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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    Thursday, July 09, 2020
     
    In Which Dr. Alice Enriches an Orthodontist

    So this morning I pulled out my credit card and made a hefty payment to my new orthodontist. In my mid-fifties, I apparently need my teeth straightened... forty years after the last time I endured it. I have a widening gap between the two front teeth in my upper jaw ("incisors," or as Ortho Guy refers to them, Eight and Nine) and crowding of the teeth in my lower jaw. Estimated time for treatment: fourteen months. 

    He's a nice fellow, if a little too prone to making tooth-related puns. Such as, "If you don't treat this it'll come back to bite ya!" Sigh. But he was recommended by my regular dentist, whom I have been seeing for years. He certainly has a lovely office and I'm pretty sure I just made his next month's rent payment for him. Very well organized, everyone masked and hand sanitizer everywhere.  They have incredibly fancy equipment which allowed my teeth to be scanned and a mold visualized in less than five minutes. No more biting into a concrete filled mold and fighting gag reflex for what feels like forever. There is something to be said for the twenty-first century after all. 

    In related news, this afternoon I drafted a query to the administrators of my medical group about my lack of remuneration for the past five weeks. I'm still working there as an hourly employee now that I have retired (semi-retired, I suppose, is more accurate) and had to fight the temptation to email "WHERE MY DAMN PAYCHECK AT" instead of substituting something more diplomatic. Well, I can't spend money on a vacation this year due to the Virus, so I may as well spend it on my teeth instead. I go back in about a month for my first fitment.

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    Tuesday, July 07, 2020
     
    Virtual Medicine

    When I retired in early January of this year I planned to come in to the office one week a month to see patients.  Then COVID came along and I found myself jumping right back into medical practice to help out my medical group. I had never done a telemedicine video visit in my career until March; turns out it isn't all that difficult. Now I work from home several days a week. I'm not going into the office for now, as I have three elderly relatives who need my help and I'm trying to minimize any potential exposure so as not to put them at risk.

    My group uses a video program which is part of our electronic medical record system, as well as an alternative which is simpler to use called Doximity. (We can also use FaceTime or Zoom, but these systems are discouraged because they don't have the same privacy protections as the other two options.) Mostly they work well, but there are issues from time to time. 

    • There's the visit where I can't hear the patient, or they can't hear me, although we can visualize each other on video. Frantic gesticulating ensues. Sometimes I have to resort to telephoning the patient while having them hold their rash, or whatever it is, up to the camera. Shingles is particularly easy to diagnose on a video visit as it can't be mistaken for anything else.
    • There's the poor data quality visit where the video screen freezes or pixilates. Watching the patient dissolve into little cubes can be offputting to say the least. ("Mr. Smith, how long have you been falling apart like this?")
    • There are occasional complications with pets - the patient's dog gets jealous or nervous and starts barking, or the cat walks across the camera's field of view.
    • And then there's my favorite, the patient (usually elderly) who simply cannot figure out how to use either of the video options. Yesterday I had a particularly memorable example of this problem. I connected to the patient via the Doximity app but they didn't pick up, so I called the cell phone and got voice mailbox which was full. I finally tried the patient's home number, they picked up - the cell phone was shut off. ("Oh, so you can't do this on the laptop?" "No, you can't... did the medical assistant explain that?" followed by a tooth grindingly long delay as the patient turned on the phone and waited for the link to come through.)  As we are booked in with patients every twenty minutes, it's easy to run late if you get more than one of these in a session.
    We can always resort to telephone visits, but the group strongly emphasizes video visits when possible. The amount of data you can get on a video visit is obviously greater than on a phone call - you can check the patient's appearance as well as their surroundings (are they dressed neatly, disheveled, short of breath, pale?) And to be honest, reimbursement for video visits is better than for telephone visits. These days that is no minor issue. The clinic has reopened but patients continue to be reluctant to come in.

    Certainly not all patient issues can be addressed via video, but I would say that overall this system has worked well. My biggest problem with telemedicine is that I need a chair with better back support. After sitting at my desk for four hours straight it's almost impossible to move...

    Oh, and edited to add that it's really special when you realize after a four-hour shift that you've been interacting with patients all the while you have a big food stain on your shirt. On the up side, though, you can work barefoot and wearing shorts because no one can see you below the waist. So there's that. 


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    Thursday, December 20, 2018
     
    AM Radio

    These days radio seems to be almost the forgotten technology. When I was a kid, AM radio was the thing and FM was just starting out. The superior sound quality and reception of FM broadcasting soon ensured that AM was left behind in the dust. Then of course tape decks came along, then CD players, then satellite radio... now radio has been reinvented as the podcast and we have come pretty much full circle.

    The humble AM broadcast band still has its points, though. If you're interested in learning a foreign language, listening to many of the Los Angeles stations might help you along. We have stations broadcasting in Spanish, Cantonese, Mandarin, Persian and probably other languages as well. There are also the all-news stations (Los Angeles used to have two, now we're down to one) and the many religious stations. These all seem to sound alike to me, though occasionally I catch part of a decent sermon.

    And then there are the low-power public alert ratio stations, which I find fascinating. These usually are the property of cities, universities or other public institutions and broadcast to the immediate surrounding area. Reception is limited to three to five miles. They cluster either at the top or bottom of the AM dial. If you drive through West Los Angeles you may hear several: Santa Monica, Culver City, UCLA and Beverly Hills all have their own radio stations. Some are more elaborate than others: Santa Monica updates every week with information about street construction and other traffic problems. Beverly Hills talks about their farmers' market a lot, as well as parking on Rodeo Drive (the main shopping street) and upcoming city events.

    Culver City, on the other hand, is what I call the zombie apocalypse station. It's nothing but a thirty-second loop of a man with a cheerful voice saying "Welcome to Culver City" and to stay tuned for information about emergencies and traffic issues. I've been listening for years and the message has never changed, which I find more than a little creepy. Sometimes when I'm driving through the area late at night I like to pretend that some unimaginable disaster has occurred and this endlessly repeating loop is the last remnant of civilization. Then I shudder and change the station.

    Even freeways have a station reserved for (presumably) emergent issues. The 405 freeway, for example, has a looped "test" message which fades in and out depending on where you are. The most recent update is two months old, dated November seventh, and doesn't say much of anything other than the date. It's a close runner up for the title of Zombie Apocalypse Radio Station.

    This website contains information about stations broadcasting alerts and public information around the United States, as well as an interesting bit on the history of such stations. Apparently it took the tragedy of September 11 for the government to sit up and pay attention to their potential in emergency situations.  They can now be found around the country. In my reading I found that low-power FM stations also exist, but these I think are mostly run privately rather than by governmental organizations. They seem to be synonymous with political ranters and conspiracy theorists, or maybe just people who want to run a radio station.

    Lastly, under Part 15 of the FCC rules homeowners can apparently operate a tiny broadcasting station without a license on low power radio. (Range is something like 200 feet.) Imagine the opportunity to play Christmas music 24 hours a day! Or 1940s big bands, or anything else that tickles your fancy. The opportunities would be endless. Someday this could be a project for my retirement. The all-Esquivel station comes to mind...


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