until I read this Globe and Mail piece. It's an absolute smackdown by no less than the editor of JAMA.Think medical journals, and the studies they publish, can't be influenced by drug companies? Ha! Think again.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-63891193783527672592008-04-24T22:32:00.005-06:002008-04-24T22:50:56.449-06:00

The underdog pharmaceutical industry finally has a wingman in their role of David vs. the Goliath of government regulators! (What's the emoticon for dripping sarcasm?)This CMAJ article discusses Canwest Global Communication's upcoming challenge to the government's ban on direct-to-consumer drug advertising. Dr. John Abramson, of Harvard Medical School, begs to differ.But, according to Canwest,

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-23389604208124004712008-04-22T19:31:00.002-06:002008-04-22T19:35:10.434-06:00

Interesting post on "Healthcare Efficiency" (April 17) about preventing hospital acquired infections in the US. Love the last paragraph about healthcare workers resistance to the ideas behind Quality Improvement and change (? Change) in general.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-15917883057783144272008-04-22T14:49:00.001-06:002008-04-22T14:51:39.974-06:00

Latest Advanced Access post "Culture Change" AKA Phase I complete!

Kishore Visvanathannoreply@blogger.com2tag:blogger.com,1999:blog-6548246160132860078.post-33582781793465961342008-04-20T18:40:00.007-06:002008-04-20T23:55:54.055-06:00

I'm still fussed about the presentation I gave at SAHO earlier this week. I've been making notes on what to improve for next time, and I have a strong feeling that I could be doing a lot more with my presentations.I think I can apply some of the ideas about transparency from today's earlier post to improving my presentations. That is, I'm going to make a commitment to improve, and record my

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-30436983017766923302008-04-20T08:31:00.004-06:002008-04-20T09:11:14.318-06:00

This Globe and Mail article struck a chord with me. While I haven't been blogging about the intimate topics (personal financial disasters, obesity/weight loss) discussed, I have had some of the same thoughts expressed by the bloggers interviewed.The article's theme is: Making your personal goals public will boost your resolve. A small example in Plain Brown Wrapper was my New Year's resolution

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-13721353343508102002008-04-17T23:41:00.007-06:002008-04-18T00:20:23.715-06:00

I've been quite liberal in my derision of poor Powerpoint presentations. But Mr. Smarty-Pants stepped in it big-time this week.I appreciate an excellent presentation. At meetings or rounds, I really enjoy a speaker who has taken the time to put his/her audience first. Who makes sure the audiovisual material is appealing and appropriate. Who checks that all the necessary equipment is available

PBWnoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-59907952732756688552008-04-15T20:53:00.004-06:002008-12-12T03:01:57.876-06:00

This is the Brandt Centre in Regina. It's an arena/events centre.And avalanche area!Unbelievable! They built it with a sloping, ridged roof that dumps chunks of ice and snow onto bystanders.Kids... Don't slam the car door!

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-49832691267275095442008-04-15T20:44:00.005-06:002008-12-12T03:01:58.262-06:00

Chef?!Oh, yeah... The new Buffalo Chicken Bite with Ranch dressing!C'est magnifique!

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-54644989258742738532008-04-07T23:25:00.003-06:002008-04-07T23:30:47.384-06:00

This wasn't on the front page of the Globe and Mail, but it should have been! Check out the examples of "using math and technology to re-engineer how the system works".

Kishore Visvanathannoreply@blogger.com3tag:blogger.com,1999:blog-6548246160132860078.post-38884668546277803812008-03-30T16:26:00.008-06:002008-12-12T03:01:59.554-06:00

This is a sharps container in the OR.I definitely agree that we don't want to misplace pointy stuff with body fluids on them. But is this the best way to ensure safe disposal?Here's a mobile computer monitor in the ER. It has 2 huge screens mounted at head height...... and a tiny support stand that makes it necessary to...... tape this handwritten note to the screen.Who designs this stuff? Do

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-22344981983233256012008-03-29T08:48:00.003-06:002008-03-29T10:12:42.802-06:00

Predictably, after the CMAJ's editorial about pharma influence over physician behavior, industry has fired back. In a letter to the Globe and Mail yesterday, Rx&D CEO Russell Williams sputters:Canada's Research-Based Pharmaceutical Companies (Rx&D), an industry association that represents major drug firms, has had a code of conduct for many years that specifically bans offering gifts or other

Kishore Visvanathannoreply@blogger.com5tag:blogger.com,1999:blog-6548246160132860078.post-57649534432799166382008-03-27T22:11:00.005-06:002008-03-27T22:45:45.169-06:00

This week's CMAJ editorial is a kick-in-the-pants for most practicing physicians. We get roasted for accepting perks from drug companies. And, mea culpa, this week, I had supper at Grand Rounds courtesy of one of our pharmaceutical reps.The Globe and Mail commentary on how cozy some of us are with pharma reps quotes Prof. Arthur Schafer, "They (physicians) deny that they're influenced - all of

PBWnoreply@blogger.com3tag:blogger.com,1999:blog-6548246160132860078.post-21530676591952205762008-03-24T21:16:00.007-06:002008-03-25T15:32:21.889-06:00

After I ranted about pharmaceutical companies direct-to-patient marketing on Friday, I was interested to read the Saturday Globe and Mail's piece on the 10th anniversary of Viagra. It's worth the read.I was struck by sociologist Dr. Barbara Marshall's view on the marketing of Viagra:"Men had to be retrained to understand occasional erectile failure as a disease, a disorder that needs to be

PBWnoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-24325713174474471482008-03-23T09:57:00.003-06:002008-03-23T10:14:20.680-06:00

Remember Jay Parkinson? In his comments on that PBW post, he hinted at a new venture that would "seriously turn some heads". He's been a busy boy...In his own blog, Jay outlines the features of hello health. This service is to be provided through Myca - a Quebec city-based company that intends to provide its services in the US. I can't wait to see Myca's EMR interface.After reading Jay's

Kishore Visvanathannoreply@blogger.com3tag:blogger.com,1999:blog-6548246160132860078.post-80516677777654665532008-03-21T20:24:00.003-06:002008-03-21T21:15:13.285-06:00

Maybe I'm too cynical. I just watched a TV commercial about fibromyalgia. I don't watch a lot of TV, so maybe this commercial has been running for a while, but it's the first time I've seen it. It had high production values, so it didn't look like a public service announcement.So my immediate (and very cynical) thought was: Some pharmaceutical company has a new drug targeted to people with a

Kishore Visvanathannoreply@blogger.com2tag:blogger.com,1999:blog-6548246160132860078.post-49730389326177365712008-03-02T17:18:00.007-06:002008-12-12T03:01:59.804-06:00

The Canadian Medical Association is running a Help Wanted campaign to convince politicians and the public that Canada needs more doctors.Here's the eye-catching ad that ran in the Globe and Mail yesterday:Earlier in the week, I received a CMA mail-out containing a postcard. There was an exhortation to mail the postcard to the Prime Minister to draw his attention to Canada's physician shortage.I

Kishore Visvanathannoreply@blogger.com2tag:blogger.com,1999:blog-6548246160132860078.post-9426171481900545152008-02-27T10:58:00.003-06:002008-02-27T11:00:23.556-06:00

I'm catching up on work after a week off, so here's the lazy man's post - a link to last week's Advanced Access progress report.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-21176357825125811982008-02-14T22:58:00.004-06:002008-02-14T23:18:18.209-06:00

I pity the poor medical students who do clinical rotations with me. They have to listen to me complaining non-stop.They're always polite and attentive about my griping. I hope they don't think their rotation assessment could be affected by the quality of their sympathetic nodding.When a student is in the office with me, my main topic to moan about is inadequate information in the referral

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-35668596231341024452008-02-08T10:34:00.000-06:002008-02-08T10:40:34.444-06:00

I missed linking to the last few "Adventures in Advanced Access" posts. Here they are:Not So Happy HolidaysDarwin's CystoscopeBlog's BreakfastAlberta Bound

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-23522580673692974022008-02-08T09:53:00.000-06:002008-12-12T03:02:00.202-06:00

This lab coat, belonging to a senior medical student, was hanging in the lounge last week. The pockets were stuffed to bursting. In addition to 6 (!!!) reference books (Surgery on call, Internal Medicine on call, etc.), there was a set of critical care flashcards. Geez, buddy, are you part pack mule?How about trading your collapsed vertebrae in for a PDA? Get some electronic references

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-65032350526263551012008-02-04T23:16:00.000-06:002008-02-05T00:29:05.104-06:00

I received this transcript from a CBC Radio Saskatchewan program:CBC-RADIO, SASK. FEBRUARY 4, 2008. 6:30 HRS.There could be warning signs at the doctor's office that say you have to pay a charge for missed appointmentsPAT HUME [ANNOUNCER]Don't be surprised if you see warning signs posted on the wall at your next appointment with a medical specialist. Those signs advise patients that if they miss

Kishore Visvanathannoreply@blogger.com2tag:blogger.com,1999:blog-6548246160132860078.post-18239729841033710942008-01-24T23:18:00.000-06:002008-01-25T00:01:59.772-06:00

My daughter wanted to know about false-positive tests this week. She's a fan of the TV medical drama, House, so I caught a bit of it while I was doing the dishes (you'll have to take my word for it). An oncologist had to break some disturbing news to a patient. Of course, there was a twist.The man had been diagnosed with terminal lung cancer, but it turned out that the test was incorrect, i.e

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-20711814055301345932008-01-22T19:17:00.000-06:002008-01-22T19:46:34.368-06:00

A member of my spy network reported overhearing some first-year medical students talking about their clinical shadowing.Medical students are required to spend time with clinicians in order to get a broad exposure to the various medical disciplines. These students were planning to surf RateMDs to check out potential mentors for shadowing!Brilliant. (Really.)Most of the comments on RateMDs

Kishore Visvanathannoreply@blogger.com8tag:blogger.com,1999:blog-6548246160132860078.post-54019877381874941602008-01-19T19:24:00.000-06:002008-01-19T19:44:41.471-06:00

Google does it again! We just moved our office holiday calendar on-line and it is great!Until this week, all the docs in our practice requested and recorded holidays on a paper calendar. That meant that we had to be at the office to check the calendar and write in our requests.Now, the paper calendar has been tranferred to Google Calender. Each doc has his/her own holiday calendar, which Google

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-33834231613341619102008-01-17T22:23:00.000-06:002008-01-17T22:50:04.598-06:00

Physicians, please take this oath:"When a patient makes a recovery that seemingly defies the odds, I will celebrate the event, but will refrain from invoking supernatural explanations." Translation: Stop calling stuff "miracles"!Our local paper recently carried the story of a woman who recovered from an overwhelming critical illness. She reported that the doctors involved called it "a miracle"

Kishore Visvanathannoreply@blogger.com2tag:blogger.com,1999:blog-6548246160132860078.post-69068037405025743902008-01-12T15:52:00.000-06:002008-01-12T15:56:18.105-06:00

Sorry if you had trouble following the links to the CMAJ letters in "What's wrong with this picture? - VIII". I've repaired the link so it connects to the Dec. 4, 2007 letters to editor.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-88521925529971648502008-01-12T15:41:00.000-06:002008-01-12T15:46:18.748-06:00

Today's WWWTP is a new post, Darwin's Cystoscope, at Adventures in Advanced Access.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-76159368731532930362008-01-10T11:37:00.000-06:002008-01-10T11:57:00.172-06:00

I just finished my morning office and I have to get this off my chest:I saw 2 elderly men, whose referring physician's letter essentially said:"This man has multiple medical problems..."... with no list of the problems! So, I had to find out about all the problems myself.Also this week, I heard from a patient's family member who wondered why the patient was repeatedly asked the same questions by

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-4303859671002506022008-01-09T22:26:00.000-06:002008-01-09T22:34:19.134-06:00

Atul Gawande's at it again. Check out this NY Times op-ed about how bureaucracy shut down a successful program that reduced central line sepsis.Excellent clinical care is no longer possible without doctors and nurses routinely using checklists and other organizational strategies and studying their results.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-11474295657464023962008-01-08T09:59:00.000-06:002008-01-09T22:19:26.668-06:00

More on the yummy goodness of checklists (c/o Atul Gawande).

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-88568258113162615592008-01-03T19:29:00.001-06:002008-12-12T03:02:00.741-06:00

Old joke:You're working class if your name is on your shirt.You're middle class if your name is on your desk.You're upper class if your name is on the building.So what does this picture mean?This the CEO of the Saskatchewan's largest employer - Saskatoon Health Region. And she's wearing a name tag.It's not just for this photo-op, either. I've seen her around several times over the last month

Kishore Visvanathannoreply@blogger.com2tag:blogger.com,1999:blog-6548246160132860078.post-19098385906119979922008-01-01T23:31:00.000-06:002008-01-01T23:49:27.298-06:00

The new year sees the launch of a new Saskatoon Division of Urology blog. But you can't see it.Sorry to be a tease about this, but it's intended for internal communication among our urologists.I see it as a repository for meeting records, schedules of grand rounds and journal club, call schedules, etc.As with all new things, the challenge is in selling it. I'll load up the blog with stuff like

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-82087346383221443442007-12-31T21:44:00.000-06:002007-12-31T22:32:50.026-06:00

I enjoyed reading Fun Works - Creating Places Where People Love To Work by Leslie Yerkes. She suggests that encouraging people to have fun at work reaps benefits of increased productivity, creativity and employee retention. Sounds like a prescription for the healthcare system.She's not talking about having fun socializing at work (although this is important). She writes about integrating work

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-73284333345128619452007-12-30T20:13:00.000-06:002007-12-30T20:32:21.229-06:00

Here's 3 recent blog tweaks. (Tech freaks only...)I had to reinstall the collapse/expand post hack from Hackosphere. I don't know where it went, but it suddenly stopped working. Something I did must have reset the template. I found another version (again, Hackosphere) that takes the reader to a post page when "Read More..." is clicked. I like this feature because...I'm tracking reader

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-79549872703580461552007-12-28T15:32:00.000-06:002007-12-29T19:35:47.049-06:00

HRH Queen Elizabeth II has a YouTube channel and, according to this story, has very recently "embraced...major technological advances" such as the internet, cellphones, Blackberries and iPods. I think this would qualify her, according to Rogers' innovation adoption model, as a late-adopter of information technology.She's still ahead of many physician-laggards.It's tempting to ridicule

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-65087042147413235922007-12-27T23:03:00.000-06:002007-12-28T00:11:21.903-06:00

If anyone needs to take advantage of Google's online Calendar application, it's my friends Paul (an ophthalmologist) and Pam (a psychiatrist). Check out their daily schedule in this Star-Phoenix column, "Hectic hockey parents".If they leverage the power of online scheduling, they could probably fit in a 6th child.Or a nap. It's their call...

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-34885793249257184722007-12-24T17:33:00.000-06:002008-01-05T22:44:42.525-06:00

Not Santa Claus... Your surgeon!The World Health Organization is beta-testing a Surgical Safety Checklist as part of their "Safe Surgery Saves Lives" initiative. You can see the elements of the checklist here.It's purpose is to improve communication between OR team members and avoid preventable errors during surgery.Saskatoon Health Region's (SHR) already has a policy that a similar, somewhat

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-85263208636774729122007-12-20T21:51:00.000-06:002007-12-22T09:31:02.118-06:00

I was listening to some rap music today. Not that I had a choice - it was coming out of a Jeep four miles away. - Nick DePauloI was listening to an elderly lady's medical history and vital signs today. Not that I had a choice - it was coming out of a paramedic student four metres away.The young man was presenting his patient's medical history to his supervisor and an ER nurse. I had nothing

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-6807519072735509122007-12-18T22:48:00.000-06:002007-12-18T23:25:15.694-06:00

Wow! I had no idea how many blogger docs were out there until I started poking around in Medicine 2.0. But what's with the anonymity?I agree with Jay Parkinson - if you're a professional and have something to say about your profession, why not put your name on it? If it's controversial, be ready to support your opinion. If it's offensive, don't post it. Sooner or later, you're going to get

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-49724362185923370882007-12-16T22:48:00.000-06:002007-12-16T23:11:26.757-06:00

Since starting to use Skype last month, I'm still very pleased with the service. I made 2 discoveries last week.First, Skype's customer service seems very good. I had a glitch using Skype on my laptop. (Of course, it turned out to be my mistake, but let's not dwell on that.) Their online help desk sorted out my problem within 24 hours.Second, I found out that Skype shows your Skype username

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-40248221783770347812007-12-14T22:07:00.000-06:002007-12-14T22:12:27.677-06:00

Doctors beware! There's a new sheriff in town and he wants his vasectomy done pronto.New content on "Adventures in Improving Access".

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-39762973793088290752007-12-13T21:41:00.000-06:002008-12-12T03:02:02.149-06:00

Here are the mail slots in our doctor's lounge.Last week, each one was stuffed with this memo. Don't get me wrong here - there's nothing wrong with the memo. It's useful info. But, once I've read it...There are about 100 mail slots in the lounge. All of them get the memo, even the ones for doctors who have retired or moved. (Why do we still have those slots?) The garbage can fills up

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-14291707376064070412007-12-11T22:31:00.000-06:002008-12-12T03:02:02.433-06:00

Where do you think this is from?A. Victoria's Secret?B. www.carwashmommas.com?C. The "Squeegee kids we'd like to meet" feature in Maxim magazine?Answer: None of the above. This is from...... the Canadian Medical Association Journal!No lie. Here's the whole ad from the October 9 issue.Testim is a testosterone gel marketed to men with low testosterone levels. You get the gist of the ad: If

Kishore Visvanathannoreply@blogger.com2tag:blogger.com,1999:blog-6548246160132860078.post-45734073284239314682007-12-11T22:24:00.000-06:002007-12-11T23:37:41.308-06:00

Deirdre Bonnycastle from the University of Saskatchewan College of Medicine hosts this edition of Medicine 2.0 Blog Carnival, focusing on medical uses of technology.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-46086047535897229722007-12-10T20:52:00.001-06:002008-12-12T03:02:02.671-06:00

The yellow sheet clipped to a notice board is an X-ray requisition.Anyone see a problem with that?While on rounds this morning, I noticed that this ward has the practice of posting their X-ray reqs like this. I presume it's so they're easy to get at when a porter comes to transport the patient to the X-ray department. Whatever the reason may be, I suggest they rethink this practice.Anyone

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-47127487669081094712007-12-09T22:35:00.000-06:002007-12-09T23:03:29.712-06:00

Here's a dodgy business plan: Give away your best services for free.But the folks at Google (stock value $714 US) seem to be making a go of it.Makes no difference to me, as long as they keep the free, online applications coming.Of the long list of apps Google provides, the ones I use daily are Documents and Spreadsheets, Blogger and Calendar. And don't forget the granddaddy - Google Search.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-17803255074366080602007-12-08T23:48:00.000-06:002007-12-09T00:02:18.382-06:00

The beauty/curse of the Internet: All your sins come back to haunt you.The latest edition of the CMAJ contains the annual Holiday Review, a collection of medical spoofs. This reminded me that I made a contribution about 10 years ago. I see it's available online, so I might as well come clean about it.I got into a little trouble over it. People have different senses of humor and medical care

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-1408432972173671412007-12-07T20:57:00.001-06:002008-12-12T03:02:02.958-06:00

O.K. Maybe I'm going overboard with this drippy-hands thing, but here it is again.This cutlery has been washed and laid out to dry right underneath the paper-towel dispenser! I know I dripped all over them when I grabbed some towel. This is in the kitchen of the OR lounge. Yes, the Operating Room, where they're supposed to know a little something about contamination, proper handling technique,

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-45455160743330390902007-12-06T22:39:00.000-06:002008-12-12T03:02:03.436-06:00

Can you spot it?Well, yuck. Someone's left their drinks under the paper towel dispenser!Which is fine if you don't mind someone dripping soapy water, hair and general effluvia into your cola. I know I'm trying to cut down on effluvia.On the ward, I notice that boxes of exam gloves are often left next to the sink, under the towel dispenser. Nothing says "I love you" better than a box of

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-59561130873061944782007-12-06T10:34:00.000-06:002007-12-06T22:38:31.846-06:00

HQC Qreview newsletter has an article about our Advanced Access project.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-25277667430054401452007-12-05T21:54:00.000-06:002007-12-05T22:46:40.869-06:00

You remember what I think about RateMDs, right? I hadn't checked my listing for a while, so I took a look recently. Two comments from November made me cringe.They aren't negative comments . In fact, they're downright flattering. Yet, they make me uncomfortable.Please don't think this is false modesty. I appreciate a genuine compliment as much as anyone. I want to do a good job for my

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-24717387094039645642007-12-03T22:15:00.001-06:002007-12-28T15:51:01.271-06:00

Canada Health Infoway promoted electronic health records (EHR) in the Globe and Mail this weekend (online here). CEO Richard Alvarez says Canadians should "demand" EHRs. If the public only knew how ridiculously wasteful the current system is, "demand" would be putting it lightly.I've explored the concept of muda in my Advanced Access blog, but here's some examples of wasted time, energy and

Kishore Visvanathannoreply@blogger.com3tag:blogger.com,1999:blog-6548246160132860078.post-88196157521297615122007-12-03T14:15:00.000-06:002008-12-12T03:02:03.818-06:00

It's holiday potluck time in the X-ray department! Everyone sign up to bring their favorite dish.Umm, Shelley, I'm going to pass on the pumpkin dump. It looks delicious, but my doctor told me not to eat anything that sounds like a trick you play on the groom after he passes out at his stag party.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-85150208424011577312007-12-02T20:07:00.000-06:002007-12-02T23:06:21.410-06:00

Is Jay Parkinson at the leading edge of innovative medical care? Or is he a cherry-picking, cream-skimming squeegee-doc? Whatever your opinion, it's fascinating to see the media attention around this newly-minted doctor's unorthodox practice model.First, visit Dr. Parkinson's website. Even if you find yourself skeptical about his practice model, you have to agree that the website design

Kishore Visvanathannoreply@blogger.com3tag:blogger.com,1999:blog-6548246160132860078.post-52777703250408226502007-11-30T22:41:00.000-06:002007-12-06T23:00:50.980-06:00

Looks like I spoke to soon about bathroom doorknob hygiene freaks. Today's Globe and Mail gives the thumbs up to "fastidious, obsessive germophobe(s)", and finesses a link between sweaty, germ-encrusted gym equipment and necrotizing pneumonia.The beauty of this article about fitness centre hygiene and infectious diseases is that it is completely generic. The setting for this health scare du

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-86862271211695051882007-11-29T23:31:00.001-06:002008-12-12T03:02:04.315-06:00

Inside the men's washroom next to our officeMissed the garbage can... again!I wondered what was going on when, regularly over the last few months, there were crumpled paper towels on the floor just inside the washroom door. But I think I've figured it out.To keep their hands clean, guys are using the towels to turn the door handle. Because there's no garbage can beside the door... on the

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-36373527136225678632007-11-27T22:45:00.000-06:002007-11-27T23:09:04.580-06:00

"If you don't like change, you're going to like irrelevance even less."General Eric Shinseki (quoted in Re-Imagine!)Re-imagine, by Tom Peters, is a book about business, not health care. Yet, all the ideas in it can be applied to health care and how we can change it (and ourselves). Peters' theme is that businesses and individuals need to change radically rather than incrementally (Re-imagine!)

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-53603537137329521262007-11-25T13:00:00.001-06:002008-05-26T22:12:47.354-06:00

This video shows a world-class presentation. Hans Rosling shows off his Trendalyzer software (now sold to Google and being developed for free, public access). His finale is a show-stopper (don't try this at home!).While the animated slides may not be appropriate for some presentations, the slide of the woman on a bicycle (at 13:23) is a great example of how to make a "Powerpoint" with visuals

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-50960053432310398282007-11-24T18:42:00.000-06:002007-11-24T19:38:11.694-06:00

The CMAJ reports that BC's Fraser Health Region has banned "physician shadowing" by pharmaceutical and medical equipment representatives. This is a significant, often ignored, ethical issue in medical practice.I've attended Oncology Rounds with a drug rep present and raised a question about his/her presence. I was assured that a confidentiality agreement had been signed. OK, let's say that

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-81414997434866650232007-11-19T20:35:00.000-06:002007-11-19T20:52:56.670-06:00

Check out "Cellular Visions: The Inner Life of a Cell", an incredible animation made for Harvard biology students. It's about the inner workings of a white blood cell. My kids (age 7 and 10) are fascinated by it. They're asking all kinds of questions about cellular biology (although they don't know it!). I can't vouch for the explanation posted here , but it's better than I could come up

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-12704621686868746642007-11-18T12:44:00.001-06:002008-05-26T22:13:41.202-06:00

I picked up a freebie copy of SOHO business magazine to have a look at "The Lost Art of Persuasion", an article on sales presentations. It's an "advertorial" for the author's book on the subject, but it has some great ideas on how to improve your presentation style. The article isn't on the online version of the magazine, but it's available verbatim on another site.Can health professionals

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-16115198243019693372007-11-17T12:53:00.000-06:002007-11-17T13:06:22.971-06:00

I recently gave up wearing ties to work, so I was interested in the Globe and Mail article about appropriate attire for physicians. Looks like anything goes, within the boundaries of clean and neat.I have never worn a white coat at the office (much to the chagrin of my father, an old-school general surgeon). The "image consultant" gave the OK for that degree of informality, but for some reason

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-80537598140400193212007-11-16T21:47:00.000-06:002008-12-12T03:02:04.790-06:00

Operating room scrub sinkSoapy water makes stuff slippery?! If you're getting the hang of "What's wrong with this picture?", you know where I'm going with this.Don't try to change behavior with signs; change the system! How about some non-slip mats on the floor in front of the sinks? What about getting rid of soap and water altogether? Use antiseptic lotions instead.

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-89835232960473271212007-11-15T21:39:00.000-06:002007-11-15T21:43:52.524-06:00

Thanks to Sam Solomon at National Review of Medicine for adding PBW to Canadian Medicine's blog links.Type rest of the post here

Kishore Visvanathannoreply@blogger.com0tag:blogger.com,1999:blog-6548246160132860078.post-84679098101831755652007-11-14T22:22:00.000-06:002007-11-14T22:36:39.030-06:00

Two weeks ago, one of my partners suggested we start using Skype at the office for our long-distance calls. Gold star to you, doctor!Skype is one of several VoIP services that let you place phone calls over the internet. You need a USB headset/microphone connected to your computer and a Skype account. You can call from your computer to another computer for free. If you want to call from your

Kishore Visvanathannoreply@blogger.com1tag:blogger.com,1999:blog-6548246160132860078.post-7151442163500334192007-11-12T21:41:00.001-06:002007-11-12T21:45:50.419-06:00

Being in the national news, I mean. Not the other thing that is good twice a week.Advanced Access in Saskatoon made the front page of the National Post last week. (Sorry if this link dies in the future.)

Kishore Visvanathannoreply@blogger.com0