Tuesday, June 24, 2008

Shrink Rap Grand Rounds: The iPhone 3G Edition

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Tuesday, June 24, 2008

My Three ShrinksGrand Rounds 2007MediphoneTortureExcellenceAnorexiaRecoveryVideo PainDrink RightThe JointDr NurseTiny ShrinkBreastNot SickPubMedWinnerADD PhonePopcornDroolingWhat's NewWeb PowerEating NemoPillgateExpressRxiPhoneMail1Safari1iPod1My Three ShrinksNSAIDLabelsSexSwaySham PtEnvironmentDevicesMore AppsPainOne HourCuttingPotter HatSpyingReformAntiPhoneDifficultInsuranceDiscrimStragglerDucksiTunesPrivacyPTSDPhone2Mail2Safari2iPod2

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Welcome to Grand Rounds, Volume 4, #40 (see future GR schedule). If you missed our first Grand Rounds last year, with our amazing Clicky Brain, then feel free to pause and enjoy.

This year, since the anticipated release of the Apple iPhone 3G is just around the corner (July 11), we asked for submissions to have some connection to the iPhone, no matter how twisted the logic is to make the connection. The medical blogosphere obliged. So we are including, free of charge, our Clicky iPhone, which will let you visually navigate this week's Grand Rounds submissions (yes, the buttons on the phone really work).

Of course, below that is the regular text for you old-schoolers. And if you have low vision or prefer to LISTEN to your Grand Rounds, you can get our PODCAST of it HERE.

We'll start off with the posts which most closely held to our iPhone theme. Why an iPhone theme? Well, besides the fact that Roy is the resident Apple fanboy and Clink the fangirl, the iPhone has a lot of potential as a flexible and easy to use tool for today's health care professional. Sure, Roy wrote a tongue-in-cheek post about using it as a multi-faceted psychiatric tool, the iShrink, complete with breathalyzer and tremor-diagnosing imaging software, but the fact that its standards are open for third-party development means that we will see a tremendous amount of software written for it and available in the App Store. Joshua from Tech Medicine reviews some of the coming medical applications. Oh, and if you're already tired of hearing about the iPhone, you may as well just close your browser window now, because it only gets worse (better?).

EDIT: Yikes! It's already into Wednesday and I found out that I missed two Grand Rounds submissions... just left them off completely. Sorry about that. But here they are right at the top, so please check them out...

1. Social worker Still Dreaming writes about "Why I Don't Care About the New iPhone." I know what you're thinking... I really did just overlook her. (She actually like the iPhone.)

2. Midwife With a Knife has an excellent, scholarly post about restrictions on work hours for residents. Wish there were restrictions on hours for producing Grand Rounds!

Here's the rest...

Jeffrey from Monash Medical Student also points out some other medical applications for the iPhone.

Annie from Home of the Brave writes about a growing body of evidence which demonstrates that nurses, physicians and psychologists have been used by the government as agents of abuse and torture.

JeffreyMD notes that "Apple has long been considered to be a company that strives for excellence in their products." Which brings us to his post on The Pursuit of Excellence on a personal level. [Good reach.]

What if Apple was no longer deemed to be a computer company? Am from the Cockroach Catcher (yum) speculates about what if anorexia nervosa was no longer deemed to be an illness.

David from Mariana's Eye is still recovering from Grand Rounds last week.

In addition to detecting intoxication, doing your laundry, and filling out your clinic paperwork, the iPhone can play videos to reduce your pain, according to How to Cope with Pain.

How do you prevent neck pain from talking on your phone too long? Jolie from Fitness Fixer teaches us how to use your neck correctly.

Does the Joint Commission have standards for iPhone use in hospitals? Kim from Emergiblog has a humorous script for them when they show up unexpectedly. (Scroll down past the part about smoking.)

PCPs, watch out! "The ascendancy and final triumph of the doctor-nurse is as inevitable as that of the iPhone. Except that, unlike the iPhone (which only has Apple and ATT behind it), doctor-nurses have the undying support of the entire federal-industrial-medical complex (not to mention the formidable Mary Mundinger)," so says Dr Rich from Covert Rationing Blog. [Who's Mary Mundinger?]

Tinyshrink from Why Am I Still Here reminds us to heed HIPAA while using our iPhone on the elevator.

Louise from Colorado Health Insurance Insider says that the iPhone 3G will be the most convenient place for doctors to find and display information about the benefits of breastfeeding to women in hospitals or in remote locations.

Hypochondriac? Jenni from Chronic Babe thinks her always-sick relatives would love the internet connectivity of an iPhone.

Second Life on the iPhone? Bertalan from ScienceRoll wonders if it's possible (this is a Medicine 2.0 carnival).

Inspired by the design innovations in Apple's iPhone 3G (see her Open Letter to Steve Jobs), Amy from DiabetesMine ran a design challenge to encourage innovations in diabetes care. The response was amazing: check out the winners. And, you can listen to the winner on out Grand Rounds Podcast.

Should your 7-year old get an iPhone? Will it cause ADD? See what Mother Jones has to say at Nurse Ratched's Place.

Sandy at Junkfood Science notes that a group in Santa Fe fear getting fried by cell phones and wi-fi, so are trying to get these banned from public buildings. Next thing you know they'll be using iPhones to pop popcorn.

Drooling over the iPhone 3G? Tony from Hospital Impact is. It's a doctor's next best thing.

Laurie at A Chronic Dose eschews the new iPhone and other new medical treatments, finding that what's old is new again. (She gets the gold blogging star for sending me her post while waiting to be seen in the ER. Who needs an appendix, anyway?) FYI, Laurie's new book, Life Disrupted, comes out this week.

Using the web (even on an iPhone) to interact with your doctor improves satisfaction of the patient and the provider. Check our Graham's post on Canadian Medicine, where he describes patients who are happy to pay a small fee for the privilege. Listen to Graham on our Grand Rounds Podcast.

Dr Shock reviews the latest Cochrane evidence-based medicine on the use of omega-3 fatty acids for bipolar disorder, noting that the little iPhone clownfish here are one of the highest in omega-3's.

What if, when you got to the front of the line, the Apple guy gave you a Blackberry instead of an I-Phone? After all, they do essentially the same things, right? Henry at InsureBlog has the disturbing story of a pharmacy chain that pulled that trick on its customers.

David from HealthBlawg also writes about the "evil" pharmacy benefit managers, and noted readers of Paul Levy's column chastised Paul for using the term "medication compliance", which has become a bit of an un-PC term to use. David dutifully points out the the iPhone is as "un-PC" as the come.
[un-PC... get it?... lol]


Will that shiny new iPhone help you remember things? Maybe, but don't expect the Motrin to help. Mona from the Tangled Neuron reviews research from our Hopkins colleague, Constantine Lyketsos, showing that NSAIDs don't help with cognition once Alzheimer's dementia begins. Aspirin doesn't help either, but it helps in other areas.

Walter from Highlight Health has seven ways to get in touch with them. I'm sure that all of them can be done from... you guessed it... an iPhone.

Patient chart out of labels? DrCris from AppleQuack snaps a pic with her iPhone. And be sure to check out her excellent post on branding oneself.

Zoe Brain has a long post about cross-gender brain differences. Somehow I doubt she typed all that on her iPhone (yes, I'm getting tired now of the iPhone references). You can also hear Zoe on our Grand Rounds Podcast.

Speaking of brains, why do smart brains make bad decisions (like paying $599 for a phone last summer that is available for $199 now)? Alvaro from Sharp Brains tells us about how our minds get swayed (and is offering 1,000 bonus points!).

Sham patients? The Samurai Radiologist discusses the reasons behind this fake-out trend on Not Totally Rad.

Paul from Medicine for the Outdoors addresses the important issue of why health care providers, and in particular physicians, should understand environmental issues and their impact upon human health.

Finally. Peter from Medical Pastiche has put his thumb on why we doctors like devices like the iPhone so much.

Dr Penna brings us yet another list of medical applications for the iPhone 3G.

Dean from the Back Pain Blog thinks the only excuse for not getting your mitts on a new Apple iPhone 3G would have to be coming down with a severe case of sciatica, which he addresses in Sciatica and Epidural Injections. Steroids anyone?

Give an Hour. DrVal from Dr Val & the Voice of Reason describes on our podcast an effort to get at least 10% of mental health providers to provide one pro bono hour per week helping our returning veterans and their families, because our government won't provide adequate access to treatment for PTSD and traumatic brain injuries.

In case some of you are struggling with violent thoughts against the iPhone lovers in you, Nancy from Teen Health 411 reviews a book about people who intentionally injure themselves.

ZXC, a family doc from Canadian Medical Blogs, thinks that the sorting hat from Harry Potter could be placed on patients with psychiatric complaints and it would tell him their diagnoses. Looks like the DSM-V will have some competition.

This one is a bit different, being a cartoon. Holly sent this one in from Candorville. I think he's not a shrink, but from Homeland Security. (There's a real Canada theme going through these posts; notice that?)

MJ from Interested Participant notes that the many in the US are pointing to the uninsured as reasons to move to a single-payer system, while folks in Canada are using similar rationale to argue for more private pay options. Maybe the grass is always greener.

The Snarky Gerbil is waiting for her anti-iPhone while talking about Biederman's fall from grace and peer review for journal articles.

Barbara from In Sickness and In Health writes about having hard conversations.

Kerri from Six Until Me writes about trying to get coverage for a diabetes device (Dexcom CGM) that insurance companies routinely decline. Also, congrats on the new hubby (how'd you get that one authorized?).

Are you feeling like a second-class citizen without an iPhone G3? Are you wondering if people will treat you the once you're relegated to the land of Nokia? Doc Gurley wades into the treacherous waters of discrimination of all kinds when she looks at a cluster of recent data about whether or not doctors discriminate when treating patients based on their - not phone - but race/ethnicity.

Zagreus from The Physician Executive got this in way late, but we got it into the post (we weren't able to get these last few on to the podcast).

And, that's the end of Grand Rounds for this week folks. Next week's Grand Rounds is hosted by The Covert Rationing Blog. If you'd like a recap of this week's GR, listen to our podcast as Dinah, Clinkshrink, and Roy take a light-hearted dip into this iPhone Edition of GR.

And, a final note of caution by Dr. Pink Freud (which I read on the podcast):
Dear colleagues,

The new Apple iPhone 3G must be stopped! I first recognized the potential dangers of the device whilst perusing Apple's description of the product:

Consider Apples assertions: "(The) iPhone already gives you mobile multitasking. But 3G technology lets you multitask in more places — without connecting via Wi-Fi. Since 3G networks enable simultaneous data and voice, you can talk on the phone while surfing the web, checking email, or using Maps. All from your 3G cellular network."

My appeal is based on the foundation of simple biology. To date, the data from numerous studies supports strong gender difference in the area of multi-tasking, consistently demonstrating that women's brains, though smaller (apparently size doesn't matter here) are inherently better suited for multi-tasking. The Apple iPhone 3G takes multitasking to heretofore unrealized levels! Simply put, the male gender is not cognitively equipped to handle such technology safely. The implications are dire. Overloading of neuronal circuitry could lead, at a minimum to temporary cognitive impairment. Worst case scenario: What if men attempt to drive and use the new iPhone 3G at the same time? Seizure activity might result, leading to increased traffic accidents. The human toll would likely be catastrophic.

Apple should, at the very least conduct research to assess the short-term effects of the iPhone 3G's multi-tasking capacity on the male gender. Until such time as the effects can be determined, in the interim, Apple could market a less dangerous product to men; perhaps, the iPaper-Cups-With-A-String-Between Phone. As mental health professionals, we need to come together on this issue and be heard as one gender-neutral voice. Who know, maybe someday, perhaps with the aid of cognitive enhancing psychotropic medication, men will be able to handle the iPhone 3G. But for now, this may just be a dream.


Christopher Bush, Psy.D.
(A.K.A. Dr. Pink Freud)

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