“But more than revolutionizing how we see disease, the stethoscope had a powerful effect on defining the medical profession.  It changed the way we see ourselves.  For those powerless to understand what was evolving within body cavities, the stethoscope put control in the hands of the physician.  And the bedside is where it happened.”  — Bryan Vartabedian (@Doctor_V) writes on the stethoscope’s quiet eclipse, at 33 Charts. 
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“But more than revolutionizing how we see disease, the stethoscope had a powerful effect on defining the medical profession.  It changed the way we see ourselves.  For those powerless to understand what was evolving within body cavities, the stethoscope put control in the hands of the physician.  And the bedside is where it happened.” 

— Bryan Vartabedian (@Doctor_V) writes on the stethoscope’s quiet eclipse, at 33 Charts. 

jayparkinsonmd: Philips just released a new iPad 2 app called Vital Signs Camera that uses the camera to measure your heart and breathing rate. It detects subtle beat-to-beat changes in the color of your face to measure your heart rate.  We’re slowly living in the future.
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jayparkinsonmd: Philips just released a new iPad 2 app called Vital Signs Camera that uses the camera to measure your heart and breathing rate. It detects subtle beat-to-beat changes in the color of your face to measure your heart rate. 

We’re slowly living in the future.

(via stenciledheart)

Source: jayparkinsonmd

Powered on

Sometimes, the blogosphere just decides they’re going to discuss something in great detail. And now, with holiday travel upon us, we’re talking about the inane rules that airlines inflict upon passengers — especially the “turn off all electronic items that have off switches” rule at the beginning and end of flights. 

This past summer, when the IATA issued a largely anecdotal report on a few dozen incidents with no real bad outcome (spanning a period covering millions of flights), I thought the time for discussion was ripe, and compared some of the rituals of aviation to similar maddening rituals in healthcare. 
But now James Fallows is covering the topic, and has terrific input from a diverse and smart audience (it helps that he’s a pilot, himself, and a terrific writer). Read it all — just not during takeoff or landing. 

@EndoGoddess:

Wow, inspiring man. RT @GHideas: It is worth reading every word of this piece on Berwick’s time at CMS http://t.co/s26a8DFa

An interview with creators of ACS Trials

iMedicalApps talks to the developers behind the ACS Trials app: “In this age of evidence-based medicine, it seems to happen all too often, especially as a trainee, that you know there is evidence for one therapy over another, but you can’t remember where that evidence came from, the dose studied, and so on. This app is designed so that when you’re at the bedside or on rounds, you can quickly and easily access that information.”

A great idea for an app — and the alphabet soup of ACS trials is a great place to start. $3 in the app store; I’ll have to give it a spin. 

Thoughts on a reading, sharing & archiving solution

Music’s pretty much done, right? It’s fairly easy to hear any song you’ve ever liked, anywhere you happen to be. As a bonus, those songs can be stored, shared, tagged, rated, and linked to lyrics and album art.

Movies and TV… their delivery is not quite perfected, but the general outline seems apparent. Already I can watch the WKRP Turkey Drop episode in the kitchen on my iPad’s Hulu app, and mirror it to my TV (via Apple’s set top box) when I’m ready to sit on the couch. Other shows or films require more effort, though the combination of Netflix, iTunes, and for the remainder, torrents plus the Air Video server app, make it easy enough.

But reading? The written word, for whatever reason, still lags behind. While strides have been made, a simple and universal, Apple-like solution to the problem of reading, sharing and archiving remains elusive.


It seemed for a while that RSS was going to solve reading, but despite this, for a while, I resisted the call of RSS aggregators. I wanted to experience sites as the bloggers wanted them laid out — if it was just uniformly presented text, I feared I’d lose some of the author’s personality and voice. I had a hierarchy of bookmarks that I perused.

But I found, even with Grand Rounds, that I was missing out on new voices. Using bookmarks to visit older blogs that were sputtering out was frustrating. Messing with my bookmarks was not as simple as adding or rearranging RSS feeds. And so, at some point in 2006, I made the leap to Google Reader.

And for a while, things were great… I could efficiently consume the blogosphere, as never before. Until I came to regard catching up with RSS feeds as a chore.

So I muddled along, using a combination of bookmarks, Google Reader, and increasingly, Twitter feeds, to keep up with old friends and new sources. Good stuff I came across was starred, or retweeted, or bookmarked, or cut and pasted into Google Notebook Evernote for future reference. Or Instapaper’d. Or posted to Facebook. At one point set up FriendFeed to aggregate all my commenting activity, but it was no way to absorb new information.

Then the iPad came along, and with it, Flipboard, Pulse, and the Kindle app. Flipboard hooked into my Google Reader feed but never made catching up on blogs seem like work — instead, it felt like I was browsing through a magazine that featured all my old blog friends and twitter buds. Flipboard also let me retweet, or post links to my Facebook page. Pulse is a little less slick than Flipboard, but they make it easier to plow through more content, add new feeds, and share or save material. Kindle’s app is pretty great, and lets me take notes that can be shared publicly. It’s a little work, though, to turn that public notes page into an RSS feed or Evernote folder. Currently, the Newsstand periodicals don’t offer any sharing or notes archives, which has really limited my use of them (though they’re still fun to read).

That the iPad should be a superior device for browsing and sharing RSS, books, Twitter and Facebook feeds is not surprising — there’s been surprisingly little demand to bring Flipboard and its like to the Desktop; Kindle has a desktop version that I’ve only used for novelty’s sake.

I just wonder if Google knows what it’s lost, by neglecting the Reader experience (which has only gotten worse lately)? I think so. Sources say they’ve got something in the works to compete, for tablet browsing. And many expect Google+ to come out with the APIs to make this kind of sharing and logging possible. Just not yet (and maybe too late).

In the meantime, I’m starting to make use of ifttt (if this then that), a simpler version of Yahoo Pipes that monitors feeds, tweets, and calendars and carries out pre-programmed actions for you — so my starred Tweets are automatically sent to Evernote, for instance, or Facebook photos tagged with me are sent to Dropbox.

Ifttt makes Twitter and FB more useful, but it only makes clear how limited these social networks are for archiving, by themselves. It seems there ought to be a universal browsing / sharing / archiving app, for Tweets, Facebook wall posts, RSS, eBooks, and magazines, that looks as slick as Flipboard but has more capacity and flexibility. The fact that I can imagine this means it’s too obvious for Apple to be working on (and probably not profitable enough, either). I worry that Google’s solution may not adequately incorporate Twitter and FB (because if it did, why use Google+?) Maybe Amazon will surprise us again, or maybe Flipboard, Pulse, Evernote, Instapaper, or another startup will make it happen.

Until then? It’s surprising but the simple, ancient act of reading has failed to adapt, technologically, to the extent that music and video have.

Goin’ Mobile

Long before my colleagues knew me as “that guy who sewed a pocket into his white coat so he could use his iPad in the ED” … but sometime after they knew me as “the guy with the blog” … I like to think they knew me as “that guy who helped edit many editions of EM Practice, the evidence-based, presentation-focused journal of emergency medicine.”


With this post, I can be all three guys at once, and recommend the wonderful, iPad-optimized PDF of of many fine flowcharts featured in EMPractice in recent years, now available for free. 

Every issue of EMPractice has a flowchart to help guide emergency decision-making with the best available evidence. We’ve taken a bunch of recent flowcharts and bundled them into a useful, navigable document that will bring the best evidence to the point of care. 

Of course this PDF works well on paper, and the hyperlinks will work on other computers or devices, but it’s sized and designed with the iPad in mind. It’s really great for teaching or reviewing, on shift. 

NB: I’m on the editorial board for EMPractice and had a small role in developing this PDF. 

Healthcare is definitely an industry that needs the simplification, and improved user experience, that Google typically provides.

That such a powerful company decided this goal was too difficult, or not worth the effort, is discouraging.

Google Health Post-Mortem: Where Did We Go Wrong?

A look at the nearly-late, nearly-great Google Health, and the prospects for personal health records. 

Source: epmonthly.com

Paranoia strikes deep

You know, I already thought that someone at Apple shared my taste in music, as they’ve highlighted Goldfrapp albums on their site, on several occasions.

But sometimes, while surfing the web, some examples hit a little too close to home. For instance, here’s an article on iPhone tracking, that happens to show my neighborhood in the Maps app.

Sure, you say, lots of iOS screenshots feature Central Park. Lest you think this is just Manhattanite navel-gazing, here’s a new Medgadget post with a screenshot of the iPhone app called FindER that just happens to show the town I grew up in, and the hospital where my scalp lac was stapled (twenty years ago).

Maybe I’m reading too much into this. Or maybe I’m reading too much about iOS apps.

Present Tense

I made my first PowerPoint presentation in 1997, and actually used Microsoft’s application to prepare 35mm Kodachrome slides for a carousel projector. Since then, I’ve seen thousands of PowerPoint presentations (and a few dozen Keynotes), and had a hand in creating many, myself.

Not since a conference a decade ago have I needed to make Kodachrome slides. Yet almost everyone still uses software built around printing slides, making a linear progression of topics. The impact of this format on human thought is substantial — PowerPoint was fingered as contributing to the Columbia disaster and has spawned a lot of discussion and linkage, even here, regarding effective communication (probably all conceived of during dull PowerPoint presentations).

While compelling presentations are possible with Powerpoint (using the Lessig Method, for example) those kinds of talks require planning, and a mastery of the material. And some great stock photos. My experience in school and training is that the PowerPoint is often made as the presenter is learning the content and so is bound to lack the organization and expertise necessary for a Lessig-style presentation. People procrastinate about public speaking, and when crunch time comes it’s just too easy to flip through a a textbook, call up a Pubmed abstract, and churn out another verbose PowerPoint slide. With practice, it’s possible to whittle down the number of words and bullets per slide — but who has time for that? Much easier to read the talk from the slide itself.

While I strive for Lessig-like clarity and impact in my talks, it’s rare that I can eliminate all the slides with three or more bullet-points on them. PowerPoint, even though it’s based on making Kodachromes for obsolete carousel projectors, is just too much of a crutch.

Which is why I was relieved to see Prezi come along. If you could imagine what presentations should look like with modern computers and digital projectors, Prezi is pretty much that — more like a mind map than a slide deck.

Prezis can still be a linear progression of images, text, bullets, etc. But even linearly, it’s easy to make big concepts stand out, and parenthetical points diminutive and aside from the main progression. Tangents can literally be tangential. Related ideas can be visually grouped, and you can easily give your audience the bird’s eye view, for perspective. Most significantly, though — Prezis needn’t be linear. A presentation can go in various directions, based on audience input or presenter’s whim. I think this will ultimately lead to much more interactive, engaging presentations.

Furthermore, Prezis just look great. I was always trained to avoid flashy animations and effects — my grad school advisor wisely counseled, “Let your data do the dazzling.” And I agreed with him, especially whit PowerPoint’s cheap, tacked-on effects. But Prezi’s more fluid animations have purpose — they are literally moving the audience’s focus along, from one concept to another, or to multiple ideas.

I gave my first Prezi presentation last week (here’s the public version, stripped of many incriminating screenshots and some diversions). It was a challenge, and I still have a lot to learn, but I think it was more compelling than I could’ve made the material, in PowerPoint. And coming at the end of a long conference, I think people were ready for something different.

It wasn’t easy, though. It took a while to get the hang of the zebra circle controller. There are still some things about frames that baffle me (no resize option? really?) But the greatest hurdle was old habits: Prezi forced me to think much more about the outline of my talk, up front. I couldn’t just churn out some slides to get the ball rolling, but really had to plan where I’d take the audience.

Other thoughts:

  • A poorly planned PowerPoint will bore the audience. A poorly planned Prezi could make the audience violently ill. 
  • PowerPoint encourages and even rewards procrastination. With Prezi, it’s hard to make (as many) last-second rearrangements without disrupting the carefully-laid path.
  • Getting videos to reliably display in Prezis is easier than in PowerPoint. Images should be as easy, but there are quirks — .png files look pixelated, and pdf’s don’t yet display on the iPad app. 
  • We are pretty close to the point where a presenter can walk around with an iPad and control (or let an audience member control) a Prezi projected on the big screen (this may already be possible with extra hardware, but the Prezi iPad app doesn’t faithfully reproduce the Flash-based web Prezis, and doesn’t yet allow Prezis over AirPlay).
Even though my talk was (mostly) linear, I’m looking forward to trying some choose-your-own-adventure style presentations, which could be especially useful for talks on medical decision-making. When you think about how many hours people spend looking at PowerPoints, it’s easy to get excited about the potential for Prezi. Other Academic EM types are experimenting with Prezi  — and someone has gone and made a Prezi touting its advantages. Finally, inevitably, there’s now a blog about Prezi tips.  

Time won’t let me go

Before the App Store, way back in the spring of 2008, I jailbroke my refurbed first generation iPhone. I claimed it was for the cool native apps but also liked the customization that was possible (even now, animated backgrounds and control over device sounds is not allowed through official channels).

The innovation came at a price — the phone became slower and more crash-prone.

When the App store was available, I quickly upgraded to the Apple-approved iPhone OS 2.0 and all my jailbreak hacks and apps disappeared.

Except, strangely, one hack.


Erica Sadun, who writes for TUAW and really makes use of Ping, wrote a bit of code that let me change the clock in my taskbar to text. The text I chose, on one fateful day 2.5 years ago, stayed with me through the upgrade back to an official Apple OS.

Stranger still, the clock-to-text hack stayed active when I upgraded to the iPhone 3GS, last year (when I restored my backed up data and apps, the text came with it).

Newer OSes were released, I never went back to jailbreaking, but still the hacked text remained. It followed me to the iPhone 4 this summer and iOS 4.1 this fall.

Yet surprisingly, upon upgrading to iOS 4.2, the clock returned, and my little bit of text was gone.

I’m sure there’s a good explanation for this, rooted in code that’s well beyond my understanding. And, truthfully, Apple was right: having the time displayed on my taskbar is a lot more useful than my little bit of personalization.

I’m just reporting this in the same spirit as my bizarre case reports: it’s good to notice and share unanticipated findings in complex systems, so that others may learn and maybe use that information, going forward.

Pad & Pen

My piece on the iPad’s potential in emergency departments is now up at EP Monthly. Check it out — especially the ambitious developers who’ve left comments.

The speculation about this device in healthcare has gotten a little more detailed — and optimistic — as people have had the chance to use it this week. Other insightful comments are available from Larry Nathanson, Chilmark Research, and John Lynn.