Thursday, August 23, 2007

Summer Facelift - What's New at Vitum Medicinus

+ job supervisors kind enough to realize that this is my summer
= free time to do some tune-ups at

You may not have noticed all the upgrades, especially if you're reading VM in a RSS reader. In order that you don't have to pore over the blog looking for them like a radiology resident scanning an x-ray film (I had to tie in that photo somehow), here's the improvements listed for you.

  • New Blog Header Photo
    I had to change it anyways since I grew a year older since I started this blog; but I figured I might as well change the photo to something that actually happened in medical school, rather than something I did during my pre-med years. This photo was taken in a hospital on my cell phone camera when a bunch of us were waiting around for a pediatric clinical skills session to start. My favourite part of it is the subtle tribute to Canadiana - there's a Tim Horton's coffee cup sitting on a table in the photo.

  • Favourite and Most Popular Posts
    a.k.a. Vitum Posticles Popularis, now available in the right-hand sidebar as an easy springboard for anybody who wants to read the best of VM right away. None of the fluff. Just the top stuff. Favourites include
    First Post, First Breast Exam, and the Top 10 List Category.

  • Feedburner RSS Feeds
    By becoming an RSS reader user I developed a lot more respect for those who use RSS readers, especially those who read VM via RSS. I also developed a healthy bit of embarassment at this up-until-now-ignored aspect of my blog, and now that I've delved into the world of RSS I added Feedburner RSS feeds to maximize the functionality of my feeds. Subscribe to Vitum Medicinus via RSS... or get a Feed Reader (Google Reader is great).

  • E-mail Updates
    For those of you who, like me, are reluctant to jump head-first into RSS without really understanding it, you may prefer to get VM posts e-mailed to you whenever they're written. If so, you can subscribe to VM via e-mail.

  • Polls & Poll Results
    You can now view all polls that have been hosted at VM, and vote in any of them or check out the results. Jump to polls...

  • Grand Rounds Hosted at VM
    VM had the privilege of hosting Grand Rounds for the first time; version 3.43 was hosted here on July 17, 2007. Reviews include "best GR in recent memory, there, I posted that for you, now where's my cheque?" and "you put way too much time into this." Jump to GR...

  • Post to Facebook, del.ici.ous
    For those of you who care about your friends enough to share a VM post with them, you can now post a VM story to Facebook or del.ici.ous thanks to the convenient links at the bottom of each post - whether you're reading it on VM or in RSS.

If you have any more suggestions on how I can improve your VM reading experience, please let me know by comment or via e-mail - and thanks to those of you who have been kind enough to bear with me as I tinkered with the settings of VM, or have suggested improvements already.

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Saturday, August 18, 2007

Top 10 List: Terrific Tips for Stupendous Suturing

Today, while shadowing in the ER, I sutured real people for the first time. Twice.

Clearly, this makes me one of the world's leading expert on skin sewing. Ask any doctor.

This, and watching dozens of lacerations put together, and taking part in a suturing workshop with very realistic artificial materials designed to perfectly simulate human skin (those materials being made of box cardboard).

Fortunately, it was the second patient - not the first - who asked, "Have you done this before?"

I answered him truthfully. "Yes," I said.

So, having learned so much from my great wealth of experience, I have decided to benefit you, the reader, with ten terrific tips for stupendous suturing of lacerations.

If you're a medical student, like myself, use these ten tips and you will blow away your classmates.

If you are a nurse or patient, read this list then verbally chastise any physician you see who does not follow these ten tips.

If you are a doctor, verbally chastise yourself right now, out loud, under the assumption that you do not know all of these ten tips.

I request no repayment for this tremendously valuable guide, other than the act of "suturing" be re-named "Vituming." With a capital V.

10. Don't have your stethoscope draped around your neck while you suture. Place it in a pocket or on a desk.
It will get in the way and ruin your sterile field (not good) - very important for emergency department laceration suturing.

(Actually, research has shown that
sterile gloves and sterile saline are not needed for ER suturing, as they don't significantly reduce the rate of infection.)

9. Don't have your ID badge on a lanyard. Use a clip instead.
It will get in the way and ruin your sterile field. So not good.

8. Don't have your lab coat on. Roll up the sleeves or remove it.
The sleeves will get in the way of your sterile field. Like, totally, so not good.

7. If the patient is getting woozy, tell them not to look at the wound.
The patient I saw was very pale.
Research shows that by telling them not to look at the wound, they will not get woozy (research pending). Research also shows verbally demeaning or physically assaulting the patient will help with compliance on this point.

6. Don't bend the needle.
This will make it a pain to get through the wound. This is partially accomplished by grasping the suture needle at the right point with the needledriver - close to the end.

Generally, getting patient blood inside you is something you should try to avoid. Mostly for the pain, I think that's what I was told once, but there are supposedly some blood-borne illnesses that are nasty.

4. Poke the patient.
You can't suture a patient if you don't puncture their skin with the suture needle. Trust me on this one. This is more important than #5; as well, the comedic value is decreased if it is ranked higher than #5.

3. Ignore the fact that the image associated with this post shows suture removal, not suture administration.
Allowing little errors like this to cloud your mind while you suture will distract you from doing a good job. Your patient will complain, and likely sue you.

2. Efface the edges.
For improved wound healing. Or something like that.


Sorry I couldn't come up with a #1. What did you think I was, an expert on the topic? I've only done this twice.

By the way, before you follow any of these, make sure you read the disclaimer below. Especially the part about not listening to any advice on this blog.

(If you actually are an expert, by all means, post your tips.)

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Wednesday, August 15, 2007

The day the ER nurses ganged up on me

I swear I was being good. Really, I was! Honest!

But still, they hunted me down and cornered me, like an angry, bloodthirsty pack of shewolves avenging the death of their young. Or something like that.

Tonight, during a ER shadowing shift, I was sitting unsuspectingly at a computer (I don't know how else to sit), looking up the difference between ringworm lesions and lyme disease target lesions. You know, minding my own business. I thought I heard some nurses off in the distance saying something like "student" or "medical student"... but I brushed it off and ignored it. I went back to my googling.

And then it happened.

I felt a massive shadow coming up behind me.

I turned around... in time to see half the ER nursing staff approaching me in a pack akin (great word) to a pack of shewolves (yes that word is worth the repeated reference).

I hadn't done anything wrong (other than written a certain blog post several weeks ago which shall remain unnamed here) but I figured I was screwed.

I felt like those folks must feel when the infamous Sumdude - a.k.a. 'some dude' - jumps them without warning, rhyme, or reason. By the way, for those who don't know, Sumdud is an emergency medicine phenom (another great word) documented by paramedics, respiratory therapists, nurses, and doctors alike.

Anyways, they surrounded me, towering over me - only because I was sitting down - and shone a light in my face. And thus they began their brainwashing session.

"Be nice to nurses!" they said. "Nurses know best." The skinny one in the back of the herd adjusted the giant, whirling spiral which I can only assume was meant to hypnotize me into oblivion. "And nurses love coffee - bring your nurses coffee."

I shifted uncomfortably. Their tactics were working. I was feeling their efforts to convince me were working. I nodded my agreement in an attempt to signal to them that the giant stainless steel probe they were holding just inches from my face wouldn't be necessary.

Okay, I was wrong about the light, the whirling spiral, and the probe. But a group of nurses did corral me today, and did tell me to be kind to nurses. They were mostly joking, but obviously there is a certain level of seriousness to their comments - I'd be dumb to assume that these nurses haven't been cruelly treated by a doctor at one time or another - though the doctors I was working with today were outstanding.

Fortunately I was able to explain to them the same thing I said in that other, previously mentioned but unnamed post, that I've been told all this already by my nursing friends and my nurse mother.

I wish this story had a more dramatic ending, but that was it, really; my comments seemed to appease them. The rabid pack broke apart, most of the nurses wandering off into the meds room, still laughing about their indoctrination method, and sharing stories of nursing back in the days when nurses used to stand up when doctors entered the room and mustard poultices and turpentine were common treatment methods, and I went back to my Tinea corporis and Borrelia burgdorferi.

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Sunday, August 12, 2007

New to medical blogs? Vitum's Beginner's Guide to Reading Medical Blogs

Over a year ago, I discovered the medical blogging community, and the amount I've learned from it has been incredible. I linked to my first blog through an online medical forum, found a series I enjoyed (the Don't Become a Doctor series on Incidental Finding's blog), and started reading every post in that series. I was captivated. I loved the humour, the point-blank honesty, and the impact the blog made on me.

I wanted more. But I didn't really have a clue about where to begin reading more medical blogs. I somewhat stumbled through blogs for a while, here and there learning neat things about being a blog reader that I wish I'd known sooner. It would have been nice to know them right from the start - to read them in some sort of concise, brief overview guide. So, after a year of being involved in the medblog community and somewhat 'knowing the ropes' by now, I've decided to put a guide together myself. Here it is.


If you're reading this, you've obviously had some experience with the medical blogging community - this is, after all, a medical blog.

You may not be aware, however, how broad the scope of the medical blog community really is - it took me a while to figure it out. Medical bloggers include, to name a few:

There is so much content in the medical blog community that it might seem overwhelming at the start. So, where should you begin?


There are many genres of medical blog posts - humour, drama, law / politics / policy, research - and any one of these genres can contain any type of content - stories, instructions, commentary, helpful advice, or interesting links.

Just Browsing?

If you're just browsing, and you are interested in a recent digest of the best posts of the medical blogosphere regardless of the topic, you should definitely check out a blog carnival. The authoritative medical blog carnival is Grand Rounds (hosted here in July 2007) - here's a list of past and upcoming Grand Rounds hosts. Other medical blog carnivals include Change of Shift, which has a focus on nursing blogs, and Medicine 2.0 which focuses on the combination of Web 2.0 and medicine.

Looking for Specific Topics?

You may already have an idea of the genres you enjoy, or, more specifically, individual topics within those genres. If that's the case, here's how I recommend finding great posts: Good ol' Google.

Two Ways to use Google

Google is a great way to find individual posts on specific topics that are of interest to you, but you might not have known there are two ways to find great posts on Google.

The first way is using the regular old, but including the keyword "blog" (for example, searching 'medical student blog') - this will sort blog posts by relevance, listing the most linked-to and relevant posts. However, this will show websites that aren't necessarily blogs - news stories, forums, etc.

The second way is to use Google BlogSearch. It works just like Google - the difference is, it only searches blogs, and the results you get tend to be very recent (usually posted that day or week), rather than sorted by the number of links to each post.


You'll find that as you read interesting posts, you'll really like the author's sense of humour or perspective, and you'll look up more posts on that blog. Like me, you might find that you'll read all the archives of a few blogs you really enjoy - every post that blogger has written.


So how can you find new blogs by blogger, rather than each individual post? Again, blog carnivals are a great way to do this, but another great way to discover new blogs is to check out the blogroll on the blogs you enjoy. Most bloggers have a blogroll - a list of links to other blogs. You'll notice my blogroll in the right-hand column, under "Vitum bloggicus" - it's a list of bloggers that I have been influenced by, and enjoy reading on a regular basis, to the extent that I thought my readers would enjoy them as well - so I figured I would post the links.

Blog Ranking Directories

There are directories that rank blogs by topic - the Healthcare 100 from eDrugSearch and the ranking are lists of blogs ranked according to a number of different criteria, which will let you find popular medblogs. These will also help you get an idea of the who's who of medical bloggers, the more famous ones such as Kevin MD and Over My Med Body.


The Amateur Blog Reader

An amateur blog reader finds a blog or two they enjoy, and then they'll bookmark them or try to remember the title. Every so often, they'll use their bookmarks or Google to find those blogs again, head to the sites, and catch up on the latest reading.

If they're lucky, the blog user has posted something interesting since the reader last checked. Otherwise, there might not be anything new. But the downside is, if you go to a blog that hasn't been updated the last few times you checked, you'll get frustrated and could even throw a tantrum, and you might not be inclined to visit it as often.

The Intermediate Blog Reader

That's how I read blogs for almost a year. Then something amazing happened. After countless tantrums, I realized that more advanced - or perhaps just smarter - blog readers make the blogs do the work: instead of you going to a blog to find out if it's been updated, let the blog come to you.

One way to do this is to sign up for an e-mail subscription to a blog that you like. Some bloggers are considerate enough to offer the ability to have new posts e-mailed to you (clearly if I put it like that, I offer this option to my readers). This is good for people who only want to keep track of a couple of blogs.

The Advanced Blog Reader

If you're interested in more blogs than just a few, you might want to consider signing up for an RSS Feed Reader such as Google Reader - almost every blog offers their posts in regular updates through a feed you can subscribe to. I took a long time before I started using a feed reader... and every time I look back I wonder why I waited so long. This way, I can keep track of a few dozen blogs without having to check them so often - I just go to my feed reader and new posts show up whenever they've been written.


Perhaps the best thing about medical blogs is you can play a huge role in the content you're reading. Almost every blog contains the capacity to accept and display reader comments, and most bloggers have contact information available so you can contact the bloggers directly - use these! Contribute to the discussion and increase the quality of the blogs, and you'll improve medical blogs for yourself - and everyone else.


If you're going to hang out in the medblog community, you might as well know about the latest gossip. A major event that had repercussions throughout the medblog community recently has been the disappearance of a couple of bloggers due to patient confidentiality issues. Both The Flea (former Best Medical Weblog winner) and Barbados Butterfly ended up getting attention in the mainstream media (such as ABC News) after they found that medical blogging is hard to mix with getting sued or working in certain hospitals - both of them suffered consequences such as being forced to settle their lawsuit or being suspended from work.

The events sparked lively discussion, and some medical bloggers posted reactions lamenting the loss of the bloggers, and were reminded to be more cautious to keep patient confidentiality an extremely high priority.

Rob from was kind enough to comment on this post and point out the Healthcare Blogger Code of Ethics, a development in the healthcare blogging community that deserve mention in any med blogging guide. The Code is designed to hold medical blogs to a high standard when it comes to the nature of medical blogging, and its goal is to provide benefit for readers and bloggers alike.


Soon you might find that you've got so many things to say in the comment sections of other blogs, that you realize you should start your own blog. Blogger and Wordpress are two awesome, free sites that will get you started on your blog.


That's all I've got for now. Maybe over the next year I'll find just as many tips about medical blogs. Feel free to ask questions about medblogs, or post your own tips for new medical bloggers in the comments below.

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Tuesday, August 07, 2007

You found this blog how?! or, Fun with search engine analysis tools: Volume I

Thanks to the good folks at (leaving out the "www" is the latest thing now, you heard? It's supposedly redundant), I have been quite entertained over the past several weeks taking note of the ways people find Vitum Medicinus using search keywords.

Every so often, I'll see that someone came here through a search term and I wish I could find out who it was so that I could say something to them. So, in hopes that any of these individuals who stumbled upon my blog (and obviously did so quite unintentionally) have
subscribed to VM via e-mail or through a feed reader or check back regularly, and will therefore read this, here is what I have to say in response to your search engine phrases. (If this was actually you, I and everyone else here would be quite interested if you'd leave a comment explaining what was going through your mind when you searched that).

And before you approach me asking "Did someone actually..." I will swear on my hamster's grave, I made none of these up.

  • "Best way to separate frozen burgers"

    I can understand how you'd get to this website if you search that, but until Vitum Recipicus® is born, you won't find the answer here. You'd only find
    how not to separate frozen burgers, something I learned from a surgeon...who did it the wrong way.

  • "Jehovah Witness are corrupt"

    Really... Chaque a son gôut (to each his own), I suppose... but I never made that claim on this website.

  • "Chronic Masturbation"
    (Variations: Effects of masturbation, effects of excessive masturbation, medicine masturbation, what is chronic masturbation, fall asleep masturbating... I'll leave it there)

    Who would have thought that perhaps my most racy blog post (posted in the name of science, of course) would be one of my top search phrases? Okay, I suppose I should've guessed. Here is the blog post you are looking for. I won't ask...'nuff said.

  • "Grey's Anatomy Scrubs"
    (Variations: Gray's Anatomy Scrubs)

    Please don't tell me you actually want to buy these. People are such corporate marketing patsys. Then again, people are influenced by marketing to a frightening degree even in preschool (Children believe carrots in McDonalds packaging taste better), so I won't blame you as much. One thing I do love about this search term - as of right now, when you search that term in Google, my blog turns up higher than the actual website that you can buy them from. Perhaps I should start selling them.

  • "Empathetic Statements"

    Finding and memorizing empathetic statements is probably not going to make you more genuinely empathetic. Oh wait, that's my med school's entire strategy to make us more empathetic. Has it worked? It might make us seem more empathetic, but are we really? The jury's still out.

  • "It's my summer"

    Indeed, it is your summer.

  • "Chest tightness+gets worse in summer and late in day"
    (Variations: How can I tell if a rib is broken)

    Thanks for coming to my site, but on this one I'll have to say, Please do not google your symptoms...especially if it has something to do with chest pain! Not only will no blog actually offer medical advice AND say you should take it (hence the Finus printicus below), but you should go see a doctor if you're sick!

  • "How to give medicine to the patient"

    What is this, an assignment for Caribbean medical students? "Okay, class, now we will learn administration of pharmaceuticals. Open your browser to Google..." (Sorry topher, low blow! I'm only jokin'!)

  • "Take my MCAT for me"

    This one kindof frightens me. I know I don't want a doctor who made it to medical school because he paid someone to take his MCAT for him.

  • "Why do we need our lungs"

    Either someone was 1. extremely, extremely, extremely bored or 2. so clueless they might actually do an autopneumonectomy (I made that up) if they can't find the answer on Google just to see what would happen. I'll ignore the obvious joke potential and not use this opportunity to make another joke about one of my naturopath or Caribbean medical student friends (whom I insult often and only ever in good fun because I actually do respect them).
To be continued with Volume II... "Common Search Engine Questions Answered, or, Google is the New Pre-Med Advisor"...

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Thursday, August 02, 2007

Why Rural Docs have to leave town if they want a vacation

I've written a few posts already about how medicine has started to take over my life. Apparently, it doesn't necessarily end once you've become a doctor.

A doc at a rural conference I went to told me that in order for them to take a day off, they need to literally leave town.

Why? They explained as follows.

One day, early in their career in the town, the doctor was enjoying a vacation day with his family. The phone rang, and the doctor picked it up. "Doctor, I need your help please."

The doctor explained, "Sorry, today is my day off," and made a mental note to not pick up the phone during his next day off.

The next time he had a day off and the phone rang, he decided he'd let the machine get it, just in case it might have something to do with work. Sure enough, the message started out, "Doctor, I need your help..."

Shortly after, the phone rang again. It was the same number. Another message was left:

"Doctor, please pick up the phone, I know you're home, we can see your car in the driveway."

And that's why doctors in a small town need to leave if they want a break from work. Yep, medicine can take over your life.

If you want to know more about what it's like being a rural doctor, check out this brief article, recently published in the Canadian Journal of Rural Medicine: You Know You're a Rural Resident When... Selected highlights:

  • You've delivered a baby in a canoe
  • You've eaten a Canada goose.
  • You've body checked your preceptor during a hockey game.

Read the rest...

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