Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Wednesday, August 19, 2009
    Beware Cartoonists Bearing Gifts

    You may have heard of Stephan Pastis, the cartoonist who draws Pearls Before Swine. I think it's one of the best comic strips currently published, and one of my favorite aspects of the strip is his ability to parody other comics. Most recently Pastis brought Mary Worth onto PBS as a guest (she stood stock still for four panels and said nothing, alluding to the glacial pace of the strip). He's also thrown a few zingers at Sally Forth and others, but he's saved his best jabs for Family Circus.

    Back in July there was a big comics convention in San Diego, and Pastis attended. The night before he was to speak on a panel he was in a bar having a quick drink when he ran into Jeff Keane, one of the authors of Family Circus. Pastis got a brilliant idea:

    “Hey Jeff, you have to come to my panel tomorrow,” I told him.

    “Why?” he asked.

    “Because every time I do a panel, someone inevitably asks me what other cartoonists think when I parody their strips.”‘

    “So?” he said.

    “So if somebody asks that question, I can surprise everyone by introducing you and showing them that we know each other and are actually good friends.”
    Keane agreed to come.

    What happened the next day? Well, you'll just have to click to read it...


    Tuesday, August 18, 2009
    A Rare Restaurant Endorsement

    "Okay," my cousin demanded a few weeks ago, "'fess up. Who went to 'Wise Guys'?"

    "It was me," I humbly admitted, raising my hand.

    We were standing in my aunt's kitchen in western Pennsylvania. Earlier that day my parents and I had been driving to Aunt D.'s house from the Pittsburgh airport, and things had been a bit tense. We had left at crack of dawn from Stratford, Ontario, and had gone through customs at six a.m. without breakfast. Plus my dad had displayed his classic stubborn argumentative self at the Pittsburgh rent-a-car counter and I had come very close to braining him with my suitcase.

    I won the "honors" of driving from the airport to my aunt's house and we were all starving. Dad had let it be known that he would be very happy to stop any old time for a bite. So when a certain red-and-white sign had caught my eye from the road, I shrieked "We've got to stop here!" and promptly pulled in.

    The sign read: Five Guys Burgers and Fries. Had it not been for a chance conversation a few weeks before this would have meant nothing to me. In fact the conversation was so random that I still cannot remember who my conversational partner was (a patient? a drug rep? not sure). Nevertheless the name of the business stuck in my head, and since I was driving, the decision was easy. Into the parking lot we went.

    This chain (it is a chain) is awesome and reinforces my adage that there is no restaurant recommendation like a personal recommendation. The unknown person who clued me into Five Guys swore up and down that it was the best burger they had ever had. All I can add is, YUM. First point: they have free roasted peanuts in the shell. The peanut presence totally escaped me but it did not escape Dad, who had a little cardboard box of the luscious legumes loaded up before I had finished ordering for the three of us. Second extremely important point: you have carte blanche to order your burger as you like it. Which is to say, you make your choice of multiple condiments, relish, onions, tomato, lettuce... etc. (Sorry, Australians, no beetroot available.) If you study the menu you'll see what I mean. My mother changed her toppings order three times and I felt sorry for the poor fellow at the register, but he handled the situation with aplomb.

    Third point: portions are HUGE. I mean, a "regular" burger order is a double. A "small" has a single patty. French fry orders are fresh, delicious and HUGE. I ordered a large standard fries and a regular Cajun fries for three of us and there were way too many fries, probably enough for five or six people. I kept apologizing to my folks for over-ordering and trying to explain that all I really knew when we arrived was the name of the place. I don't think there are any Five Guys in California, at least not that I know of. And fourth and final point: everything, everything, is cooked to order. They also have hot dogs, which I bet are delicious, but we wanted nothing but the burgers. We agreed that the regular fries are better than the Cajun (way too salty).

    Five Guys are also very fast. We hit the place in the middle of the lunch crowd, but I just had time to get sodas and paper cups of ketchup for the three of us before our order was called. After we finished I studied some of the rave reviews posted on the walls and deduced that "Five Guys" was started in the Virginia/Washington D.C. area about 1996 and has since then expanded up and down the Eastern seaboard. Given that there are three such restaurants within an hour or so of my aunt's place I have to believe that they are doing pretty well. For those of you who know western PA, there is one on Rte. 22, one on Rte. 30 and one in Johnstown.

    My cousin confessed that she can never remember the name "Five Guys" and always calls it "Wise Guys." Whatever you call it it's a darn good burgers-and-fries place and I would highly recommend it.

    Our collective mood improved greatly after our visit. As we piled back into the car on that humid afternoon my father announced, "You know, even King Tut didn't have air conditioning. Or a car."

    "He didn't have Five Guys either," I retorted, backing out of the parking lot and back onto Rte. 30.


    Monday, August 17, 2009
    Team Bonding! Or, We're Totally in Dilbert Territory Now

    I have great admiration for my boss in many ways. He has overseen The Firm from its small beginning with just a few doctors to its current status as one of the largest medical groups in L.A. His schmoozing skills are unparalleled - make no mistake, this is a major asset and one I wish I possessed. And he believes in the value of corporate culture, which has kept us together and going strong for lo these many years.

    Having said that, he's come up with some mighty hairbrained ideas in his time and he has just emailed us the latest of such. He wants us all to do Myers-Briggs personality testing prior to the next corporate retreat.

    Yes. Personality testing. I can see where this might be relevant if he were dealing with a group of managers, but I don't really see the point when applied to physicians. Granted, diplomacy and tact are relevant when it comes to running a practice but doctors are trained to treat patients, not to herd cats. When it comes to running a practice you find the rhythm that works for you and stick to it. I'd say also, at least in our group, that the physicians who don't like how we do things self-select and leave. That doesn't mean they aren't good doctors or that we had horrible disagreements; it just means the group practice model didn't work for them. And I admire them for realizing this and striking out on their own.

    I guess what I'm really asking is, what is this supposed to accomplish? And my answer is not a lot. The docs who are talented holy terrors (and we have a few) already know this. Those of us who are eclectic (not to say eccentric) already know that. No matter what my Myers-Briggs results show, I don't see that they would change my practice style any... I've been doing this for sixteen years.

    V. sent me a succinct email after we got the news: "OMG!!!" I responded as follows:

    I seem to recall during our mandated pain management training that there was a chapter on Myers-Briggs which included the results for serial killers like Ted Bundy. I think I may go look up those results and copy them onto my test… ought to be good for a laugh.

    It's a delicious thought, but I want to keep my job. I thought better of it.

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    This Pretty Much Says It All

    funny pictures of cats with captions

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    Sunday, August 16, 2009
    Birth Control: an Underused Option

    Via Not Martha I found this link to an excellent article about IUDs. I agree with the writer: I can't understand why more women don't use them. You do have to pay up front if your insurance does not cover the device, and this can cost from $300 to $500; but they are good for up to ten years. Even if you only used it for five years that would come to less than ten dollars per month, cheaper than the pill. I always offer it as an option, especially if the patient is looking for a birth control method which does not involve hormones.


    Thursday, August 13, 2009
    Tech Support? Hello?

    Well. It's been brought home to me once again that when it comes to technology you can file me in the "epic fail" category. For months I've been struggling with an extremely slow computer line and have done nothing about it - mainly because I didn't know where to start. This afternoon, having a recent phone bill handy as a reference, I finally called the 800 number for Verizon and was directed to their website. It ran a program, checked the speed of the line and reported that yes, I did indeed have a speed problem. I clicked around some more and finally found a FAQ which suggested turning off the modem, waiting fifteen seconds and plugging it back in again.

    It worked.

    I can't believe it was that simple. I really can't believe I waited months to do something about this. At any rate, at least there's a happy ending.


    Wednesday, August 12, 2009
    How To Celebrate a 50th?

    I always enjoy reading Mark Bittman's food blog, Bitten. Over the last several months he's accumulated a few guest posters whose writing and recipe ideas are also excellent. A recent post by Daniel Meyer, dealing with his efforts to create a nice fiftieth birthday dinner for his mother-in-law, contained a suggestion that made me laugh out loud:

    My first thought was to buy her a quart of ice cream, a bottle of whiskey and a box of Kleenex, but that seemed insufficiently celebratory.
    I have not yet reached this milestone, but several of my friends and colleagues have. Perhaps when it's my turn I will mark the occasion in this manner. We shall see.


    Bons Mots

    1. Last week I was examining an older patient. When I tested the range of motion in his knee I noted some crackling and noted that he had "crepitus" in the knee.

    "Why do you call it that?" he fired back. "Does that mean I'm decrepit?"

    2. Reviewing notes from urgent care today, I saw that the medical assistant had listed the patient's chief complaint as a "staff infection." She had a boil which was likely staph, all right, but I could not help thinking that an infection of the entire office staff would indeed be something to complain about.

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