Docnotes

CLL

Chronic Lymphocytic Leukemia is a rotten thing to find.  Last night's phone call from the lab with an alert value of 50.2 WBC's with smudge cells was unexpected .. as are most diagnoses of CLL.

Today's meeting with my otherwise healthy patient was challenging too. 

Here's a good patient information handout on CLL.

Next step is flow cytometry.  Here's a nice little  review of flow cytometry methods,  rationale and interpretation.

I'm so sad about this.  Most of this job is fun.  Delivering babies this weekend was exhausting but exciting .. and the "routine" work of seeing patients - primary care issues - hypertension, Diabetes, depression etc - is all fairly straightforward and fulfilling. 

But bearing the news of a chronic and likely deadly illness - even if it's very slowly progressing -  is just plain sad.   No - not an "interesting case" as the medical students seem to think.  Just Sad.

Informatics Education

The NHS has some great resources available for anyone developing a curriculim on medical informatics for clinicians.

Newborn Neurologic Exam

  Figure. Summary of the neurologic examination with respect to gestational age. ATNR = asymmetric tonic neck reflex. From:   Yang: Neurology, Volume 62(7).April 13, 2004.E15-E17

This is a useful table that I often look for when teaching students and residents.  Now I'll never need to look very far.  ;-)

Stupid and Dangerous

Stupid and Dangerous is a new weblog written by my neighbor here in the suburbs ... He poses a great idea that Condi Rice was leading up to in her recent appearance on Fox News Sunday:

Dr. Rice was quoted as saying, "I think we also have to take seriously that they might try during the cycle leading up to the election to do something. In some ways, it seems like it would be too good to pass up for them, and so we are actively looking at that possibility, actively trying to make certain that we are responding appropriately."

"Canceling the election would have the additional benefit of allowing us to declare, “Mission Accomplished” in our reconstitution of Iraq’s civil authority. We promised the Iraqi people a democracy. If we cancel the 2004 election, we can announce in all sincerity that what they now have is an American-style democracy."

Trichomonas

Today's find:  a nice handout on trichomonas.

NAPCI

Health Data Management reports that NAPCI now exists.  After years of work, this organization, the brainchild of Moon Mullins and John Zapp, has finally hatched from the egg.

NAPCI is a good idea, and has support from nearly all of the primary care specialties.  "Nearly all" means that AAFP is missing, and this is an ambarrasment for AAFP, IMHO. 

As a member of the Board of NAPCI (I represent STFM) .. I am clearly biased.  But as an AAFP member, I am also compelled to help "my" organization understand the needs of its members.  I've therefore been part of a recent effort to help educate the AAFP on the reasons for NAPCI membership .. and to understand why they have chosen not to join.  Ideed, the boards of STFM and NAPCRG have communicated formally with the leadership of AAFP - imploring AAFP to reconsider this decision.

Alas ... I fear that AAFP's vision for how primary care informatics needs should be expressed lies largely in the hands of David Kibbe - a bright and assertive man who has a clear vision that AAFP should:

... serve as the "physician voice" about the information revolution in office-based medical practice -- to make widely known the views of physicians, and their patients, as they relate to empowerment through HIT.

But if AAFP is the physician voice .. where does that leave all of the other specialties?  Long downtrodden as the Rodney Dangerfields of medicine, we family physicians should have well learned not to be so excluse as this sort of language suggests.  We need to work with the other specialities.  NAPCI therefore needs to become the primary care provider's voice -- with AAFP an active particpant in framing the statements.

At our Board meeting in early March, several representatives of other specialties reported that the leadership of the EHR collaborative had concerns about involving the AAFP because they perceived AAFP to be "going its own way."

This is troubling.  David K denies that he's been uncooperative - and insists that collaboration is a core component of his work.  Yet somehow this is not coming across, and the failure of AAFP to join NAPCI is a rather clear message that AAFP does NOT want to collaborate .. isn't it?

 

Web Strategy

Working with my colleague on a web strategy proposal. I've found some useful resources. a) Jakob Nielsen's March 29th article on usability is a good reminder that a well designed website (or intranet) will same time and therefore money. b) This is a nice little document that serves as an excellent introduction to web strategy/tactics with a clear glossary as well.

Smoking in pregnancy

Thorax -- Abstracts: Svanes et al. 59 (4): 295 Early exposure to parental smoking appears to influence the development of the airways and predispose to respiratory symptoms. A study was undertaken to determine whether the consequences of parental smoking could be traced in adulthood.

A Treatable Cause of Painful Breastfeeding

Pediatrics -- Abstracts: Anderson et al. 113 (4): e360 A Treatable Cause of Painful Breastfeeding

How Should Parents Protect Their Children From Environmental Tobacco-Smoke Exposure in the Home?

This Pediatrics  Electronic Artice  asks (and answers) the question: How Should Parents Protect Their Children From Environmental Tobacco-Smoke Exposure in the Home?