What is the worst way to combat school shootings?

Please read carefully because there might be a test.

A school district in Pennsylvania placed a 5 gallon bucket of rocks in each classroom two years ago. If locking and barricading the classroom door does not work, the students have been instructed to throw rocks at the would-be shooter instead of hiding under their desks.

According to a Buzzfeed story, the school superintendent for Schuylkill County believes the rocks serve as a powerful deterrent. He said, “If an armed intruder attempts to gain entrance to any of our classrooms, they will face a classroom full of students armed with rocks. And they will be stoned.”

Maybe it’s working. Since the arrival of the rocks, there have been no shooter incidents in any Schuylkill County school.

What has society come to?

A medical student who corresponds with me wrote the following. It has been edited for length.

She was shopping at a mall with her husband and their children.

As I walked underneath the escalators, I heard a horrific sound. I looked up and saw a body cartwheeling down. I ran to front of the escalator to push the stop button. An 80 or 90 year old gentleman was lying partly on and partly under his walker. He seemed unconscious with blood all over the place. I said "Sir, sir," saw his fingers move, and called 911.

A black man from the top of the escalator made eye contact with me and came running down to see how he could help. He hesitated, his face and body language screaming fear, but he came over. He knew he had to once we made eye contact because I was the only one actually doing something.

A security guard who was heading to work arrived. He had no gloves, no radio, nothing. Why wasn't anyone from security coming? What's the point of security cameras? Wasn't there anyone watching? I turned around to see who else could help. About a dozen people were just standing there with their cell phones taking pictures and videos. Not a soul asked me if they could call 911. In fact when I called 911 a second time, the dispatcher asked me if there were more people with me because I had placed the only two calls.

Is obesity a disease, a disability, both, or neither?

In 2013, the American Medical Association recognized obesity as a disease. Dr. Peter Ubel, writing in his blog on the Forbes website, thought this was a bad idea. He feared that calling obesity a disease will result in people having less motivation to lose weight and cited a study which found that people who were told that obesity is a disease tended to be less concerned about their weight and when offered a sandwich for a hypothetical lunch, chose less healthy food.

Although he gave good reasons why obesity should not be considered a disease, he favored retaining the disease label because it would help reduce the stigma attached to obesity and build public support for programs to conquer obesity. I am not sure about that.

Back in December, the BBC reported that the European Court of Justice heard the case of a 352 lb Danish childcare worker who was fired from his job because he couldn't bend down to tie children's shoelaces. He denied the allegation.

The European Court "ruled that if the obesity of the worker 'hinders the full and effective participation of that person in professional life on an equal basis with other workers,' then obesity can fall within the concept of 'disability.'" Danish courts need to hear the case and decide if the worker is truly disabled. The ruling affects all other countries in the European Union.

The Editorial Board of the Chicago Tribune commented on the issue in a piece entitled "the dangers of treating obesity as a disability." It mentioned a Texas case in which a court said a company that dismissed a 600 lb materials handler could not do so because they had not tried to "find ways to help him perform his duties."

The Tribune article pointed out that one-third of Americans are obese with 15 million (7% of the population) classified as morbidly obese. The board felt that this was a potentially very costly expansion of the Americans with Disabilities Act, which they say was intended to help those who were disabled not by individual decisions, but rather were "victims of fate." It did not address the fact that many are disabled from smoking-related emphysema. Are they victims of fate or poor choices?

A recent editorial [full-text here] in the American Journal of Medicine took it up another notch. The author, Dr. Robert M. Doroghazi blamed obesity on eating more calories than one burns—a hypothesis held by many. Regarding the war on obesity, he said, "We will not make progress until we tell obese patients they eat too much, and it is their personal responsibility to eat less." Too harsh?

Disease, disability, both, or neither? What's your opinion?

Dr. Topol's bad day

Dr. Eric Topol is a cardiologist, author, editor-in-chief of Medscape, and genomics professor. In 2009, he was named one of the 12 Rock Stars of Science by none other than GQ magazine.

But even rock stars occasionally have a bad day. After blogging for almost 5 years, I sometimes have trouble thinking of things to write about. This apparently happened to Dr. Topol the other day. He published a Medscape article with an accompanying video about how doctors are being squeezed by many outside forces that require them to do things they don't want to do.

It was kind of a rambling discourse in which he suggested that doctors should offload the responsibility to do these "more mundane aspects of care" to the patients. He thinks this would make medicine more exciting "the way it used to be."

Dr. Topol offered this cartoon to illustrate the outside forces that are squeezing doctors.

Genomics is a focus of Dr. Topol's research, but I don't think a lot of doctors are concerned that they lack knowledge about it.

His post created a lot of controversy prompting Medscape to take down all of the comments.

With great foresight, one physician, Dr. Kristin Held, preserved her comment with a screenshot which I have thoughtfully provided for you below.

What do you think she really wanted to say with the start of her second paragraph? Could it have been "How about growing a _ _ _ _ of _ _ _ _s?

Like Dr. Held, I have no idea which of the "mundane aspects of this new world" Dr. Topol had in mind to offload on the patients. Of the 16 forces squeezing doctors that he illustrated, I don't see many of them being taken over by patients. They already control patient satisfaction and what's written on Yelp. Maybe they can cover the lack of genomic knowledge too.

It's sad that an influential doctor like Topol is so lost in the woods. However, the bright side is that gave me something to write about.

Does anyone really read anything online?

Not long ago, I tweeted a link to a very long story. Within 60 seconds, it received three retweets. Since the article would have taken at least 10 minutes to read, it is highly likely that those who retweeted it did not read it.

This phenomenon is not limited to Twitter. A couple of recent articles revealed some interesting data about what people really do online.

From Time magazine in early March: "A stunning 55% [of those who clicked into an article] spent fewer than 15 seconds actively on a page. [emphasis theirs] The stats get a little better if you filter purely for article pages, but even then one in every three visitors spend [sic] less than 15 seconds reading articles they land on."

Analysis of 10,000 articles shared on social media "found that there is no relationship whatsoever between the amount a piece of content is shared and the amount of attention an average reader will give that content."

A Slate article noted that about 5% to 10% of those who open an article leave it immediately and 38% of people who click on it "bounce" [leave it] before the end of the first paragraph.

At a few hundred words into the article, about half of the remaining readers have left, and very few of the rest make it through to the end.

The amount of scrolling can also be tracked. "There’s a very weak relationship between scroll depth and sharing. Both at Slate and across the Web, articles that get a lot of tweets don’t necessarily get read very deeply. Articles that get read deeply aren’t necessarily generating a lot of tweets."

On April Fools' Day, NPR published a story called "Why Doesn't America Read Anymore?" There was no article [emphasis mine]—only the headline and an explanation of the fact that they wanted to see if people would comment anyway. They were not disappointed as many brainless comments rolled in. This Gawker post has the best of them.  

The Washington Post noted that in addition to diminishing attention spans, we are developing into a nation of superficial readers. “It’s like your eyes are passing over the words but you’re not taking in what they say,” said a graduate student in creative writing.

Attempting to stay with the trend, last week both the Associated Press and Reuters directed their reporters to limit stories to fewer than 500 words.

If anyone is still reading this, what it means is that I should not feel slighted that people are retweeting me without necessarily reading what I so carefully and lovingly select for dissemination. 

It's not me. It's you.

PS: I am aware that some people retweet things and plan to read them later. But how do they know that what they have retweeted is worthy? Or does it matter?

Who would ask an anonymous blogger for medical advice?

I'm often asked why I use a pseudonym. When I first started blogging almost 4 years ago, I was still in practice. Some of my posts are a little edgy and my sense of humor is not for everyone. I didn't want patients to google me and have my blog come up on the first page of hits.

Now that I've been retired for over a year, I still have not revealed my true identity. You may ask, "Why not?"

I like being anonymous. I feel that I can be more honest because I am not worrying about what someone is going to think. A quote from Oscar Wilde says it all: "Man is least himself when he talks in his own person. Give him a mask, and he will tell you the truth."

Some people have questioned my credibility. They say how can anyone believe what you write when they don't know who you are? I've been referred to the UK General Medical Council's rule #17, which states "If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely."

Regarding the previous sentence, I agree with the first part about trust and strongly disagree with the second part. How could anyone think that what a single doctor writes is representative of the profession more widely? I am reasonably certain that is not the case in my situation.

You want credibility?

A single post of mine called "Appendicitis: Diagnosis,CT Scans and Reality," which I wrote about three weeks into my blogging career, has received almost 14,000 page views.

In the comments section of that post or via email, more than 50 people have asked me questions about their own or a family member's abdominal pain. I've had to add numerous disclaimers over the years reminding readers that I could not give medical advice without examining the patient.

Despite the disclaimers, the questions keep coming with the most recent one submitted two days ago. I can only guess that they are either reluctant to ask questions in person or not getting satisfactory answers from the doctors they are seeing.

Premed and medical students and residents frequently look to me for career counseling. Last week I even got a question from a high school student who was thinking about becoming a doctor. The students and residents occasionally preface their questions by saying that they didn't want to ask someone from their school or residency program for fear it would reflect poorly on them.

I have been amazed at how many readers seem to trust me enough to ask personal questions about their health or their career. To be able to connect with so many people despite my use of a pseudonym is rewarding.

Patients and aspiring doctors—that's who would ask an anonymous blogger for advice.

A prank in the OR backfires

An anesthesiologist at a California hospital pasted stickers simulating a mustache and teardrops on the face of a hospital employee while she was having surgery on a finger.

According to the LA Times, the doctor said, "I thought she would think this is funny and she would appreciate it."

And if that wasn't bad enough, a "nursing attendant" took a photograph.

The patient, who said she had to quit her job because of the humiliation, is suing the hospital and the physician for this confidentiality breach.

The woman who took the photo said she deleted it after showing it to the patient and didn't post it anywhere. One version of the story is that she texted the photo to the plaintiff.

Others have testified that they saw the image on Facebook although the hospital said that there is no proof the photo was ever posted online. Multiple news outlets, including the LA Times, have published the photo which was obtained via court documents. 

One thing is certain. The photo is readily available now.

The plaintiff also claims that general anesthesia was unnecessary and only used so that the picture could be taken.

The anesthesiologist and some hospital employees were disciplined, but the hospital says the patient has fabricated and exaggerated some of her complaints.

At a deposition, a nurse manager at the hospital testified that in 2009, a sales representative took some pictures of a naked patient in the operating room. The hospital maintained that no such photos were ever taken. But then not only barred that sales rep from its OR, it also established a policy that no cell phones or cameras would be permitted in that area. This was an attempt to rectify a human error in judgment and common sense with a system correction. Obviously, it didn't work.

There are lots of issues to discuss.

It seems the OR is not a good place for a prank.

Bad ideas. One, pasting the stickers on the patient. Two, taking a photo (without consent). Three, texting it to the plaintiff. Four, posting it on Facebook (allegedly).

The Internet doesn't forget. Once something is posted it tends to stay there—somewhere—forever.

There is this thing called HIPAA, which contains many strict rules about patient privacy. People have been fired, fined, and even jailed for breaches of patient privacy.

Why didn't the hospital settle this case, which has gone viral? Do they really think they can win? Have they never heard of the "Streisand Effect"?

The hospital had a policy of no cell phones and no photos in the OR, but it was observed about as well as the 55 MPH speed limit. 

If there is nothing else to learn from this case, a hospital should not establish policies it cannot or will not enforce. Lawyers feast on that sort of thing.

Bottom line: The cell phone and its camera are not the culprits here. Smartphones don't take pictures of people; people take pictures of people.

Is this the most bizarre bad doctor of all?

There seems to be no shortage of bad doctor stories going around right now. Just when you thought you'd heard the worst, along comes another.

A "cosmetic surgeon" in California has lost his license to practice medicine and has been charged with involuntary manslaughter in the 2010 death of a 61-year-old woman during a 10-hour liposuction procedure being done in his office. She apparently died from an overdose of lidocaine, fentanyl and oxycodone.

Like some other cases involving doctors who lost their way, this physician trained at renowned institutions. In this case, the doctor was described as having done a residency at Columbia, a chief residency at Johns Hopkins and a fellowship at MD Anderson Cancer Center. 

His training was in obstetrics and gynecology, and he was not certified by a legitimate American medical board. He called himself a cosmetic surgeon but apparently had no formal training in cosmetic or plastic surgery.

Here is a list of some of the other major issues with this doctor.

 

In addition to the manslaughter charge, he was charged with elder abuse of a 77-year-old woman who also had complications during liposuction.

He charged patients exorbitant fees for procedures, allegedly as high as $650,000, but routinely in the range of $50,000 to $100,000.

He once anesthetized a patient for surgery, and while she was sedated, had her sign for more surgery at an increased fee.

He offered discounts to patients if they would enroll in a Harvard University study, which was later proven to be fictitious by Charles Feldman, a persistent investigative reporter for a Los Angeles radio station.

He is currently in jail, having been tried and convicted of attempted grand theft for trying to sell $20,000 worth of medical equipment he did not own.

The California Medical Board was warned about him by other surgeons two years before the death of the liposuction patient.

He has been living illegally in the United States since his visa expired in 2006. Apparently the California Medical Board and most other boards do not check on things like visa status when doctors apply for or renew licenses.

After the death of his patient and the restriction of his license to non-invasive procedures, he started advertising his services using only his first name so that Internet searches would not reveal his licensing problems or stories about the patient who died.

At some point near the time of the liposuction patient's death, the doctor was rushed to a hospital from his office having called an ambulance when complications arose while attempting to perform a hernia repair on himself. The homicide detective who investigated the case said, "That caused me to question whether [the doctor] was in complete control of his faculties."

It is ironic that he even botched the surgery he tried to do on himself. He should never have believed his own advertising, nor should anyone else have.

Once again, this doctor could have been stopped before that liposuction patient died, but the medical board did not act.

It is sad for the patients and the families he harmed. 

PS: His Healthgrades score today is 4.4 stars.