Posted by: sayamika, the killer bunny | 2010 February 27

Informed consent

Dear Young Mum:

Yes, she’s gorgeous. Growing beautifully. You’re doing everything right.

I understand you were concerned about her vaccinations. It’s okay, there’s a lot of information out there and it can be hard to sort out the true from the woo. You just want to do the best for her.

I want to say thank you for asking me, for voicing your concerns, for allowing me to voice my bias and the reasons behind it. I want to say thank you for listening with an open mind. I want to say thank you for asking for clarification.

You made the right decision.

You also made all the time I spent in school to get to this point worthwhile.

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Posted by: sayamika, the killer bunny | 2010 February 19

*ahem*

Mine is a small, no-traffic blog. You won’t miss it when I move.

However, suspending an account because someone called a quack a quack? Seriously wordpress? Uncool.

UPDATE: For the Sake of Science is back up. I don’t know what changed the minds of the powers that be, but I hope they learned a little about debate, science, and the Streisand effect.

Posted by: sayamika, the killer bunny | 2010 February 8

Men are funny

Me: “Nice to meet you, I’m Dr. Red. What brought you here today?”

Man: “I dunno. My wife made the appointment.”

Posted by: sayamika, the killer bunny | 2010 January 31

Retraining

Dear new patients:

Thank you for your lovely wishes and expressions of happiness that I will be coming in to take on a portion of Dr. Mentor’s practice.

You all seem lovely.

I think I have figured out why she needs to retire, however.

There are going to be a few changes to how things are run. Firstly, I will do my utmost to keep afternoons open for same-day/next-day appointments, so hopefully your access will not be compromised.

Second: I will ask you every time I see you if you have sufficient medication to last to your next visit, and if the answer is no, we will renew your medications then. I do not want to continue having 60 faxed prescription reqests a day. It is a waste of paper and time.

Third: if you need pain or antianxiety medication or antidepressants, I need to see you.

Fourth: If on three consecutive visits you show up wearing a copper bracelet, talking about your chiropractor, and telling me you are “controlling” your cholesterol (which is 8.2) with herbs and you don’t want to take medications, I will ask you to remove yourself from my roster and see a naturopath, because that is bullshit. Ditto for refusing flu shots and not vaccinating your children. Clearly you don’t need real medicine if you don’t believe in it. Right?

My goal is to do my best to serve the population that wants and needs a family physician, while not getting burned out in the process. Thank you for your understanding on this matter.

PS: I love my staff. Just sayin’.

Posted by: sayamika, the killer bunny | 2010 January 30

Ortho dudes R kewl

Actual conversation had today:

Ortho dude- Did you ever dislocate someone’s hip before?
Me- Urr, no.
Ortho dude- It’s all about the leverage.
Me- *barf*

Posted by: sayamika, the killer bunny | 2009 December 28

Update 2010

1: Get up to five a day. – that was easy.

2: Get a dog. –not home enough to give one a good home. Yet.

3: Get a real job. –I’m taking on half a practise, doing some ED work, and some surgical assists. I think that counts.

4: ….or locum for a while. Meh. –Did that, last locum this week.

5: Convince my husband we don’t need to repaint the kitchen. – ok, so that wasn’t hard.

6: Stain that giant naked piece of furniture. –it looks great.

7: Figure out where I want to put the tomato plants. –I think it’ll be somewhere different next year.

8: Trim the apple trees. –did that, now just need to trim the cherry and pear trees.

9: Get over the arachnophobia already. –hehehehe… no.

10: Catch the mouse (mice, surely) in the kitchen. –caught four this week. Ugh.

11: Bully my hairdressser into a style I like. –I gave up on her and got my hair done in the city. I *love* my new hairdresser.

12: Learn the alphabet in Arabic. –yeah, no.

13: Travel someplace where it isn’t snowing while it is snowing here. –this year, I hope.

14: Get more comfortable with rheumatology. –hm. Still more to learn.

15: Get my complete neuro exam down to four minutes. –not possible. Seven minutes is OK.

16: Do an LP. –not yet.

17: Do my ATLs. –not yet.

18: Refresh my ACLS. –scheduled.

19: Stop eating chicken. –more or less. I just hate the battery farming, so I choose not to contribute.

20: Get more White Stripes into my daily life. –  still love ’em

24: Update my “absolutely essential groundbreaking articles” file. –ongoing.

25: Get a pedicure. –heheheh.

26: Join a hockey team. –hm. This should be prefaced by “improve skating abilities.”

27: Get drunk enough to try karaoke. –lol, no.

28: Go back-country camping. –not this year, only car camping.

29: ….with canoes. –*sigh*

30: ….. and don’t get eaten by bears. –success!

31: Reclaim at least one committed set of anti-vaccine parents for rationality. –not really, but gave out a lot of information and made people think about where they were getting their information.

32: Post some manner of sign in my office that will prevent religious people from trying to convert me. –it’s not “officially” my office yet.

33: Drive to Hamilton without getting lost. –I don’t even need the GPS anymore!

34: Finish this flipping project. –it was a hassle, and now it’s OVER!

35: Get published. –hm. Not even tried.

36: Go horseback riding. –no.

37: Make more crepes. –O yes.

38: Use the breadmaker at least monthly.-I think on average it’s close to monthly.

39: Teach my husband to grocery shop. –FAIL. If he does the shopping, we will have exactly four items: milk, bread, tea, and beer.

40: Frame the paintings I brought back from Malawi. –one down, three to go.

41: Get used to saying “president Obama.” –  like most liberals, I’m pretty disappointed. But he’s a step in the right direction

42: Avoid Walmart entirely. –Oh fail. But I love this about Walmart.

43: Win something. Anything. –no, but that’s OK.

44: ….even if that means buying raffle tickets. –hm, that may be why.

45: See one of my heartsink patients without getting a headache. –once or twice, but still, they kill me.

46: Remind people that Volkswagen is built in the US, Subaru in Canada, Toyota in Canada, and Honda in Canada. –constantly.

47: …. and that they are just better products. –also, constantly.

48: Convince my co-worker to let me test-drive his Porsche. –not yet, but I’ll keep trying.

49: Visit my sister. –yes.

50: ….and my mother. –yes.

51: ….. and my cousins. –yes.

52: …..and meet all the new babies.-yes. Well, most of them.

53: …..before they learn to drive. –  ok, so I have a little time. And there are more babies on the way!

57: Go to a Habs game. –no. *sob*

58: Go to a Leafs game (preferably vs the Habs). –no, but I’ll live.

59: Get all those birthdays into something that will remind me to send cards! –getting there.

60: Learn some guitar. Elvis only knew 4 chords! –no. Also, guitar is way hard on wimpy fingertips.

89: Stop obsessing about my BMI. –FAIL

90: Practise my français. –yes. I had no choice.

91: Finish all this busywork. –yes. There was a deadline.

92: Get rid of the defunct Nissan in the garden. –yes.

93: …..else bite the bullet and use it as a planter. –hmm. O, that would have made me popular.

94: Get more than just basil to grow in the garden. –yes. Rosemary, thyme, onions, oregano, chives, and cilantro. But the basil refused to grow, for some reason

95: Save myself for the really good chocolate. –mostly.

96: Reduce the procrastination to something manageable. –c’mon, I’m only human.

101: Do the BMW driving course. –Oooooh…. not yet.

102: Plant strawberries to go with the rhubarb that is taking over. –I forgot!

103: Go snowboarding at least 3 times. –O. I guess I’d better go twice this week.

104: ….preferably without needing to visit the ED. and there is that.

105: Go snowshoeing. –yes. Many times. Invested in a pair.

106: …. or ice skating. –yes. Many times.

107: …. or hanging out in a hot tub. –yes. Once or twice. Outdoors, in -20C. It was AMAZING.

108: …. or whatever it takes to put the kibosh on seasonal affective disorder. –Hurrah pharmaceuticals!

109: Find something cultural to do in rural Ontario. –still working on that.

110: Pass the last of my exams. –yes.

111: Join a yoga class. –no.

112: ….. and actually go. –boy do I know me.

113: Learn to knit (because I can). –yes.

114: Get my Td. –yes.

115: Become the local “travel doc.” –on the road, but not there yet. It involves storage of very sensitive vaccines, so we shall see.

116: Plant more roses. –yes.

117: Clean out the Rabbit. –yes.

118: Win the thistle war. –that was optimistic!

119: Call a truce with the dandelions. –depending on what you mean by truce. I think it’s more of a war of attrition.

120: Learn to like spinach (yuk). –yuk.

121: Use more fresh cheese. –mmmm cheese.

122: Switch to whole-grain pasta. –yes.

123: Look into a legal name change. –no.

124: Go to an OHL game. –yes. One.

125: …..as the team doc. –not yet.

126: Get Sari to come visit. –yes.

127: …. and Cathy. –yes.

128: …. and Marieke. –(you’re invited, hon!)

135: Chuck three (3) drug reps out of my office for entertainment. –no. I’ve successfully ignored them, but they are a necessary evil here in Ontario. We need a stash of “free” drugs for people without presciption drug insurance who cannot afford their drugs. This is not an issue in Quebec, and it allows people to fall through the cracks.

136: …and then chuck their drugs after them (are you listening ezetimibe?). –*sigh*

137: Give a presentation. –yes.

138: ….. without blushing like a rose. Or a tomato, whichever. –yes.

139: Start OR assisting again. –yes. Scheduled for January.

140: Learn to do c-sections. –no. A change in plans. Maybe at some point.

141: Feel comfortable with my sloppy house. –I wonder if that’s possible.

150: Equalise my uptodate and facebook time. – *crickets*

151: Call my mother. –yes.

152: ….and try not to argue with her. –yes. Once or twice.

153: Wash my car. –I must have, at some point.

154: Figure out an alternate means of transport when I live 37 km from my office in rural Ontario. –still working on that.

155: Start hypermiling. –no. But my car is tuned, and I don’t jackrabbit off stops. I’m running 9.5 L/100 km with snow tires, warmups, and full time AWD.

156: Go treetop walking. –yes. And it was BRILLIANT.

157: Bring my husband back to my childhood home. –not yet.

158: ….. but make sure he doesn’t stay there. – that might be a workout.

159: Spend more time in Montreal. –yes.

160: Find something about Toronto I like. –still looking.

161: Re-visit NYC. –yes. I *heart* NY

166: Pay off VISA and make a dent in Mastercard. –yes. Actually, both should be paid off this month.

168: Learn to hate potato chips. –still working on that.

169: Stop having the Tim’s breakfast of champions. –yes. They stopped making what I like, so I don’t go anymore.

170: Vote. –yes.

171: Get on the do not call list. –yes.

175: Celebrate Robbie Burns’ Day. –yes.

176: …. whilst avoiding actual haggis. –yes. *phew*

177: Clear up my computer. –yes. But someone messed it up again.

178: Restart quilting. –not yet.

179: Throw a party. –nope.

180: …. for more than just two people. – errrmm…

196: Buy some wine glasses. –yes. And someone broke them. Two steps forward…

197: …. not at the Dollar Store. –yes.

198: ….. and teach the man how to not break them. –FAIL

199: Download Relentless by Theory of a Deadman. –yes. *sigh*

200: ….and take the opportunity to go see them next time they come. –missed it!

201: Do things instead of making lists. –Oh. Crap.

Pretty sorted? I thought I would be pretty sorted?

Ah, optimism. It’ll bite you in the ass every time.

Posted by: sayamika, the killer bunny | 2009 December 1

Dalton McGuinty’s big FAIL

As a physician, I am somewhat perturbed by the idea of allowing pharmacists limited prescribing privileges. From what I understand, the reasons behind physicians not being permitted to dispense are multifold.

We’re not trained to do so.
The multiple steps involved in writing and filling prescriptions allow for more chances to catch interactions and errors.
There could be a conflict of interest if the prescriber also collected money for a medication, leading to prescribing of more expensive medications or medications that have a higher profit margin instead of perhaps a more appropriate medication for the patient.

Why none of these are an issue with pharmacist prescribing is beyond me. I don’t want to dispense. I am trained to diagnose and manage various conditions, through lifestyle advice, counselling, surgical intervention, and yes, medication.

Pharmacists have an excellent understanding of medications, dosing, delivery, interaction, and biological effects, far superior to mine, and I do call and ask for advice when I’m in doubt. They call me and query my nonstandard or off-label uses, but a short conversation regarding thought processes and safety usually clears things up. But they do not have my training any more than I have theirs, so I’m not in favour of pharmacist prescribing.

All of that said, pharmacists have a highly evidence-based training. They have, as I have said, an excellent understanding of pharmacologic effects on human physiology.

Naturopaths on the other hand?

Not so much. Phytotherapy, as an example, being the study of herbal medications, must needs be limited to those herbs for which there either lacks scientific evidence for effect, and those for which there is actual evidence for lack of effect. If there is evidence for an effect, mainstream science quickly and merrily assimilates it. And aromatherapy? Seriously?

Naturopathy is based upon the idea that left to its own devices the body heals itself.

With which statement, fair credit, evidence-based medicine agrees, to a point. Macrobid, for example, is a common antibiotic used to treat bladder infections. If the body was not participating in its own cure, this particular antibiotic would be useless, as it merely prevents growth of the bacteria, and relies upon the body’s own defences to cure the infection.

Naturopaths have long been opponents of the evidence base that medicine uses to decide the standard of care. They demand to be allowed special privileges regarding the standard of evidence they use. They cite “other ways of knowing,” and “there are limitations to the randomised placebo-controlled trial.” Indeed there are limitations, but anecdotal evidence, while making for great advertisements and internet arguments, is, if anything, a starting point in science.

Shorter: pftft to other ways of knowing, it’s either useful or it’s not.

Naturopaths are part of the anti-vaccine movement. They buy into the “toxins” theory of disease. They have long argued against the medications they now argue to be allowed to prescribe. If they think medications are so toxic, why on earth do they want to be prescribing them?

In Ontario, Dalton McGuinty’s Liberals originally removed Naturopaths from the list of professions with prescribing privileges. Pressure in the form of a letter-writing campaign put the Naturopaths back on Bill 179, which will soon see its third reading. They are going to allow Naturopaths- anti-evidence based woo practitioners- to prescribe powerful biologically active medications about which they have no understanding. I don’t get it.

This is the government which is currently doing a great job on the largest mass immunisation campaign in Canadian history.

Message to McGuinty and Party: stop this stupidity in its tracks, before you fuck up, something fierce.

Posted by: sayamika, the killer bunny | 2009 November 5

Channeling Nelson Munch: Point and laugh now

Behavioral optometry and homeopathy are probably compatible, both being based on no science that scientists understand. Check out this very entertaining video for an explanation that leaves me, for one, scratching my head.

“So, if I wanted to make a bomb, and I… took all these chemicals and I encased it in a… ss… you know a… a BOMB… ok… and tonight my neighbour lets his dog poop in my yard. Literally, ok. And I’m mad at that dog and my neighbour. So I’m gonna take this bomb and I’m going to get back at him. So what if I threw that bomb at his house? ” -Charlene Warner

Um. Sure. I’m glad I’m not your next-door neighbour, even without a dog.

Even more entertaining: the person who originally posted the video on youtube has now received this letter:

Dr Charlene Werner

I thought you would like to know that you will be contacted by Dr Werner’s Attorney shortly regarding her video. The posting of this video is in violation of copyright laws. We are aware that you have had this video up since March of ’08 however I suggest you delete it immediately.

Jayson Patrick

*sigh*

Lady, you do not understand how teh interwebz works. Good luck with that.

Please repost! Everywhere!

h/t Pharyngula, Science Based Medicine, and a few others.

Posted by: sayamika, the killer bunny | 2009 October 31

Another reason to love ebay

When a group of poisonous obsessives wanted to hold an online auction to raise money for the murderer of Dr. George Tiller, ebay refused to host it, stating that the items in question violated their policy regarding offensive materials.

That anyone would want to raise money for a doctor-killer creeps me out. That they’d do it by auctioning materials which describe how to bomb a clinic….

I am speechless. H/T Feministing

Posted by: sayamika, the killer bunny | 2009 October 20

CC: Diarrhea

Me: How long has this been going on?

Patient: Oh, about two months now.

Me: Are you losing weight?

Patient: Well, no, I seem to be fine.

Me: How often are you having this diarrhea?

Patient: Once and sometimes twice in a day.

Me: Do you get cramps? Pain?

Patient: No, just I have to go.

Me: Is it watery?

Patient: No, not even very runny, just awfully soft.

Me: Any blood or odd colours?

Patient: … er…. it’s just a medium brown.

Me: Are you particularly gassy?

Patient: Oh, I pass the odd gas, but not terrible.

Me: So, to recap, you’re having soft, medium brown stools one to two times a day with no pain or urgency. That doesn’t sound like diarrhea.

Patient: Well, no, I suppose, but I usually have one big hard stool a week.

Me: Has your diet changed at all?

Patient: Not really.

Me: You live around here, right?

Patient: Yes.

Me: You grow your own food?

Patient: Well, I garden a bit.

Me: What’s good this year?

Patient: Oh, well, the beans and the squash have been excellent. Not to mention the cabbage. And the cauliflower! And….

Me: I think we’ve discovered what’s going on…..

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