Priceless Electrical Activity

Social media for doctors - where the brains meet

2012-05-19T00:00:00.002+02:00

Now and then...

A whole lot has been written about social media but not so much for doctors and many of my colleagues still are confused what all the fuzz is about, still excited to try it out but tiptoeing around it like a cat around hot pot of milk as some stigmata is tied to it. As an emergency physician with many years of interest in IT and social media I would like to share with you my thoughts and help you to start a rewarding journey, an odyssey, you will not regret. It is definitely not a one day travel but it is exciting and fun from the first moment and will leave you with new contacts and educational sources changing your way of practice forever. Personally it took me weeks to get the full grasp of it but everyday brought a new exciting discovery. So let's dig into this strange new technology everybody is talking about.

Part 1: Why should doctors care?

The one most important question doctors will ask about social media is "what's in it for me, why should I put time and energy in this?".

You will meet new smart and interesting colleagues from around the world, broadening your horizon by far as you expand your contact network. They will be your new source of wisdom, feeding you with interesting journal articles and reading material, podcasts and vodcasts (video recordings of talks) to enjoy and learn from right from your laptop. They will summarize articles, leave you clinical pearls or tips from cases they have learned from, all having the power to change how you practice.
Your new contacts will also provide you with answers to your critical questions, aka crowdsourcing!
Speakers or authors of articles you are inspired by are now reachable as easily as your local colleagues , giving you opportunity for direct feedback and conversations.
You will discover and learn to use the most important online learning material; websites and blogs which are slowly but steadily becoming the new textbooks for many emergency physicians. Emergency medicine written by emergency physicians!
When you meet your new e-contacts on the conferences you will already have been introduced so that you can go directly to business.
While sitting the conversations; use Twitter to stay awake and suck in more learning points than before

We are just seeing the beginning of what social media has to bring to us as individuals and corporations are jumping the train and then a new generation of doctors is coming to practice who was raised with computers and the Internet from the beginning. Social media may only be a part of a bigger IT revolution but it's something you have too much to gain to pass it by.

=> LITFL recently had a interesting discussion in the comments section where people were asked to mention if and how social media had changed their practice in some way, check out for some great real-life examples.

Part 2: Debunking some myths

As for every new technology, some skepticism and stigmata is surrounding social media and we'll start by addressing these.

#1 "I don't have time for that"
It's true that getting to know social media requires investing some of your time but there is a high return of investment (ROI). There are some websites and technologies you need to get comfortable with but going through that learning curve is a journey which can easily be enjoyed as it's path is through a jungle full of life. And you will do that journey with your new e-friends who will be glad to help you.
That is the whole point with social media; meeting new people and discovering new, valuable information. In the end, social media will save you time as you will learn more by new, more rewarding methods than before.

#2 "It will only bring me patients breathing down my throat"
Using social media to connect with your patients is a totally different story than the one I am putting through in this blogpost. Social media is the people's revolution leading to better communication and access to information and obviously a tremendous potential for patients and some doctors who have long-term contact with their patients. Social media for patient contact is obviously irrelevant for emergency physicians but most certainly you will want to encourage your patients to use it to connect to other patients and be better informed (the 'e-patients').
As you go online with your profile it is totally up to you how much of yourself you want to disclose. You can be invisible if that is what you want or you can go 'Full Monty' and patients will be able to discover you and contact you online. Privacy settings is something you will learn as you go along and you can always fine tune these afterwards. Fear not, your patients will not be on your doorstep in cyberspace unless you want them to.

#3 "I will get fired if I say something wrong"
Certainly if you're not careful. But this only holds true for doctors who are posting sensitive information with details tying them to a specific patient or touching hospital policies you would normally only discuss with trusted colleagues. There are lots of good articles to teach you the silent etiquette of posting online, see below in the 'more reading' section.
It has been said "don't post what you wouldn't say in the hospital elevator". Respect your patients, respect your colleagues and your hospital and you will not have anything to fear.

Part 3: What social media really is - a brief history

If you google "what is social media" you will get lost since the definitions and answers are in the count of thousands. So you will sit there wishing you had a colleague to ask directly instead.

With that, you have actually learned the basics of social media: it's all about people and contact networks.

The Internet boomed about year 2000, by which social media was an unknown concept. Fancy webpages popped up everywhere but the information they contained was created by a few who web programmers or those hiring them. The content was the same for everyone since you browsed the web as a guest. Logins and user accounts evolved and set the stage for browsing the web as an active user, a person with a name and profile. Now you could interact with the pages, leave comments and see what others had to say.

Web 2.0: the Internet created by the people

Suddenly, average Joe was creating big part of the Internet without knowing web-programming or mastering IT tools. The concept of a "e-friend" was born as you could meet people you never met physically and follow their activities, almost like in real life. This silent milestone in the development of the Internet has been called Web 2.0 and marks the the era where the Internet was created by the people and thus, social media. A blogpost would be written about some article and in the comments, the author of the article would now appear and leave his or her feedback!

Almost overnight, hundreds of platforms were started with different approaches to how people profiled themselves online and created content. Many of these have drowned in fierce competition while a few have stood up as the giants, we'll be back to these later. Now that you know the history, let's see what social media is really about.

Part 4: Why social media matters

Doctors browsing the Internet are there to find facts and answers relating to real-life patient scenarios. Let's take as an example that you want to know the prognosis for type A dissection.
Traditionally we use the search engines and browse through a swarm of results but there is a huge random factor deciding if we ever find what we are looking for. After all, we are being answered by robots who despite clever algorithms and genuine wish to give us the best possible results don't have the human factor; knowing who is behind that question and molding the answer accordingly. The robots don't know if we want to know the mortality number or how patients surviving this disaster fare after discharge. If we had a colleague to ask, he or she would give us much better answers by knowing our interests and background. Our colleagues at work, our contact network, is and has always been our most important resource. Long before the Internet, we asked and learned from our colleagues because they are doing the same things as we are and provide us with an environment which stimulates us to learn more and stay up to date to provide best possible patient care.

Your contact network is your one most important resource

When it comes down to it all, your contact network is your primary source of information, discoveries and opportunities. Every doctor relies on a good contact network. Ergo, this is where social media is changing it all by providing for new technology to expand your contact network and thus access to valuable resources and knowledge. In the old days your network consisted mainly of colleagues from your workplace and a few you met in conferences - with social media you will discover colleagues from all over the world, sharing same interests as you do in providing best possible patient care.

Part 5: The different platforms

As said previously there are too many social media platforms today to know them all. Fortunately only a few stand out and knowing these is an important step for embracing social media. Today, there are three main social media networks worth putting effort into, each with their own characteristics.

Twitter (140m users)

One simple technology, thousands of platforms

Twitter is the 'short and convenient', limited by 140 characters the stories are straight to point and rich of content. With Twitter it's very easy to follow people you think are interesting for the first 'e-contact', any communication more than that needs to be done on more sophisticated platforms like email or Facebook/Google+. In short, great for discovery. It also works great the other way around that is if you want to attract attention to your product (like blogs).

Facebook (900m users)
Facebook is the biggest social network and has a critical mass to do powerful things. Facebook started as a small network for colleague students sharing their acts of heroism or stupidity to make impressions. This background overshadows Facebook as users' privacy are a low priority and interesting posts tend to disappear in a pool of useless information. Facebook is good for keeping contact with family and friends and even reviving old relationships but as a professional network there better alternatives.

Google+ (170m users)
Google was a late to enter the game but with monstrous muscle power and anticipation to give Facebook some real competition it's launch of Google+ in 2011 was welcomed all over the world, breaking records as new users flocked in. Despite great user interface, innovative and aesthetic, only a few users have stayed because of lack of activity, compared to Facebook (a true Catch 22) - thus G+ being called the ghost town.
Google+ has a completely different approach to privacy than Facebook. The Circles method invites you to categorize your contacts for complete privacy control and minimal distractions while browsing. Google+ is stratified; you don't read everything from everybody but decide for yourself what you want to read, giving you breathing space to socialize.
Thus, many are expecting Google+ to see first time users coming back because it has turned out to be a great platform to discover new people and follow hobbies and interests, without being bombarded by the uninteresting clutter prevailing on Facebook.

=> Why Google+ is better than Facebook as a professional social media platform

It has been said "Twitter is people I don't know posting interesting stuff, Facebook is people I know posting uninteresting stuff". I'd like to add "that's why I Google+". I've tried out them all and Google+ is the one I'm staying with. For me, it brings me great way of creating contact networks, filters information flow to me to fit only my interests and giving me complete control over the visibility of my own posts. It just needs the masses so please do try it out!

Part 6: How to get started with social media

There is only one thing you need to get started, genuine interest. Let curiosity drive you deeper and deeper into the jungle, enjoy every part of the journey and before you know it you'll be an expert. What you need to learn is not sophisticated or else there would never have been the social media revolution (the people's revolution, remember).

Here are a few starting points to start your journey:

1) Create a Twitter account and spend some time to learn the 'Twitter way'. On the Twitter help page there is an excellent tutorial for beginners explaining the basics. Start with updating your profile so that people can get to know you, take care to reveal your full name and some highlights of your current position. Just as you would while giving your name tag on a conference. Don't worry about being followed by people you don't want to connect to - you can reject followers and even change the default settings so that you have to accept each request. Remember though, all tweets are public (there are no private groups or channels) it's just much more difficult (almost impossible) to find your posts amongst the 5-10.000 tweets created per second.
Then start looking for your soon-to-be e-colleagues, a good starting point is the #emergencymedicine or #acep channel (enter that string exactly in the search bar). Follow the people you think are writing interesting posts. As you start following more and more colleagues your main stream (the first/home page on Twitter) will be filled with posts from these, that's you sitting in a cafeteria with your new friends, listening to what they're chatting (tweeting) about. Sometimes there will be conversations, other times flow of random posts about this and that. The more interesting people you find to follow the more interesting posts you will be seeing on your main flow.

For a real kickstart, check Ivor Kovic's list of emergency physicians on Twitter and even see recent activity from this group to pick some.

As you scroll through the tweets you will stumble upon all kinds of exciting blogs containing interesting articles, podcasts (audio) and vodcasts (video). This is the first crop from your new contact network.

...and RSS to join them all

2) Learn to use a RSS reader to collect your favorite blogs in one place. Here's a great post to learn about RSS. I use Google's RSS reader, a powerful yet intuitive tool for free with your Gmail (Google) account.

3) Start collecting blogs. It's been said that emergency physicians are the most active medical bloggers and as this list from Life in the fast lane (the mothership of EM blogs!) confirms, there are great many blogs existing and you will never be able to follow them all, even with RSS. You should still take some time to go through them and pick a few favorites to follow since these are going to be your complementary reading material in the future.
In the future we all hope to see the great material dispersed on diverse blogs collected to a one single place but until then you could try using Google custom search to search your collection of blogs instead of doing the standard Internet search where you will commonly get guidelines for treating horses as well as your patients.
The LITFL list is a very good one to start from but for a more detailed description of the blogs you have my list of EM blogs where all of the big blogs (the ones you really should follow) are listed.

If you want to cheat you can have others do all the work for you, there's the LITFL Review, a weekly episode where highlights from all the major emergency medicine blogs are concentrated in one heap. A great way to sense what's going on in the emergency medicine world.

4) Start your own blog!
There is nothing as rewarding and as writing about your discoveries and pearls you have to share. It's easier than you think!
=> Dr. Steve Smith tells about how his now renowned ECG blog started and what he has achieved

Part 7: How I and social media met

As a practicing emergency physician the last 10 years I can boldly state that few if any advances have impacted my learning curve as social media has done but it may have to do with my background. I specialized in southern Sweden, our emergency medicine program being one of the first of its kind in Scandinavia. With no long-time experienced specialists and limited educational resources we have been pretty much on our own.

This changed a few years ago when I was Googlin' to find something more than the traditional teachings in the textbooks. I needed something more than guidelines and tables; I needed clinical pearls and tips, pragmatic, real-life descriptions of how to handle the difficult scenarios not described in the textbooks. What started with small victories ended up as a whole new world of online learning material, finally I'd found my way home. From Life in the fast lane (the best EM blog ever) to free video recordings from great speakers on All LA Conference. I learned about Mel Herbert and his awesome products like EM Rap and USC Essentials. I found Free emergency talks and now Amal Mattu was in my headphones while out jogging, revealing to me pearls about difficult ECGs in the ED. And Stuart Swadron with his endless wisdom and medical knowledge. Scott Weingart on EM Crit entertained me with his amazing rants about advanced trauma and sepsis care in the ED, suddenly I felt like I knew at least a little about vasopressors. Then HQ MedEd arrived on the scene with amazing video recorded ultrasound cases, they got me at hello.

By commenting on the blogs or through Twitter I could now correspond directly with the authors of all this fantastic material and suddenly I was not alone any longer. And my interest in emergency medicine exploded as I felt much more in power of my specialty, being part of a network of great doctors and stimulated by them to learn more and never give up.

=> What a wonderful (IT) world
=> Video learning in emergency medicine
=> E-learning in emergency medicine

Today, I learn in a totally different way than before. I learn mostly online and with the help of all my note-taking system in Google Docs, I consider my self a much better doctor today than before.

Part 8: The future of social media

With social media, physical barriers are no more and we now have unlimited access to colleagues all over the world and richer learning material with the possibility to interact with it. The coming years are even more exciting as this revolution comes to practice and we eventually witness a new generation of doctors who are better informed and better connected.

In my mind there are two special issues which wait to be addressed with the new recent revolution.

1) We need real-time consulting service; every doctor has a dream of being able to connect to their network in the middle of the night to ask for advice with the difficult patient. Or just that damn difficult case in daytime where expert opinion is needed. The current platforms like Twitter and Google+ are worth a try but we need an organized framework to make this happen.

2) We need a centralized database of guidelines/links. As huge amount of high quality text and multimedia about every possible clinical scenario occuring in the emergency department is being published online, it's getting painstakingly difficult to know where to look for what. Even with Google custom search as the amount of results are just growing.
We need all this in one place, categorized, tagged and easily searchable with not only text but photos, videos and links to articles or blogposts for further reading. Such a big project needs joint effort from lots of emergency physicians and should therefor be collaboratively edited, supervised by selected individuals to ensure maximum quality.

Actually LITFL has already begun some of this work with their amazing databases of cases, blogs, podcasts and what ever you can think of but (I hate to say but about LITFL!) I think we still need a A-Z page for each of the clinical scenarios we have in the ED with text, multimedia and links.

Emergency physicians have already shown they are geeky and smart with IT tools. I think we ought to make this a pioneer, exemplary project, in the hands of many it is an easy task. We have the technology, we have social media to get us connected - we just need it to be started, somehow.

I am all open for discussions and more than willing to help out so if any one out there is thinking the same, feel free to contact me!

More about social media

[Mashable] The infographic history of social media
excellent and detailed history of how it all started...

E-learning in emergency medicine
a detailed description of my top educational resources I use.

Emergency physicians give answer to the question if and how social media has changed their practice.

[Boston.com] As Facebook grows, millions say, ‘no, thanks’
It's not just me who thinks Facebook is overwhelming!

The birth of Steve Smith's ECG blog and The birth of the Ultrasound podcast
two great stories of how a blog/podcast is started and what it has given done for their authors.

Doctor reprimanded after patient privacy breached on Facebook
There are two sides of the story, interesting discussion also in the comments.

Distilling the essence of medicine using Twitter
A rheumatologist describes how he uses Twitter to stay learn more from conferences.

Why Google+ is better than Facebook as a professional social media platform

2012-05-15T15:36:00.000+02:00

So many social media platforms, so many decisions...

From the battle of social media platforms have come three giants we all know; Twitter, Facebook and Google+, all very likely to stay for a while. Twitter, restricting posts to 140 characters, has a different approach and has turned out to be an excellent medium to discover new, interesting information. It's also good for making new contacts but minimal profile information and communication features makes it limited for anything more than that. And thus it isn't even considered to be a competitor to the other two giants, Facebook and Google+.

Many have said that Google+ is nice but it isn't making the expected impact and I see most my colleagues ignoring Google+ because it lacks the critical mass of users to have any power. I think this is a pity since Google+ has some powerful tools and features and in my opinion is a much better network for professional networking, unlike Facebook which still today has reminders of it's roots in a network for college students. As I learn more about Google+ I find my self leaning more and more towards it and actually stepping away from Facebook as it is becoming just too much nonsense. Let me explain why.

Google+ enters the scene and breaks records
Facebook has been around for years while Google+ is the new kid on the block but it has Google's enormous back-end with complimentary IT tools- and services not to be undermined. Integrated with Gmail, Picasa and Google Docs (now Google Drive) amongst others it is so much more than just another social media platform and has many tools to be more than an entertainment platform. This along with excitement, as people were eager to see Google's implementation of a social media network, made Google+ welcomed as it was launched in July 2011. Records were broken in just a few days as users flocked in to try it out but the sunshine story faded as most users didn't return. What else was there to expect, it was like coming to a banquet full of food but with only a few attending. Google+ newbies got lonely.

Facebook is not a professional playground
Facebook was started as an online network for college students. Nobody could have foreseen the tremendous growth Facebook was to go through in the coming years but this growth spurt has also turned out to be Facebook's Achilles heel. As a network for college students, privacy was never an issue - the kids wanted to see their classmates doing heroic or stupid things and seeing someone dead drunk in a bush on the schoolyard was simply cool. Posts were open to everyone and as Facebook opened to the rest of the world this non-privacy approach lived on until new users started crying out, asking for fixes. Major issues were plastered and privacy settings introduced but too complicated for users to grasp. Still today, the average user has no idea how much of his or her posts are visible to other contacts or even rest of the world through the search engines. The fact remains; on Facebook, you mostly read everything from everyone. Not only is it a privacy concern but also you are easily overwhelmed by useless information like 'Joe just ate a meatball yesterday' and 'Jane Liked it'. A little like a kids playground if you ask me.

Google's approach: Circles

Google+ Circles

This is not the kind of media I want as my professional platform (nor for private purposes!) and Google was smart as they recognized the problem and came up with a solution: Circles. For each friend (contact) you add on your Google+ account, you define what circles your friend should belong to. A little extra work compared to Facebook's way of just adding a friend, but this way yields a high ROI (return of investment) as you, through your Circles, define not only who can read your posts but also what you want to read on your wall (called Stream in Google+). So when I want feedback from my emergency medicine colleagues I will post that post only to that circle and if it's personal family photos my colleagues will not have to read that. It is very important you understand this is not only a major leap for privacy but also a way to have your wall fed only with what you are interested in, you will not read about your friends Like-ing the meatballs somebody else ate.

To Facebook's defence, they have actually added the 'Lists' feature to try to achieve the same results and even a mute button for individuals - but these were introduced too late. Nobody has time or energy to go through their hundreds of contacts and group each and everyone to a list. Google+ does this right from the beginning and even does it with an intuitive and graphical drag 'n drop interface to make the task of circling friends an easy one to do, almost fun even.

Hashtags for discovery
Social media is a great tool for discovering new content, you can do that either by watching posts from your contacts or follow a particular channel. The hashtag (#) is a simple technology for the latter; using #emergencymedicine as a search pattern on Twitter or Google+ will show you in real-time what people or posting, relating one way or the other to emergency medicine.

Notice the 'Sparks' on the top for easily selecting
your channel

You can also save hashtag searches (Google+ calles these Sparks) for fast access later (your saved searches also affect what is displayed on your main Steam ('wall'). This is yet another feature to minimize the clutter you are confronted with on your wall (said a little rougher; cut the bullshit) as you can easily select what 'channel' you want to read from. So when I don't feel in the mood to be fed with random clutter I click the Emergency Medicine Doctors and read only posts from these. Or I click #Linux and read only what's going on in the Linux world. It's a feature you will love once you've met!

Facebook lacks this feature and actually returns a rather awkward, cluttered list of search results if you search 'emergency medicine' without the hashtag. Google+ returns a more intuitive list of results and even attempts to prioritize them to fit your interests.

Google Hangouts for easy video-conferences

In 2011 a few lucky ones got to speak directly with
Barack Obama using Google+ Hangout

Many have tried to provide for a decent interface for video-conferencing and most have failed, succumbed to technical challenges or just lack of users (in todays competitive climate you literally have to give gold to attract users). With Google+ the Hangout was introduced as a easy and quick way to start a video conversation with up to 10 users simultaneously. This is a tool companies would have paid thousands of dollars for only few years ago and is now available for free.
Add to this how easy it is to discover and contact interesting people on Google+ and you should realize the potential. Online discussion panels or debates about hot topics in emergency medicine... and you can participate from your living room - how awesome is that!

Other minuscules I like about Google+

Google+ integrates very nicely with the mothership, Google's search engine, for smooth and easy publicity of your posts on the Internet (if you wish so). Defining posts as public or confined only to your selected circles is very intuitive and hard to do wrong. Facebook has had years of criticism for this as the settings were introduced late and are cumbersome to use.
Your posts can not only be deleted if you regret but also edited, something that Facebook amazingly doesn't allow.
Google+ is tightly integrated with Picasa, Google's excellent photo & album manager. With Google+ you can instantly edit and arrange your photos stored on Picasa and those you add through Google+ are instantly accessible through Picasa. With the Android app (I don't know about the iOS or Win versions, anyone?) you can ask for all photos to be automatically uploaded to your Google+/Picasa account, sparing you the hassle of plugging the phone to a computer to get your photos.
On Google+ you don't get the feeling that you are a puppet being used to create treasure for money makers in the market. Advertising is minimal and I don't expect Google+ to disgust me with the idea of asking for money for prioritized status updates as Facebook has just introduced.
Finally, this is what had me come back repeatedly to Google+ for good laughs and inspirations: animated GIFs. Just try the #GIF channel for yourself, be warned - you are going to have a hard time stepping away from your computer!

Animated GIFs make life so much easier

More about Google+

Google+ is better than Facebook and this is coming from PC Magazine, a journal that usually promises Microsoft products above all

Graphical Google+ features intro
Great introduction to the major features of Google+

Google+ FAQ on Quora
Quora is a fabolous Q & A platform for asking questions out to the public to get human answers. Google+ FAQ introduces some common questions and has links to get you started.

The difference between Facebook and Google+
Facebook helps you keep in touch with the people you already know, Google+ helps you get in touch with the people you want to know.

KevinMD: Why doctors should embrace Google+

Automatically posting to Twitter from Google+

The PEEP mystery solved

2012-04-20T10:51:00.001+02:00

Soon I'm finishing my 6 month ICU rotation, a period full of wisdom and clinical pearls which will certainly help me give better care in the ED in the future. I plan to write more about this later but today I was shown a short video illustrating what PEEP really does for the lungs. Seeing is believing, check it out!

The cryptic abdominal pain

2012-04-02T16:27:00.003+02:00

I really love the thrill of evaluating the patient with abdominal pain of unknown origin. True abdominal pain is a symptom, not just a complaint and an underlying pathology should be sought. Emergency physicians have a critical role in diagnosing what can and should be treated and sending home everything else. They are the gatekeepers and must know uncommon diseases presenting as common symptoms.

I recently had an interesting case of abdominal pain which had valuable take home lessons for the EP, I would like to present it for you to share my learning points.

A 50y/o male who was treated three years ago for non-Hodgkin lymphoma and was cured. He now comes to the ED with two day history of sudden onset, aching pain in left lower quadrant. It was worse when he was lying on his left side. No fever/chills, nausea, diarrhea or other symptoms. Despite pain been able to eat and is not generally sick or affected by his pain.

Patient is worried that this might be his lymphoma coming back since at that time he had a similar diffuse central, upper abdominal pain going on for 5 weeks until he finally had his diagnosis.

On examination the patient has normal vital signs and is afebrile. Abdomen is non-distended, soft on palpation with localized pain about 5x5cm in left lower fossa. No muscle guarding. No palpable tumors. Lab tests all normal (WBC, CRP, hemoglobin, electrolytes, LFTs).

A clever surgeon temporarily working in the ED has a theory and asks for a CT abdomen which reveals this diagnostic image:

Hint: look in LIF!

The radiologist says no pathological lymph nodes in abdomen/pelvis, normal colon with and without contrast but notices "stranding of fat near colon descendens and nearby an enclosed capsule containing fat". Bull's eye for the surgeon: epicloic appendagitis it is indeed.

Patient is sent home on NSAIDs to expect full recovery within 1-2 weeks.

Now this is certainly a rare condition but definitely worth knowing as we are working with abdominal pain all the time in the ED. The patient was indeed very sensitive in exactly that 5x5 area but unaffected otherwise. It was tempting to send him back home but it just didn't make sense, there had to be something explaining his pain. So in the future it will be on my ddx list of unexplained abdominal pain.

Then there was another take home lesson from this particular patient. It turns out he had a long and worrisome period of pain for 5 weeks until he screamed at the doctors to make a CT. And he was right... His epigastric/thoracal pain was at first diagnosed as 'gastritis' (the all too commonly used trashcan for unspecific symptoms!) and treated unsuccessfully with PPIs and later Tramadol. When the patient couldn't sleep any more and caught fever even he comes back and gets a CT which shows a 17x15x12cm big retroperitoneal monster tumor!

So what are the take home lessons?

First of all, we need to suspect lymphoma to find lymphoma. The lymphomas are after all a relatively common disease (about 5% incidence), highly curable but presenting in many different ways. All medical textbooks describe unexplained abdominal/chest pain as one of the presenting symptoms so the lawyers will expect you to know that.

History and clinical examination are as always the cornerstone of diagnosis - nothing new here, just that they are all too commonly ignored. "B-symptoms" (fever, night sweats, weight loss), enlarged lymph nodes >2 weeks duration (be careful with unilaterally enlarged tonsil in children!) and if bone marrow is involved expect hematological symptoms (anemia, infections, bleeding...).

Use your ultrasound! As bedside ultrasound is becoming available in every emergency department there is no excuse of not making a quick look. If you know FAST you know how to localize the liver, spleen, aorta and surrounding area. Of course you are not expected to find deep enlarged lymph nodes but the above mentioned monster tumor would have been hard to miss.

LD/LDH is a cheap labtest worth considering, neither sensitive or specific but abnormal value should raise your eyebrows.

Any tips or thoughts from the readers?

Choosing the best technology platform

2012-03-24T14:32:00.002+01:00

The Commodore Amiga story is one I like to tell to examplify that even the best technology will sometimes succumb to market (money) power. The Amiga was introduced in 1985 and was at the time a technological breakthrough as it could easily display colorful, animated graphics and play high quality sound while PCs (and even Apple) at that time were black & white and had one single speaker that could only beep. It's operating system was cleverly designed and handled windows and multitasking (like playing music and writing text simultaneously) with a breeze while PCs at that time were playing hangman with you on a green DOS screen. The Amiga was geniously designed by brilliant engineers, incorporating clever and advanced technology so that it was way ahead of it's competitors and thus jaw-dropped everyone who saw it in action, below is one of the first demos showing of Amiga's capabilities

Despite technological advances, the Amiga was elbowed out of the market mostly because the public's attention was where the money was and vice versa, so IBM, Microsoft, Apple and the big giants won with their inferior products.

For me, like many, this was a sentimental battle. Not only did I love my Amiga but I felt the world could gain so much with it's advanced technology. The revolution came finally but only many years later as the PCs finally caught up and the IT boom set off and changed the world as we know it forever. Still today I wonder what had been if the Amiga had had the impact it was designed to have?

Today I feel pretty much in the same way about some technologies being in the shadow of others enjoying the spotlight without really having done so much to deserve it. Now you may say I am arrogant but let me remind you I've been using computers almost since infancy and I've tried many different technologies so that what I use today is the result of many years of trial and error. I have made dramatical u-turns when I feel there is another technology which fulfills my needs better - like when I switched to Linux after having been a Windows fan for more than 10 years.

For this reason I get irritated when the world seems to believe there is only one gadget existing like Apples' i-products. Physicians are head over heels about iPhones and now iPads but what most of them haven't done is to actually compare them to the alternatives. I have done this and for many reasons (open source software, USB connection, high configurability just to name a few) I prefer Android to iPhone.

The Linux vs Windows one is a no-brainer, Windows is a totally overvalued piece of software that exists today only because of the power of money (you could start with asking yourself why it is so hard to buy a computer without Windows pre-installed). Read my above mentioned blog-post to find out why.

Then there is the Google Apps vs MS Office debate. I was an Office fan too and I found Google Docs to be a lousy product in it's beginnings. But it has advanced a lot and today it is one of the most important IT tools I have and has dramatically changed the way I work and stay organized both as a physician and family man with three children.

The message? Be critical, open-minded and picky about your technologies. Don't just buy a product because the word of the street thinks it is the best. There is no thing such as 'one size fits them all' when it comes to software and gadgets - decide what to purchase based on what your needs are and what you are going to do with it. There are plenty of blogs and IT magazines out there to do some home-learning!

Lazarus' sign

2012-03-19T15:23:00.001+01:00

Lazarus' sign is one of these signs that you just have to know because it is just so perversely stunning. Basically it is a corticospinal reflex in the brain dead where the patient (or it's body) will flex both arms as if he was grasping after some object or even trying to 'give a hug', scaring the hell out of family members or inexperienced personnel. BTW, Lazarus's sign is *not* the same as decorticate or decerebrate reflex.

Today I heard a story from a college who was doing the apnea test to confirm a patients' brain death and while bending over to auscultate the heart, the patient performed the Lazarus' reflex and seemingly hugged the doctor while showing no other signs of life. Nice!

Backing up your data the modern way, power to the cloud

2012-02-27T18:08:00.000+01:00

Caring for your most precious belongings
should not be taken lightly!

Everyone not living in a cave has sometime lost important data and consequentially had their days of remorse and pulled hairs. Classically, a laptop with years of work is stolen or a hard drive with invaluable personal photo albums crashes unexpectedly. As in the flight industry, human errors are your biggest threat - more than once I have accidentally deleted precious files.

Our data is our life-collection of work and memories and as the days of pen and paper are being replaced by electronic data it is becoming the one most important property to hold account of. As 9/11 showed us, corporations survived huge losses of business documents but there is nothing to replace your years of email correspondence or personal photo albums. Not only is it an emotional loss but it will set you back by months as you try to pick up pace again after losing all your office data. Just the thought of losing my calendar data gives me the chill - loosing track of planned meetings and events for the next week would render me butt-naked!

Backup is no more
The traditional way of backing up data is to copy to other medias such as CDs, DVDs or external hard drives. This is how it all started before the Internet came and cloud-technologies and we were happy just to have a second copy of our data in case of disaster. There are many drawbacks with this old approach such as:

No media is safe when put up against time: DVDs and even high quality hard drives have an industry accepted failure rate of 1% meaning that your data will in time corrode.
Modern data includes huge media files; high quality photos and videos and we are adding up more files every day. A DVD counts 4,5gbs - barely enough to hold 1.000 high quality photos. USB memory sticks are the modern DVDs and might be safer storage medias but they will also fail on you eventually.
External hard drives are growing bigger every year but you want to store them far away from your desktop to ensure maximal security or they could easily take collateral damage if your desktop is hit. It might be a virus, hacker intrusion, water damage, fire... you have to place it far away, preferably at a friends house.
As you are every day creating more data you will have to manually grab that hard drive, connect it and backup the new files, a process easily forgotten or just ignored in the long run.
Eventually you will edit some old photo or document previously created and suddenly you have obsolete files on your backup hard drive. Unless you have a list of which files are updated since last backup you will have to backup your whole data collection. Or you could use software that does incremental backups but still, you will have to connect your backup drive to make it work. And know the inside and out of your software to be certain no mistakes are done.

The data-cloud is changing it all

There are plenty of problems with traditional backups but one emerging technology has the potential to relief your headache for once and for all... the data cloud. It's about moving your data from your local hard drive to online servers, virtually locked in databases which only you have access to. With the cloud, your data is available wherever you go.

Dropbox is by now know by everyone and is one of the first examples of cloud-computing and replaced many USB memory sticks, symbolizing the old approach of moving data around, between different computers. Dropbox is now loosing ground again and the reason is the lack of an interface to work with the files it stores. The amazing developments of web-technologies (such as HTML5) is moving the power from local to online software, thus the term "web-applications". Google Docs exemplifies this trend; not only can you store whatever document on it's servers but you can also work with the data (e.g. work with 'word' documents or 'powerpoint' presentations) online and even shared with closed or open group of friends and colleges. Combine these features and you have "collaborative editing" where one or many can simultaneously work with the same document in real-time without worrying about multiple versions being emailed back and forth.

I have previously written about the "online office" concept which is based on this development exactly and is the sole reason for my boosted productivity despite much more information to take care of.

So... not only do you need an online host for your data (there are now too many out there to keep count of and new services being born every day) but also you need front-ends to work with your data. One service for your office documents, one for your photos, another for music, yet another for videos... Now that's a lot of accounts and passwords to keep track of and add to that, you will have to have 100% trust in each and every service since they're literally taking care of your electronic life. We need simple solutions, preferably one key to all keyholes. And now the good news: this is indeed possible and that is exactly I am going to teach you in the rest of this post.

If you insist the old way
Only five years ago I would have told you a completely different story since there was no cloud then. I used to have a huge hard drive storing my most precious memories and had a clever software solution to synchronize my backup sets. In the end though, I was totally lost as some weeks my photo collection would grow by gigabytes and I accepted the fact that relocating my backup-drive between various physical locations even once a month was an impossible task to do. I tried USB sticks to make it a little easier but it was the same, I gave up. I installed an online Linux server in a safe location in my house and setup automatic and synchronized file transfers but felt highly vulnerable to catastrophes such as theft, fire or water leaks. I had just started considering using a friends' online server and synchronizing backups over FTP connection when Dropbox arrived, the rest you know.

Today, all my important documents are in the cloud and my hard drive is empty besides some downloaded podcasts and vodcasts which are easily replaceable. Going online is a point of no return after which you will sleep free of all worries about loosing your data.

Going online
Now this might be the point were some might be skeptic so I would like to remind you that there are many alternatives out there but through years of experimenting I have found the Google applications to fit my preferences the best, please check my special Google post if you have doubts.

Besides a few special applications (Pixlr and Crocodoc, that's all!) I am using the Google services for all my data. They're free, I trust Google and I am very satisfied with working their applications. The true power lies in having only one account (password) to take care of.

Introducing Google Docs
To most people, Google Docs (GD) is a simple, online document editor with sharing and collaboration functions. The Google Apps have a common 1 gigabyte pool for your data and you can easily add more storage like $5 for 20gb/year (which is cheap, compared to other services).

Uploading my vodcasts to Google Docs

What many do not know is that GD actually allows you to upload whatever document type you wish, be it a 500mb video file, your mp3 collection or zip/rar archive to name a few examples. It literally stores whatever you throw at it (you can even upload a zip file and GD will allow you to browse it just as any folder). If you have Chrome you can even drag your files or folders to Google Docs and it takes care of the rest.

As your heap of files grow by thousands it becomes essential to organize them and GD's tagging features makes this a breeze. You can of course search your collection both from top-level or inside a tag ('folders' are known as 'collections' in GD), this way you can never loose a file in your online data-heap.

My ABG document, shared with colleges.
All can view, some edit too.

Sharing is GD's pride; every file (or collection) can be shared with one or many of your friends or even as a link to the whole Internet if you like. This way I upload my home-videos to a special folder (collection) and then send the link to my family who can either view them from there or download to their own computer (GD allows you to disable downloading if you only want files to be streamed).

Editable documents can not only be viewed but edited and while you share a document you can specify what restrictions each user has. The ABG document is private to the Internet but could also be shared openly so that anyone having the link can view or edit if I decide so.

Now this is technology we are used to these days but what makes GD unique is that the organizing and sharing functions apply to all files (and collections).

For most purposes, uploading through the web-browser is just fine but it doesn't quite meet my wish for synchronizing cloud based files with those stored locally on my hard drive (the Dropbox way). Google's highly anticipated Gdrive, rumored to be out early 2012, will change all this and provide the final functionality needed for a fully equipped online hard-drive.

Despite most software now being available through the Google Apps suite there are still some missing, requiring you to have your files on your computer for locally installed software. Adobe Photoshop and Microsoft Access files are some examples. Except for image/photo editors, online multimedia editors are still in their infancy and need local software. Downloading and uploading files back after edit is cumbersome, expect GDrive to fill this gap.

What GDrive will bring is is currently unknown but for basic backup purposes, Google Docs serves it's purpose quite well. If you wish for extended features and even editing you should consider alternative services and I will now finish this post with specific details on where to store the three multimedia types we commonly work with so that they are not only backed up but also easily viewed and manipulated.

Photos/images
What makes photos unique is that you want to organize them by years, themes and even people. Picasa used to be a standalone service but was bought by Google and as such is part of their application suite. Picasa is both a great local software for working with your photos but also an online front-end, the web-Picasa. Picasa can easily upload your photos to your online storage and smartly processes the uploaded images and always keeps a copy of the original photo file - the essential feature making it a backup tool.

Picasa uses the common, above mentioned, 1GB storage pool but it doesn’t count images up to 800x800 pixels or videos <15 minutes in length. If you sign up for Google+ the photo limit goes up to 2048x2048 pixels. This has important implications; if your camera is set to store high quality photos, you will most likely have bigger sized photos and thus meet quota limitations.

My family album now counts about 250 gigabytes after 15 years of photographing digitally and most of the images are bigger than 2048x2048. Despite Google space being cheaper than most competitors I am not sure I am willing to pay $100 annually for the 400gb storage pool required for this massive amount of data even though it is probably the most secure way of keeping my digital memories away from unforeseen catastrophes, even though prices will most likely go down in the future. At least until having the synchronizing feature of GDrive, as a temporary solution, I will stick to old fashioned external hard drive backups here. In the meantime, I keep the newest (not HD backed up) files secure on my Dropbox account.

Finally, I find the web-based Picasa still a little clumsy (as opposed to the local software which is a 5 star product). It has all the features needed but it's user interface really needs to be modernized (it's been the same for years now), it's browsing and folder/collection features are ages behind Google Docs' approach. Until worked on, I am not ready to give all my digital memories to the online Picasa.

For other photos such as my collection of medical photos or saved images I use for my presentations, Picasa is my best friend - every single photo stored online for easy access and share functions.

Now all this is fine but what about advanced photo/image editing? Picasa is very very basic and you will not be able to do any photoshop effects with it. For this, you will either have to manipulate your files locally or you could try out before mentioned Pixlr. This is a gap in my backup plan - the files can only be stored on Google Docs for backup purposes; you will have to download and upload them to work with. Or you could sign up with Pixlr (for free) and use their online service. This should not be a problem unless you are editing your photos every day - in that case I suggest Dropbox and hope for GDrive to come anytime soon.

Videos and films
My video files are made up of home-videos and downloaded teaching modules such as vodcasts. The latter are for viewing purposes only and I like to be able to share them with colleges, perfect for storing in Google Docs.

Home videos are different. They are precious and must not be lost, ever. Also, I would like to be able to work with them locally, making special clips for family or friends. Now many would think that Youtube is an excellent backup service for these but that is a fallacy; Youtube does not keep the original files and you cannot get back your files in their original formats (as with Picasa). Youtube is a sharing service, videos are played as streams. Even more, you are not guaranteed that your uploaded videos will stay forever. Youtube is strict about copyrights and can anytime erase your video if it has any violations (copyright background music might be enough to trigger the deleting machine) and if violated several times might risk your whole account.

This is very important:Youtube is NOT a backup service!! So what to do?

As said above, Picasa accepts video files as well as photos - voila! Even better - you have free unlimited storage for videos <15mins which should suite most of your home videos. Actually, as Picasa works with photos and short-videos in exactly the same way, I treat my home-videos the same. So again, waiting for GDrive and Picasa update but that's where I'm heading!
Finally, Youtube is not all bad. Actually, it is a great service for putting my edited clips online to share with the world. Youtube has some basic editing functions, enough for most of my needs for home-videos.

Music and audio files

All my podcasts and music in one place

First of all, your mp3 (music) collection can easily be stored within Google Music which allows you to store 20.000 music files for free. Not only have I uploaded my music collection but also do I put my downloaded podcasts to Google Music so that I can listen to them from my mobile when I'm out jogging. After putting some work into tagging the podcast files, my collection is now easily browsed by authors, topics, production year etc.
Google Music provides a small software to install on your computer which then takes care of seamlessly uploading your collection.

Currently a podcast subscription feature is very much needed on Google Music (iTunes style), in the meantime I subscribe to them with RSS Reader, download files locally, tag and upload via GM's uploader tool. A little more work but I worth it as my podcast collection is now so easily accessed wherever I go.

Finally - what about passwords?
Passwords are also precious. Even more precious as they are the keys to all our data. Keeping account of all passwords today is a true first world problem, especially now that we need to make them very complicated to defeat hackers and viruses threatening our online presence.

I have some of my less important passwords kept in a well hidden file in Google Docs - making them easily reachable wherever I am logged in or just from my Android phone. For those more important ones there is an excellent app for keeping them in an omnipresent but safe way. Check out my previous post about passwords and the importance of protecting your online data - now that you are uploading your electronic data to the cloud, you absolutely must know how to protect yourself from intrusion!

Windows vs Linux story

2012-02-27T09:38:00.000+01:00

You have been warned, although mostly emergency medicine related, my blog is also about IT. To the heart of my IT experience is converting from Windows to Linux, the best decision I have ever made.

I like collecting stories about why this is good. I've just read an interesting article from PC World where IT geek Tony in 30 days tries out one of the Linux flagships: Ubuntu. I will not go into his incomprehensible approach of installing inside Windows and expecting to get a Linux clone which completely defeats the purpose of his experiment... But reading through the comments has revealed to me some very good Windows to Linux conversion success stories and learning points which I'd like to collect here.

Take home point: "... but the point should be clear. Microsoft effectively owns your Windows computer, while you own your Linux computer."

ricegf Mon Jun 06 06:55:52 PDT 2011
"@blamblam: What are some concrete examples of things that you cannot do with a Windows computer that you can do with a Linux machine

Excellent question. Though I'm not the original poster, I'm a libre software advocate based on hard-won experience, so I appreciate the opportunity to point out some practical implications for free vs proprietary software. I'll do so with first-hand anecdotes, and leave you to draw general conclusions.

I helped Mike (a friend), whose hard drive had crashed, to install a new one. When we reloaded Windows, the software refused to accept the 40 character authentication code (a pain not inflicted on Linux folk), deeming it invalid. We spent 30 minutes on the phone with 3 different people at Microsoft while they decided if we would be permitted to use the software he'd bought or would be required to purchase a new copy, since his machine might be considered "new" because of the replaced hard drive - the End User License Agreement (EULA) didn't define "new", leaving its interpretation at their discretion. In the end we were "permitted" to use the product for which he'd paid (via a new 40-character code), but this was the wake up call that caused me to begin my Linux transition.

I've received two physical letters from the Business Software Alliance (BSA) asserting their right to enter my home and "audit" our personal computers at their convenience to see if any of my applications are improperly licensed. They claim their members' EULAs grant them this right (the specific EULAs are not identified). I would certainly deny them access to my Linux computers, however, since they run no EULA-impaired software at all (the Gnu GPL is not a EULA).

I helped my daughter build a desktop, and purchased a retail copy of Windows XP so she could run certain games. After it was overrun by malware, we reloaded from CD - but the authentication code was rejected as "pirated". Unable to convince Microsoft that we'd purchased an original CD, unable to obtain a refund for an "opened product", and unwilling to continue buying new copies for the same hardware, we acquired a copy via different means to get the machine operating again (though it won't accept any non-security updates).

I have more stories, but the point should be clear. Microsoft effectively owns your Windows computer, while you own your Linux computer.

From another perspective, I'm able to upgrade any of my computers to the latest or any older version of Ubuntu, Fedora, Mint et. al. at any time, to share any of these systems and all of my apps freely with friends, and to run as many copies as I like in my virtual machine system (Windows most common EULA limits use to 3 copies total on the same hardware). I can run and publish benchmarks and comparisons (which was prohibited by Microsoft's EULA last time I checked). I also have confidence that the software isn't siphoning off information without my knowledge: I haven't checked personally, but independent people that I trust have - and have found that some proprietary software (not Windows) does indeed send personal info back to corporate headquarters without the user's knowledge or consent (instances occasionally pop up in the trade press, in case you follow it).

From a practical perspective, I've found Linux software to be generally better than Windows for my needs. New versions of Microsoft Office, for example, often require reformatting of complex documents while OpenOffice.org (which uses an ISO-standard file format) does not. Of course, we can (and do) use the same software on the Windows computers in the house, which illustrates another advantage of libre software - it typically has been ported to all systems! You can even find mainstream libre software on quite obscure systems such as Haiku and Plan 9, while many proprietary Windows apps won't even run on a Mac.

Speaking of apps, installation and maintenance (which is centralized through an "app store") is certainly far better under Ubuntu than any competitor I've tried (except perhaps the late unlamented Lindows) - Microsoft plans to address this at last with an app store for Windows 8. The Linux system is also far more useful out of the box (which you concede), and obviously is far less expensive to set up from a licensing perspective.

The biggest practical barriers to a Linux transition are for Photoshop users, those dependent on certain Windows-only vertical market apps, and for those with a large investment in DRMd media (Linux generally doesn't support DRM, since given source code DRM is trivial to defeat - though no DRM system has survived very long in the wild even on Windows).

Overall, my personal experience with proprietary software has been quite negative, because power corrupts and the BSA members seek near-absolute power over their customer's computing devices as the above anecdotes illustrate. My experience with libre software has been uniformly and overwhelmingly positive, and I'm far more productive - and certainly more free - than I was on Windows.

I speak only for me, your mileage may vary, but I hope this gives you some food for thought.

JoeAnotems5445 Wed Jun 29 05:53:34 PDT 2011

"The author missed the most important thing. With Ubuntu or Linux Mint, you don't use AV and you don't get infected. Microsoft gets infected with viruses, botnets and has many other security issues. Microsoft Windows cannot operate without AV, ever. Microsoft never had secure source code, and with millions of lines, it's unlikely they will go back and fix it. Linux has open source (freely available to anyone) source code and security is designed into every line. It's been that way since version 1 in 1991. Android is Linux.

I've used Linux for over 8 years without any AV and with absolutely no infections. Linux Mint is based on Ubuntu but has many extra codecs for playing Microsoft media and playing and recording DVD's - right after the install.

I've never seen the problems with arrogance from Linux users on the help posts the author mentions. If he is a Microsoft user, he is probably not familiar with the terminal commands that are commonly used when someone is trying to help. These commands have to be typed in exactly as described or they will not work. It can be frustrating and overpowering to a new user.

Also, Microsoft enjoys a large market share that has been developed over the years, even through some monopolistic practices.

Linux was never meant to be a copy cat of Windows. The authors' approach is to treat it like a Windows wanna-be. Remember, almost all Microsoft programs use a proprietary function called Active-X or Direct-X. Over the years, this has been responsible for a tremendous amount of security issues. Linux does not use Active-X. Neither does Firefox or Google Chrome. That's why they are becoming so popular, people are getting increased security using them with Windows instead of Internet Explorer.

Linux Mint is the #2 Linux OS in popularity. It's absolutely fantastic. I'm using the 64-bit version on a dual core HP with 2GB of ram. I have an ATI 2GB graphics card with a custom ATI driver meant for Linux. I use FireFox4 and Google Chrome 64-bit, both with Ad-Block Plus. I installed Google Earth, Google Picasa, TrueCrypt, FileZilla, K2B CD-DVD burner, Scribus publishing, Google DNS, Youtube-dl among others. Also, Mint comes with LibreOffice office suite that parallels Word, Excel, Access, and PowerPoint. It also comes with Gimp, which is a multi-layer photo editing program similar to Photoshop.

There are over 33,000 free applications that can be installed from a repository with a couple of clicks using the Software Manager. All you have to do is Google for the Linux equivalent of the Microsoft program you want, and you can usually find it. For example if you Google Microsoft Publisher, you get Scribus and Lynx, which can be installed for free.

For me, Linux installs in about 8 minutes with no product keys, WGA or DRM to contend with. I can't even imagine my family or I going back to any MS product. If you are a Windows user dealing with one or two computers, AV and infections seem to be manageable. If you're responsible for 20 or 30 computers, Linux requires virtually no maintenance and gives you your life back."

@AndreCostaubn:
"Windows is a lot harder to install than Ubuntu. People usually don't care because it's preloaded on new computers (as well as bloatware).

I have to remove all the viruses/trojans from my Mom's windows computer everytime I go visit my family. I installed Ubuntu on her laptop so that she stops complaining about it being slow. She was doing fine after that.

Windows doesn't just work, or else I'd be still using it."

Gotta love these keyboard shortcuts - speed through Google search

2012-02-15T13:57:00.001+01:00

I love fance keyboard shortcuts. They help me keep my hands on the keyboard and just focus on writing. This is one just incredibly powerful every Googler should know of;

When you've entered a search term on Google search, instead of moving the mouse pointer back to the input field and type more to refine your search, you can just start typing and voila!

There's even more I didn't know of; pressing enter and then tab selects the first result and you can move up and down through the results with up & down arrows.

Oh my oh my!

The modern, online office for boosted productivity

2012-02-03T13:46:00.000+01:00

Productivity is the holy grail
Wether you are a physician striving to be better in your specialty, giving better care to your patients or just trying to meet the demands of modern life - productivity is the one quality you are trying to increase. Or else you would still be using pen and a paper instead of your PC.

Computers are wonderful machines, capable of tasks we could only dream of even 15 years ago. The picture on the right is of an IBM hard drive being transported from an airplane, it's capacity is FIVE MEGABYTES (5mb). Now that's less than the memory of your digital watch. A common SD memory chip today isn't sold less than 2 gigabytes! Facts like these makes us understand the potential of our computers and why I am constantly preaching that you should give your self time to learn to master it so that you make use of this power!

Creative perhaps, not productive at all! [source]

The office is the common workplace, the place where we think, produce, communicate and organize our professional and daily life. The old office may have been creative (at least when you look at these old photos!) but certainly not productive. How productive your office is today really depends on you and in this post I want to tell you about the "online office" concept.

Papers are thing of the past and will only slow you down, it is time to put all your documents to a virtual electronic data-stack to open up the powerful tools to work them and open up for the modern, mobile office. The modern office should be available anywhere, it's data well organized and searchable, invulnerable to data loss and finally it should have a rich set of tools, easy to use.

Nirvana for the minimalist

For me, the key to making all this work is minimalism. The less I have to take care of, the more I can make out of what I have. The poorer I feel the richer I am! My laptop is running a slim, yet powerful and highly configurable Linux operating system so that I have full control of my computer and minimal distractions from system messages, popup windows or other annoyances such as user interface decorations. Most applications I use are web-applications, freeing me from the hazzle of software updates or crashes. Finally, I use as few online services as possible to reduce the amount of login accounts to keep track of.

Available anywhere
Your productivity should not be limited to a physical location. When you have dead time at work, sitting on the bus or out jogging you want to learn by listening to podcasts, answer emails, write stuff or browse through previously read journal articles. The other day I had a complex patient with sudden vertigo, most likely of central origin, and I recalled having recently read an extensive article about HINTS. It took me only a few seconds to find it in Crocodoc and saved lots of time since I could tailor the work-up to the suggestions of the article. Every now and then I use dead time at work for writing blogposts and my "Presentation" collection of 150 or so photos in Picasa is then available at my fingertips to decorate the posts. If I need to make any adjustments (crop, resize...) I have Pixlr, a free, online Photoshop mimic where this can be easily done through the web-browser. My office is truly omnipresent!

At work I rarely use the same computer and sometimes even several different ones in the same day as I wander around the hospital. The minimalistic approach makes it easy for me to launch my office from whatever computer I am sitting at since all I need is to login on a decent browser (or run Chrome as a portable app from USB if the dreaded Internet Explorer is the only one available). If there's no computer available I always have my Android, providing a mini-portal to my online office.

It's data well organized and easily searchable

Without documents there is no office, at most you can pick your nose and call your colleges to tell about it. Equally bad is an office with stack of unorganized documents and notes. You have to be able to find your documents in an instant whether you browse through them or search. With your data on your hard drive you might have folders within folders to accomplish that task but it is very easy to get lost as the folders grow fatter and count more.

Tagging (also called labeling) is the modern way of organizing data and essential skill for the online office. A document can have one or many tags, unlike the old fashioned folder arrangement it doesn't have to belong to any one tag. You can rename or even erase a tag and the belonging documents will not disappear, just not belong to this tag any more. By carefully tagging your documents they are much easier to access when browsing through them. Everyone knows the old problem of saving some document and then never finding it again, tagging will prevent this from happening again. So if you're still confused about what tagging is, check out this article explaining the concept.

As we will soon find out, tagging and searching is the one of the key features of my selection of the online office tools.

It's data invulnerable to loss and security breaches
Backing up your data is crucial, yet most people wake up it's importance when it's too late. You can read these people's stories and you will literally feel their pain.

Backups will be a problem of the past as you move your years of documents, notes, photoalbums, bookmarks, etc to the data-cloud. Even if your house burns down at least your electronic data is still available. Surely the odds are low but the potential damage is trivial.

Just backing up the "my documents" folder is not enough. What about your email? Or your calendar and contact list? Besides, the traditional backup medias are not as safe as you thought, external hard drives do fail and even CDs and DVDs are overestimated (some DVDs for example will in only 2 years!). And what if your laptop is stolen - surely you have your data backed up but don't you feel a little uncomfortable knowing that all is now in the hands of some mischievous person?

The key here is using the data cloud and the best way to use the cloud is to use web-applications. The data cloud is a term that describes a huge network of online servers (data farms) storing your data instead. You should not have a single document on your hard-drive unless for a very good reason. A thought that might be pervasive at first but when you realize the comfort of not having to worry about if your data you will never look back again.

Check out my post "Backing up your data the modern way, power to the cloud".

OK, I got your idea - now what?
Install a decent browser
Using web-applications, your browser is the alpha and omega of your office, it is like the hud and steering wheel of your car. It has to be fast, secure and rich of features. I have tried all the major browsers and I always come back to Chrome, in my opinion the best there is currently. Read my post about it and the extensions which can make your office life so much easier.

Extend your office
As I've previously said, your office does not have to be bound to your personal room at home or work. Portable apps and smartphones are the keys to extending your office.

Chrome can be installed on it as a "portable app" so that you can open your office even on computers that don't allow installing additional software. You could even install it on your own USB stick for additional convenience (also see my above mentioned Chrome post for additional info on this).

If you decide to use the Google Apps you really should consider also using Android since it is from the same software maker. Surely there are some apps on the iPhone but with Android you can be sure they are always the best you can get (Gilette style).

Picking the tools in the toolbox

So I've explained the concept: all your documents online and use web-applications. So where to start from, what should I do? Well from now on I can only tell you how I have done it and thus I ask you to read my post abot Google Apps, the core component of my online office. You might have expected a lot of websites and online services to register to but the beauty of Google Apps is that they have most of the tools you will need and registration is free. The most important tools that Google Apps have are:

Gmail for secure and online email and contacts
Google Calendar for organizing your daily life and tasks
Google Reader to follow your blogs and articles
Google Docs for working with text documents, spreadsheets, presentations and even more
Google Music for your music, podcasts and audio books
Picasa for managing your photo albums
Blogger for my blogs
Google Sites for your managing your webpages
Google Groups for easy team communication
Google+ for your social networking experience

To introduce all of these if out of the scope of this blogpost, I just want to introduce you to the Google suite as it is the one most important ingredient of my online, mobile office, a true Swiss-army knife. I will be writing more about each and everyone very soon and emphasize how they work for me as an emergency physician.
In addition to the Google Apps, there are a few additional services (also free) I use to complement what GA doesn't have:

Crocodoc for my PDF collection (since GDocs misses highlighting feature for PDFs)
Pixlr for a free, online "Photoshop mimic"
Grooveshark for my discovering music

Though not strictly an office tool, I'd still like to mention Quora as it helps me a lot finding answers to my questions, a common office task. It's a professional Q & A community, sometimes giving me better answers than traditional search engines.

Learn some IT skills
The computer being so powerful, not only do you wan't to have the best components but also you want to know how to use your computer for maximum performance. Check out my posts on IT-skills: taming your computer!

Why I Google

2012-02-03T13:40:00.003+01:00

The Google applications are a core component of my online life and thus are mentioned a lot in my blogposts. Here I will explain why exactly so that you don't think that I am bought by Google!

You might also be interested in my rant about choosing the right technology platforms.

Most of you have used Google search and very likely Gmail but not everyone is aware that those two are just a small part of the bigger Google application suite, a plethora of powerful online tools for productivity and creativity. If Google Apps is new to you, I highly recommend this short introduction to this toolset which can seriously boost your productivity.

Alternatives
It is but fair to tell you that there are alternatives to Google Apps, indeed there are thousands of them but none that I know of that has the broad spectrum of application types as Google has. For Google Docs I could mention Zoho and Office 365, commonly compared to Google Docs. Remember The Milk is a nice todo-list application. To read about the others you could check this article.

Why Google apps?
Google Apps is a prime example of web-applications - they run from the browser and use the data-cloud, providing you with easy access to your data wherever you are and a fully automated backup. They are therefor the core component of my online, mobile office - as long as I have a decent web-browser running my office is up and running, ready to untap my productivity. I have previously written a post about web-applications and the data cloud and why you should seriously consider converting to these, here I will rationalize why Google Apps are my first choice.

Single login to all apps, all data in one place

Sitting in the cockpit of a 747 is very much how I feel when I have logged into Google - I have all controls within the reach of my fingertips. With a single login account I have about 30 different applications before me and only one password to take care of. Even with only a few different web-apps, it would be a hazzle to login to every single one and major treshold to start working and getting things done.

Not only are the apps interconnected but so is their data. On the surface you will not notice it but under the hood all your data within the Google apps is pooled in a single database, just showing up differently within the different applications. This means that each and every application can access your different data pools, for example Blogger and Google Docs can easily grab photos from your Picasa account, your Gmail contacts are accessed with Google+ and vice versa. Seeing is believing - from Google's dashboard you can see how your data is stacked within the different apps.

All eggs in one basket?!
Now some will feel violated by privacy issues - the fact that a private company stores so much of your personal data and there are tons of articles and discussions wiggling this issue back and forwards. This is of course a double sided coin; there are indeed companies that will use your data to personalize your ads and some might even abuse your data but if you trust your company there is so much to gain. Consider for a moment how big Google is and that their existence relies on public opinion - they simply cannot afford violating your data in evil ways, one false move and they could go down the drain over a night. Besides, whether you like it or not, in Google's huge data-cloud, you are just an ID number and your data is handled by robots who don't give a damn about what you do or don't do, like or don't like, for them you're just a bunch of binary 1s and 0s! Some think that Google's employees have fun reading emails in the Gmail database, wake up - that's just as silly as claiming that doctors sit and read patient journals for fun.

The times are different!

If you still feel insecure, I think you should consider leaving the Internet altogether and start using paper and pen again. This is the era of Web 2.0 tools where storing personal data online is the prerequisite for them to work. That is not unique for Google, it's just the way it is today. Google is well aware of these issues and provides you with an easy way to take out all your data if you should want to close down your account - Google takeout (also an excellent tool if you want to have an extra backup of your data on a local hard drive).

If you want a 3rd party solution there is Backupify. No need to worry!

Actually it makes me sleep better in the night to know that a corporation with pockets full of money and enormous muscle power is keeping my data safe. Should Google go bankrupt or be hijacked, your personal data is the least problem of all since that scenario would be a major event touching not only individuals but corporations, countries and even the whole world. You can be sure someone with greater interests will already be working on this before you even have had time to say "ouch"!

Google is also offline
Since the start of the Internet, downtimes have occured in all major services and Google is no exception but it is so rare and short that in effect you would barely have time to have a cup of coffee while it is being fixed.
A more likely scenario is that you are without Internet connection e.g. while flying or sitting on the train. This is yet another reason to choose Google Apps as they are very well aware of the possibility and have been eager to implement offline options to most of their applications. Their current technique is based on HTML5, an universal standard not likely to disappear over one night and since HTML5 support is growing even on smartphones, you will not have a problem with this on your Android or iPhone. Google Docs for example allows you to mark which documents should be available offline and they will be downloaded and synced automatically without you having to do anything but just enjoy.

Simplicity is power

Ever since Google's search page appeared, simplicity has been Google's style. Wether it's Google Docs, Picasa or Blogger - everything is easy to setup and work with, yet providing the most important features needed. Thus the Google Apps are easy to learn and use, you can start working in minutes.

Constantly updated
Google is eager to provide you with the best tools and state of art technology. I have used Google Apps for almost five years now and the features have grown enormously. Almost every month something new is being added and I feel that Google is listening to their users, adding the features most requested. As web-browsers become better every year we can expect even better features in the future. On the Google OS blog you can follow all additions as they are being implemented.

Android integretation
It should not come to a surprise that the Android operating system has great support for the Google applications, they are after all the brains behind this great OS. With the Google Docs app for instance, it's easy to search, read and even edit your documents and recently offline support was added - this literally means that your online office is available whenever and wherever you go. A technology most would have though to be impossible only several years ago.

Totally free
Last but not least - the Google Apps are totally free, for up to 1gb of storage. Despite having every single document of mine and 10 years of emails there, I've still only used 25% of my quota. In time, I will upload my 50gb or so of photoalbums to Google's services for an online backup and I have no problems with paying $20/year for their 80gb additional storage, if you ask me - the price is ridiculously low, it's just a fraction of the price of a hard drive.

A success story for me
A few years ago I uploaded every single document from my hard drive to Google Docs. My laptop now has no hard-drive installed (runs much faster off a 4gb SD memory card with Linux installed), backup and working with different versions of the same document are a things of the past. With Google's Chrome installed on a USB chip I can start my office up from any computer in the hospital in just seconds and the IT department won't have anything to say about it since I'm not opening any security threats to their in-house network. With my Android I can easily access all my online data and I use it every day for better patient care and to steepen my learning curve in emergency medicine. I am a happy Googler.

Please check out my post about the online, mobile office if you wan't to know the details!

Finally - the disclosure
And now you should understand that my choice of Google for almost everything in my online life is not just a sentimental one, it is truly the one tool that helps me the most for my productivity and creativity. I have nothing to disclose; I have no affiliation in any way with Google or related services and my choice to use their tools tools is utterly my own and solely based on years of "trial and error" with various solutions. There was even an era in my life where I had almost grown roots into the flagships of Microsoft, Windows and Office - but I woke up one day and found out there were better ways to achieve my goals.

Master the search engines, find your relevant answers

2012-01-27T19:47:00.000+01:00

Searching is the one most common thing you do on the Internet. Searching for fun is easy but as a physician you don't want just any result, you want information from credited sources and you want to find relevant information. A Google search for pneumonia will give you results in the count of millions, even veteran sites describing pneumonia in horses in details. Surely somewhere in there is the answer to your question but you will probably have had your own pneumonia when you finally get there. In this post I will try to help you get better search results, an essential IT skill for the modern physician.

I will be mentioning Google's search engine a lot since it is the one I use and know from inside and out. Most of what I write here below can be applied to other engines such as Bing or Yahoo.

Refine your question - what do you really want to know?
Googlin' for "pneumonia" is not very smart. Pneumonia is a broad topic and the facts and details are endless. Before blaming Google for stupid results, you might consider what is it exactly that you want to know and what kind of result are you willing to read? Is it the pathogenesis or just a general description? Or do you need a patient information leaflet?

To begin with, you might consider Wikipedia for a quick introduction to whatever you want to read about, Wikipedia's credentials are thought to be excellent and it's quality has been scientifically compared to Encyclopedia with good results. The medical topics in Wikipedia even have dedicated doctors onboard, scanning topics for obvious errors (see BMJs "Wikiproject medicine").

Google has a very powerful search engine and cleverly indexes all words within a website for best results. A special syntax (see below) allows us to use Google to search every open website there is and this can be useful for sites not having their own search function. Some sites have sloppy search engines where using the Google machine gives us much better results. Sometimes though you will want to use their own, advanced engines - the Pubmed search is definitely one of these.

Special syntaxes for advanced searching
Google will accept "human queries" such as "i need patient information about pneumonia" but let me introduce to you special search syntax parameters which give you the real power of web searching. The two most important to know are:

"xxx" (quotation marks) will search for the exact term, without them (the default), pages will be found where words in the query are close to one another but not necessarily. This will filter out a lot of irrelevant results.
minus (-) sign will exclude words, say for example you want to find a nice ABG calculator but online, not iPhone app: "abg calculator -iphone". This way you could exclude pneumonia in horses or even veterinary medicine.

All of the special syntaxes can be called through Google's advanced search page and by just taking a quick look you will quickly familiarize yourself with them. Some of these even are found on the left margin of Google's main search page. Those that I use regularly are:

Order by time brings up newest results and can make your results much more relevant. Some months ago I read an extensive article about "posterior circulation stroke and HINTS", refining the search to display only results from the past year immediately brings up Scott Weingart's post and the CMAJ 2011 article I needed.
site operator: As I actually remembered having the article on his blog, emcrit.org I could also have refined the search using "site:emcrit.org" which then reveals results from emcrit only. Now that is a very powerful function and worth knowing. Emedicine is every emergency physicians' darling and now you know how to get to their pneumonia article with one click only!
Commonly I use the "site:.se" operator to find local, swedish guidelines.

Search all your favorite sites simultaneously!

The "site" operator can be used to search more than one source but a lot of "site:xxx" operators will make your query long and prone to errors. I have a few favorite websites I regularly use to find specialized answers, sites I've used for many years and have my full trust in. So the question arises - can they all be searched simultaneously? The answer is yes and the solution is Google custom search, click to read another post I've written about it - it will be one of your most powerful online tools.

Tricks & tips

Google has a lot special search features providing you with instant answers to special questions like weather, flight times and stock prices, some of them are definitely worth knowing. There are some I use very commonly in the ED:

The built in calculator is a very time saving feature for instant calculations right from the search bar. Even better, you can use the calculator from insde Chrome. In the same way you can convert units on the instant eg 3 miles returns 4.83 kilometers
Using "define xxx" you can in an instant look up word definitions, synonyms, translations or grammatics, very useful for an Icelander living in Sweden, trying to speak English! With the tilda sign I can ask for synonyms for a word eg "restricted~" revealing answers in just seconds.
Conversion is ridiculously simple, try for instance

"98.4 fahrenheit to celsius"
"5 inches to meters"

You can even use Google search to check spelling, right now I made a quick check to see if I had spelled "ridiculously" correctly, and got corrected!
Finally, try putting this query in Google and see what the magic is all about
sqrt(cos(x))cos(300x)+sqrt(abs(x))-0.7)(4-x*x)^0.01, sqrt(6-x^2), -sqrt(6-x^2)

=> list of all the special search features

The best tip of the lot: ctrl+f and Quick scroll plugin for Chrome
Learning keyboard shortcuts is one of the best things you can to do boost your productivity. Ctrl+f is one of these I use every day to faster locate search results. Say I have searched for "erythromycin" and opened a page full of text, containing all there is to know about this antibiotic. Using ctrl+f I can type "breast" and I will instantly see the chapter about breast-feeding to find out if there are any risks involved.

If you are using Chrome you will wan't to use a great plugin which helps you scrolling directly to what you were searching for.

=> Quick search plugin for Chrome

The social networks might be changing it all
The evolution of the social network has been so fast that even the king of search, Google, missed it and didn't realize it's potential until it came up with Google Plus in 2011. Social networking essentially means power to the people and in the context of finding relevant answers could mean the end of finding results through Internet-browsing robots but having the answers from the people around you - the ones you trust. That is the good old "before Google" way - remember the days when our grandparents knew anything and we'd asked them the complicated questions?

Well modern technology surely is catching on. Facebook as the flagship of social networks has already taught us how we can ask our circles of e-friends and most often get relevant answers within minutes.

Even better is Quora, started in 2009 and now rising to become one of the Web 2.0 titans. The idea of a Q & A web is simple and hundreds of others have been there before, it's just that Quora somehow has the easy yet powerful user interface and packed with features. The idea is simple: you ask a question and tag it so that followers of this particular interest ("specialists") are immediately there and answering it. That is, if Quora doesn't point you to the same question being answered before... that's where the real threat to Google comes since it is the perfect mixture of advanced technology using human expertise to answer well defined questions.

I am waiting for more emergency physicians signing up but I have a feeling this could be a breakthrough technology for physicians all around the world since it allows for instant (or almost instant) expert answers from hundreds or thousands of online colleges. To be continued!

Have you met Linux?

2012-01-25T18:50:00.002+01:00

Did you know that Linux powers some of the worlds biggest websites such as Facebook, Wikipedia and Google? Did you know that 95% of the world's supercomputers are powered by Linux? Or that Android is built on Linux? Have you heard about LiMux, the project of converting all IT systems in Munich (Germany) from Windows to Linux and that many others are now doing the same since it has been shown to be highly efffective?

Considering that the operating system (OS) is your one most important interface to your computer, don't you think Linux deserves some of your attention? I used to be a Windows/Microsoft fan for many many years, digging deep into Windows as it was my programming platform. One day I wanted to try "this Linux" I had heard about on a 7 year old HP laptop I used as a media server in the kitchen, I got it for free from a friend who thought that it was too slow. Well, I haven't touched Windows again and for the first time I feel I am in total control of my computer and worries about malware and viruses are a thing of the past.

Think differently! (source)

The Apple story
Increasingly Apple products are being seen, pushing ever more users out the Windows monopoly. Especially I noticed this at MEMC in Kos where many physicians spent their time between lectures gaming their gadgets instead of enjoying 30’ and sunny weather outside. Apple is certainly king of user-friendliness renowned for high-quality multimedia software. I have never had an Apple product my self and thus can't make any bold statements about it when comparing with Windows or Linux (actually, Mac OS X is based on Unix, a common ancestor to Linux). From what I've heard from friends and seen over their shoulders, OS X seems to be a pretty decent product, giving their users speed, stability and functionality, the main requirement for the productivity boost I want from my computer. So OSX might be better than Windows but still I think Linux rivals them both and I will now ask for a few minutes of your time to tell you why.

Why bother?
You are a busy physician and always in lack of time. Your computer probably is a very important tool in your daily life and you depend on it to start up smoothly every day, be fast and responsive, reliable and user friendly. Most importantly you need it to be immune to security threats since your important data resides inside it. You may or may not be a geek but you want to be able to configure your computer and adjust to your own preferences. Without hacking the command line.

My point exactly

The description above is just that of Linux. It is one of the most secure OS:es made, so secure actually that anti-virus software is not needed (but exists for the faint hearted - besides no OS will protect from human mistakes like opening bad attachments or links), sparing about 10-20% of CPU and memory resources. Not only are you free of viruses but annoying malware (ad-displaying banners and toolbars) will never plaque you on Linux. This article about the US military converting to Linux because of security issues really says it all!

Windows is a bloated OS with updates stacked one after another on older versions, eating up hard drive space, memory and CPU power. The sole reason Linux can be installed on a dusty, old laptop is that it is extremlely light on resources. My own laptop has Linux running on a cheap 4gb SD memory chip, no hard drive needed. Slick and smooth, from power on it's up and running in ca. 15 seconds. Chrome starts in 2-3 seconds and even then there's only mere 250mb of memory used, doing the same on a Windows 7 installation eats about 1,2gb of memory.

Windows also tends to grow fatter. One of the most common question I get from my friends is “why is my computer getting so slow”? Linux stays slim and fit for years, software you add is compartmentalized so that it's libraries and plugins don't leak into the big OS pool. No additional load is put on the core. Because of this you don't have to upgrade your computer hardware every two years or buy software to clean your computer, Linux will not grow old on you!

Linux is free. All applications on Linux are free. What's even better, installing software is so easy it will make you laugh. For instance if I want to install GIMP, a high quality (free!) image editor I can either go to the "software installer", browse to GIMP and click install or from the command line I could write "pacman -S gimp" and voila. Let me repeat this again; Linux is free - the installation is free, updates are free and you get assistance from a huge online user community for free.

In 5 minutes only you can put Linux to an USB stick and try it out without changing anything on your computer. If you like it you can install it alongside your Windows or OSX and choose on startup which one to go with. Linux does not take over your computer - it's your choice!

=> Why Linux is better, a very good, detailed and graphical summary of Linux's strengths.

So what is Linux?

Linux is one of the earliest operating systems made and has since been developed and updated by the worlds most active programmers and computer enthusiasts. Thus it has a word for being for computer geeks only and people commonly visualize someone with thick glasses writing complex commands in the terminal. It's true that Linux originated from a world of geeks but that is also it's strength, it is a community based OS.
Linux has endless of different versions for different requirements - there exists a very minimalistic command line driven Linux and a full-blown desktop version with advanced 3D user interface features and everything there between. Linux is commonly compared to Lego since the user has the power to choose how to put together the individual Linux bricks. The user can do it himself or have a ready built package, called “distros” (short for distributions).

You can choose a highly advanced distro where you build everything from scratch (Arch Linux) or a simple works-for-all distro which will run on every computer imaginable (Linux Mint is currently the most popular one). This is the elegance of Linux - the power of choice is left to the user. Compare this to Windows (and even Apple OS) where everything is pre-cooked and decided for you. In Linux, you decide if you want fancy 3D effects or just a plain, minimalistic interface to focus on your work. If you don’t like your choice, you can remove it just as easily as you installed it and try something else. Below is a short video of Ubuntu (very similiar to Mint) effortlessly running 3D desktop effects:

Another important distincting feature of Linux is that it is open-source, meaning there is no one commercial company behind it. Linux is a project “owned by nobody but managed by everybody”. The source code is open for anyone to read or edit - if you spot a missing feature you can whenever you wish join the team and design this as you wish to have it. If you accidentally dropped an error or misfeat the matrix of programmers all around the world will quickly fix it and the next time you choose to update your Linux all this is included. A great example of crowd-sourcing!

The open-source community thrives on a totally different way of thinking, since money and making income is not the driving force but rather the ambition to have software push technology to its limits and seeing the world enjoying it. In the Linux community, like in a symbiotic ecosystem, your ask for help is welcomed and newbie’s are well taken care of on multiple of forums and help channels. Compare this to the big M & A who will not lift a finger unless money is involved. I am not saying this is wrong, just that the Linux community is a much more friendly one, everyone equal... aarg I knew I couldn’t write this without getting political! To cut it short, all I wanted to say is that you should not be afraid of Linux - on the contrary, you will have more help available then ever before!

If Linux is so great why isn't it all over?
Good question and I cannot give you any good answer but as many will tell you, most probably it has to do with money. Microsoft with it's deep pockets presses manufacturers to have Windows preinstalled on every computer sold (the Windows tax). Linux is not a corporation pushing it's products actively (no ad campaigns for instance), it is community based and spreads by word of mouth. That's just the way it is today, money rulez.
=> MS struggles to discredit Linux

Nothing is perfect and there are two major issues with Linux which might keep some refrained; drivers and software. Unlike Windows, 99% of all drivers are built inside the "Kernel", the heart/core of Linux common to all distros. The Kernel is constantly being worked on and since version 2.6 driver issues are becoming a thing of the past. There are some peculiarities with older computers but support from the community is very good and with a few searches with Google this can almost always be fixed. Besides, Windows is no angel with regards to drivers either - last month I had to throw away my sons graphics card because it was not supported on Vista. Had no problems running it on Linux!

WinXP running from inside Linux [source]

Software on the other hand is not straight forward. Since Linux is an open-source community, proprietary software is rare and the big software makers have very little profit of porting to Linux. In effect, you will have to revert to new software you have not worked with before. Not a problem really, just an inconvenience since it takes time to learn new software, just as it would on Windows or OSX. And so, LibreOffice (previously OpenOffice) replaces MS Office, GIMP replaces Photoshop etc. All of these are absolutely free. The Alternativeto website is a great site for helping you finding alternatives.
If you insist using proprietary Windows/OSX software, you can always run the other OS from inside Linux with a so called “Virtual machine”. It will behave 100% as if your computer is running your other OS, just inside a window in Linux. There are both Windows and Apple OS emulators available making most proprietary software work. Another option is to install Linux alongside your other operating system and then you simply choose at startup which one your prefer for your session (see more on dual-bootin').

I have installed Linux on my friends' computers and unlike before when Windows was causing them pain and struggle, I haven't heard a word from them afterwards. Happy as hippos.

OK, you’ve got me excited - what next?
Before we continue, you might want to read this blog post from someone who tried installing Linux (Ubuntu) for the first time, it will give you a short introduction of what is to come.

You will first want to decide which distro is the most appropriate for you and this and this time only I will decide for you what is your best option. If you do your own research you will get drowned in thousands of different opinions.

Ubuntu is one of the best known distros and is famous for it’s easiness of use but recently has had criticism because of their choice of the standard user interface. Thus many are now going for Linux Mint and friends of mine who’ve tried it have been delighted. Here is a recent article comparing the major distros for 2011. If you want to run a distro even lighter on your resources (great for very old computers) I would like to recommend Lubuntu.

Now don't get me mistaken, all of these distros are Linux and they will all run the same software and have the same options under the hood. As said before, they are just different configurations of Lego bricks and you can always adjust their setup afterwards.

Just remember it's easiest to install from a USB drive and follow those instructions and you will be fine. When you feel comfortable, set aside a few gigabytes of your harddrive and make a full installation. Later on you can remove the Windows/OSX partition or just have it there for fun. By the way, Linux has no problems with reading your documents on that other partition.

Last year I switched from Ubuntu to ArchLinux which is has a very minimalistic user interface (desktop) and is intended for advanced users, providing total control of it's configuration and settings. It is by far the fastest Linux distro I have tried yet and after some fiddling learning by mistakes I now have it installed on all of my computers, faster and snappier than ever before, all running from a small 4gb SD memory card and without hard drives (my data is all in the cloud anyways!). Oh sweetness!

Finally
You're off to go! I would love to hear feedback from you in the comments if you go all the way. I might even lend you a helping hand. Now that I've finally written this long introductory post to Linux I will most likely be shedding off a few tips and thoughts every now and then from my own personal experiences so stay tuned.

I will end this post with a few recommended readings if you are eager to know more about Linux:

A great site about the strengths of Linux and graphically explained
[Lifehacker] An easily comprehended article about the first steps of starting Linux
[MakeUseOf] Debian vs. Ubuntu vs. Linux Mint (and check out the user comments, lots of valuable feedback)
No games for Linux? Not true!

Tame your computer part 2 - choose your software wisely

2012-01-24T20:31:00.001+01:00

This is a continuum of an article about "taming your computer", be sure to read also Mastering the mouse and keyboard.

Choose your software wisely

There used to be the days when I would preach alternative software over the better known, "popular" ones. When it comes to software, the most expensive does not necessarily mean the best. The big brands with deep pockets have had great success in having us thinking exactly that. And so I have tried to inform people about alternatives and actually there is a great website, Open Source alternatives which will help you with that.

With the rise of web-applications, the importance of choosing the right software is becoming a thing of the past. Many of our tasks can be done with online applications which reside within the web-browser. As your primary interface to the Internet, the most important software choice nowadays is which browser to use. Usability, speed and security of your web-browser is now more important than ever. Internet Explorer, despite being the most commonly installed, is probably the worst piece of software Microsoft has made, having had not only programmers but also end-users pull their hairs in frustration (try and compare Google Docs on Chrome and Internet Explorer and you will see what I mean). Fortunately this is changing and competitors such as Firefox, Chrome and Opera are pushing IE out . This is a highly sensitive topic and I will suffice to say that I have tried them all and consider Chrome to be the best of them all, a true Swiss army knife. Whatever you do, don't do IE! And also, do read about web-applications and how they can boost your e-life.

Think Linux!
Speaking of software, I also want to encourage you to check out alternatives to Windows. If you're Mac OS you're fine, even better though in my opinion is Linux. Linux is free, more secure than Alcatraz, faster than Porsche, more configurable than Technics Lego and is so easy on the computers' resources it will run smoothly on a 10 year old laptop... A special post on Linux is just behind the corner!

Tame your computer - mastering the mouse and keyboard

2012-01-24T19:52:00.001+01:00

Imagine having a private jet (they call them "bizjets"), never putting it airborne but just driving it around on the country roads. Or driving a Porsche in first gear only. Or just driving blindfolded... You get my point, it's about having a very powerful tool but not seeing its true capabilities. All too often I see my colleges 'driving their bizjets', they have powerful PCs in their hands but haven't mastered the basic computer skills and thus end up fighting the mouse, joggling windows to find the work-area or poking the keyboard one letter at a time. Surely this is fine if you have all the time in the world but if you are serious about productivity and GTD (getting things done), you really should give this some consideration.
While giving my IT lectures I always dedicate a few minutes to the "back to basics" concept. Below you will find my main take home points.

The mouse
As banal as it may seem, this is the part of your computer that you use the most. It is the steering wheel of your computer, the bread and butter, salt and pepper, alfa and omega. You hold it in your hand most of the time and without it, you wouldn't be doing anything!

#1 Be picky about your mouse - don't just buy the most expensive or fancy one. There are small and big mice, heavy and light ones, those with lots of buttons and others minimalistically designed. Try out them all and find out which one gives you the best control. I prefer a wired mouse since batteries inside it makes it heavy and awkward to use. My mouse should have a scroll wheel and back & forward buttons since these save me a lot of time while web browsing and reading text - which is what I do most of the time.

#2 Make sure the bottom of the mouse is clean. Dust will easily collect under its pads and distort the movements of the mouse pointer. It only takes seconds, flip the mouse and wipe off dust collections with whatever you have nearby.
Nowadays most mice sense movement with an optical laser beam underneath. The older generation mice had a huge ball in it which rolled smaller wheels inside the mouse, these would easily collect dust and make the mouse pointer stubbornly resistant to movement - easily fixed by just cleaning the wheels.

#3 Use the scroll-wheel! It is the fastest way to scroll a page up and down. Some scroll wheels will even let you scroll horizontally by bending it right or left. Yet others will allow pressing the scroll button and the mouse pointer will change to a "scroll pointer" so that you can easily move around a big document.

#4 Learn to use the ctrl+scroll button combination. You use it to zoom in and out while viewing a document, a very handy function when web browsing or reading PDF docs where you will often want to zoom out to see the outline and then go in again to read the text. Experiment this function a lot as it is a universal shortcut applicable to most applications, it will make your e-life a lot easier.

Keyboard shortcuts

I started this article with a slightly dramatic metaphor of the blind driver to help you understand why you need to master the basic skills of using your computer. Now imagine that the gear stick of your Porsche was on the roof so that you would need to open the window and reach out your hand each time you were changing gear. Well this is what all too many computer users are doing when they constantly move their hands back and forth between the mouse and keyboard. What you want to do is to have your fingers fixed at the keyboard. Every time you reach out for the mouse you are pressing the break pedal. This is exactly why the renowned Thinkpad was designed with a TrackPoint, a small stick in the middle of the keyboard to simulate a mouse (there are lab-verified statistics that the TrackPoint is 15% more efficient than using the traditional touchpad).

It turns out that much of what you are doing with your mouse can be done with keyboard shortcuts. Every OS has it's shortcuts and applications even have their own. Now if there is anything I would like to emphasize in this blogpost it is memorize common keyboard shortcuts and always strive to learn more. They are *the* double espresso of your productivity curve!

First of all some universal shortcuts, common to all operating systems and applications.

ctrl+a: select all text
ctrl+c: copy selected text,
ctrl+x: to cut it instead
ctrl+v: paste it
ctrl+z: undo!
ctrl+y: redo!
ctrl+arrow: while writing some text this will move the cursor back/forward by words instead of characters
ctrl+f: find text, this is very highly recommended while browsing a document with lots of pages, you will instantly find the word you were looking for and most browsers will even help you scrolling into the location of the word

Then there are some specific for Windows (and Linux)

Win+d: minimizes all windows and displays the Desktop, your main working area
Win+e: opens the File manager from where you can browse your hard drive, CD/DVDs, USB drives or whatever device is connected to your computer
alt+Tab: switch between windows

And finally the ones specific for each application. If you use Word a lot there are shortcuts you must be familiar with. If you're working with Photoshop there are shortcuts which will regain hours of your life. Et cetera. Use Google (or whatever search engine fits your needs) to find these in the applications you use the most. I have previously written about Chrome's amazing shortcuts and features. If you are like me, web-browsing 95% of the time while sitting at the computer, this will boost your productivity by a whole lot of double espressos!

Now there are many more shortcuts for you to learn and when you feel ready to dwell into this, I would like to recommend Keyboard-Shortcut.com which has some very nice articles on this subject.

Touch typing

A slow typer will write at a speed of 23 words per minute (wpm), slightly above Stephen Hawkin's 15wpm. With some training you can easily achieve 40wpm and by learning touch typing you're on the road, the world record being 216wpm. A professional typist will work at 50-80wpm and can with some effort reach 120wpm. An audiobook is read out at a speed of 150-160wpm.

The average Joe has 19wpm for composition. Now let's say that you write 2500 words in a 8 hour shift (notes, medical letters etc). For the average of 19wpm that's 132 minutes or 2.2 hours or 28% of your valuable time (add to that the above mentioned clutter of moving the mouse pointer, picking, selecting and moving around windows and we're up to at least 3 hours!). Then say you have trained typewriting to reach 60wpm, now we're down to 42 minutes, only 10% of your work time.

Can you imagine then how many hours, days, even years are wasted in non-productive time for one of the world's most educated and expensive professions? Do we have the gut to convert that to lost dollars?

Touch typing is the technique of placing the fingers strategically on the keyboard, having your eyes fixed on the screen and being able to focus on the content of your text instead of the letters. Touch typing can easily be learned and trained in just a few days. If you Google the term you will find several courses online both free and costing some.

A well known online game, TypeRacer, is an excellent starting point for you to try out your writing skills, I was very happy with my 81wpm until I saw I was being totally overshadowed by keyboard ninjas on steroids, competing with me online...

Finally a short introductory video on touch typing:

=> Part 2 of the IT-skills series: Choose your software wisely

Picking the right social network, storing your 'read articles' collection

2012-01-10T21:51:00.000+01:00

I am currently updating my PEA blog as it was an aesthetic disaster. I have dwelled deep into Blogger's infrastructure and found a way to almost completely takeover the HTML code which allows for much more advanced layout. That along with CSS and jQuery has the potential to make it an awesome interactive site. I will post more details about this later.

I am now having the dilemma of choosing the one social network to "mini-blog" on the side column. Running the feeds from Twitter, Facebook, Google Plus (and even more!) is too much, my readers will end up with a randomized chaotic nystagmus.

Until now Twitter has been the obvious choice but with Google Plus on the rise as a highly advanced and professional (FB for me is the personal network) social networking tool I am tempted to use it not only to mini-blog but also to store all my favorited articles, read on the Internet.

Previously it was easy to do with Google Reader's Shared items function whereas you could mark each favorited item (article) in your subscriptions and export this as a special RSS feed. That way widgets and gadgets could grab that feed and display it on your blog aka 'I am now reading:' list in a box on the sidebar. Well in nov 2011 Google made a unpredicted and very unpopular decision to remove this feature (previous items fortunately are found through Google's Dashboard and can even be exported). Most probably their intentions were benign and to have the crowd use Google Plus instead which is not a bad idea considering it is their main social media platform. But as we speak, half a year after Google Plus entered the scene, there has been none official RSS export function introduced [april 2012: this function is now available through a 3rd party solution!]. There are hacks but the only way to be sure it will continue working tomorrow and the day after tomorrow is to have an official version from Google and thus I have not used these.

Now why do I want to obsessively pin my online readings and share this way? Actually sharing is a lesser important feature, I can live without it, but I have repeatedly found my self going back to my previous readings to find again "just that great article" I read some months ago (like this great piece of work on things that will more likely kill you than sharks). This commonly happens while writing a blogpost or just having a gust of inspiration to kill the writer's block. I am aware there are other options for this like Evernote and StumbleUpon.com but they are not Google services and thus require another sign up and login which is against my idea of minimalism and one key to all doors. Besides I want smooth integration with Google Reader which despite all is still my favorite RSS reader. I am sure you will eyeball my decision but this is my choice after years of trying different services, loosing data and trying to port data between them, an awkward waste of time.

Wanting the Google Reader integration I have found a relatively painful new way for pinning by creating a special "Pinned articles" circle in Google+ and using the G+ share function in GR, it allows the pinned circle to be selected specifically (and is remembered next time as default choice). You can then decide if you want to invite your friends to this circle or just keep it publicly readable for everyone. This is an ok solution to the problem but I really miss an RSS export feature to create some magic from my feed, eg displaying it on the blog.

The search will continue - please comment if you have any thoughts!

Of Android, e-readers and tablets

2012-01-02T17:26:00.001+01:00

Happy new year everyone and may 2012 be a great end of the world... or whatever!

The pretty nuns decided to loosen up a little

I have decided to loosen up a little and do more of spontaneous think-a-loud on my blog. Since I started blogging I have always had the feeling that I should stick to facts and facts only and skip personal opinions and thoughts. After all, my readers - mostly emergency physicians I believe - are constantly short of time. What I have found out is that this format makes me nervous and stiffens my fingers, leaving a dozen of unfinished or drafted blogposts because I feel 'they don't meet the right format'. From now on, I will never again force my self to separate the left and right side of my brain!

Therefor, you will in the future see more of personal thoughts from my daily life of information technology and emergency medicine. With a dash of uninhibited ideas from the right hemisphere and without the expectations of a scientifically correct format, they will be the perfect IT-EM-rants. Phew... I feel unrestrained already!!

---

I love my Android and have found lots of use for it in my daily EM work, most importantly easy access to Google docs where I have all my notes and books in a electronic book-shelf. I thought I would never need a tablet computer but now that I am reading almost everything electronically (see my post about Crocodoc, the perfect tool for your PDF/article collection) I really feel the need for a bigger screen. For highlighting and annotating my books or documents the small-screen Android keyboard just doesn't do it. Although I have very small 10" netbook, speedy and snappy with Linux installed, it feels clumsy and noisy and so the urge to try a tablet has grown. And it won't fit into my pockets at work.

Today I stumbled upon an Android e-reader which also has a highlight feature - something that has been missing until now and kept me away from the e-reader buzz. It's the Mantano reader and judging from the online reviews I've found it seems to be welcomed by the market. In the same review you will see the Moon+ reader also providing highlighting/annotating features but it doesn't support PDF files which in my opinion makes it unusable.

However, being a minimalist, I suspect I will continue to use the online Crocodoc (and patiently wait for Google to implement highlighting feature to Google Docs), after all it's free, incredibly featured and has the same look and feel wether accessed from a mobile or tablet device or a computer. Besides, all notes and highlights will be saved in the cloud so that they are still there when I login next time from somewhere else.

So once again, I prefer the power of web applications instead of local applications. Running Crocodoc on a tablet has thus become a dream, let's see if we can find a juicy plate to try out, BRB!

Addendum:
The Moon+ reader is for me a fail since it doesn't read (and highlight) PDF files, that's 99% of my electronic book shelf! That leaves Mantano as the winner.

The best podcasts I enjoyed in 2011

2011-12-14T13:11:00.000+01:00

Now that Christmas lights are finally brightening the dim afternoons of Scandinavia my mind is drifting and looking back to review 2011's top events. A five hour trip by car from Stockholm to Lund in July comes to my mind where I listened to some great emergency medicine podcasts, making my fingers tickle with excitement to get back to work after a well earned summer vacation. My kids so quiet in the backseat and my wife reading Game of thrones besides me, this trip was a e-learning blizz. Now that I look back I see that thanks to newly discovered e-learning resources, I have never before learned as much in a year as before. I consider my self a much better doctor, thanks to great colleges out there sharing their learning experiences and discoveries.

And now I would give back and share with you those podcasts I enjoyed the most this year, hopefully inspiring you to try out the 'road lesser travelled' and waking up to the fantastic world of e-learning. Here they are, in no particular order:

Having just had a tough case of bleeding aorta aneurysm with atrial fibrillation, Scott Weingart's rant about the crashing atrial fibrillation patient helped me understand better how to approach this 'shit has just hit the fan' scenario. This was how I discovered Weingart's amazing, almost aesthetic, collection of podcasts, bringing me EM wisdom in an unprecedented way.
Scott's "Sympathetic Crashing Acute Pulmonary Edema" rant is also a ten bagger, I will never again be afraid of the dyspnoeic patient having razzles up to neck level.
I have yet to dig through EM:Rap's wonderful collection of excellent EM lectures from all around the world but of those I've heard have already become all-time favorites. Especially I remember Michael Chansky's Diabetic emergencies as a total wow moment, the talk was so rich of valuable pearls I actually listened to it three times!*
Stuart Swadron is one of my favorite EM ranters as the clinical pearls coming from his mouth are non-stop. Mel Herbert actually calls him "captain cortex" as he remembers the most petit symptoms and conditions. Earlier this year I listened to his discussion with Dr. Lopresti (who's seen more myxoedematous comas than any other physician!) about severe hypothyroidism in the EM; the ominous yet subtle presentations that you could easily miss in your ED. If you haven't already that is... In an hour's listening I learned more than my 3 month rotation to the endocrine clinic. In EM:Rap's june 2010 episode the same party discussed hyperthyroidism.*
At Kos 2011, I had the fortune to enjoy Joe Lex's stunning talk about the assassinations of the american presidents, from the medical perspective. A lesser known fact to the world is that some of the deaths may actually have been early recordings of a medical malpractice as the patients (the presidents) were treated with utterly unsterile techniques. As Guiteau said himself in court: "The doctors killed Garfield, I just shot him". Even more stunning though is that these talks are free to listen to from freeemergencytalks.
Definitely not the most educating EM podcast but absolutely the most entertaining one, what else would you expect from Mel Herbert? "Famous Deaths!" from Doctor's Unplugged and make sure you have plenty of floor space to ROFL!
You know Rosen's textbook of Emergency medicine... well can you imagine this respected author and honored emergency physician telling you about the first years of emergency medicine, back in USA in the 1950s? Be prepared to hear one of the most interesting and even shocking EM talks you'll ever hear; Peter Rosen: Beginnings of Emergency Medicine. BTW Rosen's talk can also be viewed on All LA as a video-talk.
ICU Rounds is a non-EM podcast site but hellya the overlapping of these fields is so extensive anyways, it's just like two sides of a slice of bread... (I already hear the footsteps of ICU trolls coming to my blog). A podcast about acute kidney failure had all of my attention this year and has taught me wise things about a scenario which is otherwise so boring to read about that the textbooks are soaked of drool from snoozing.
Amal Mattu is an old favorite of mine and his talks were in 2010 my eye opener to the world of podcasts, as I discovered the freeemergencytalks collection. This year I listened to his great talk emergencies in the geriatric patient - a gentle reminder that the elderlies are not to be taken lightly in the ED.
Finally, something to remind you that the world of podcasts is just half the story - there are also lots of excellent 'videocasts' out there; talks from the big conferences, academic lectures, grand rounds etc. They might not be a thriller for you working in an academic ED where emergency medicine has been alive for 50+ years but for me where we're almost in the startholes, without senior specialists with experience dripping of their clothes, having a video lecture with occasional academic shouts from the audience in the background has changed everything... I've seen a lot of good ones in the year and I can't easily say one is better than the other but the USC case presentations, escorted by Captain Cortex amongst others have had a great impact for my learning curve. Try for instance this excellent presentation of two mystery cases - just sit back and enjoy!**

That will be all. If you're new to the fascinating world of blogs, podcasts and vodcasts I have a not too long yet detailed introductory post for you to prepare for your first e-date. By the way, I would really like to see your highligths too, please feel free to jot whatever sits at the top of your heads here below in the comments!

With that said I wish you all a happy Christmas and let's hope I manage before 2011 is over to finish my post about Linux - aren't you curious to know how that can have anything to do with emergency medicine!

* I decided to use this as a shout-out for Mel Herbert's excellent EM:Rap, if you haven't heard of it before then read my lips: you are missing one of the greatest educational sources for emergency physicians, ever! EM:Rap is not free but you will not regret a single cent of your purchase. To prove my case I have uploaded the above mentioned podcasts for you to try out (with Mel's permission).
** The same goes for EM Core Content, also a Mel Herbert production. As you might have noticed, Mel Herbert is a very productive physician indeed and I seriously suggest you read my post about his wonderworks! Please notice the video quality is consciously reduced as this is only a introductory video!

The Bristol Stool scale

2011-11-27T09:23:00.001+01:00

Next time you want to gain some points when talking to the house surgeon you could report your patients' stool characteristics with the professional Bristol Stool scale... Expect at least 3-4 seconds of silence on the line!

Ask a friend - the universal EM questions experiment

2011-11-18T15:03:00.001+01:00

My emergency program here in Lund (Sweden) is one of the first in Scandinavia and for that we are proud of. Our ED is a well functioning one with highly ambitious residents. There is no doubt we have had enormous help from modern IT and social media, especially since we are a totally on our own whereas the program is only 10 years old. I am not sure Joe Lex understands what an impact his Free emergency talks has had for our group, giving us opportunity to listen to the great talks from the big conferences - that was how it all started.

The problem is still that we haven't got so many to ask when our group is exhausted. But that doesn't silence the hunger for an answer, in the opposite the frustration just grows.

I am sure there are other colleges out there, in dark corners - having exactly the same problem. So I decided to start an experiment to see if we can relief the frustration with modern crowdsourcing. Therefor I have started a Google Docs document, open for everyone to edit, with a few questions from our group to kickstart this project. Michelle Lin (UCSF) has previously had experience with Google docs crowdsourcing and has a huge interest to in EM academics so I asked her to help me and she even has a question on the list, waiting for a clever EM physician to answer.

Should this go well I am prepared to take it a step further and develop a better platform but currently I think Google Docs this is the easiest way to start. Remember if you have a Google account the document will reside as shared on your GD home page and be bolded everytime there is a new question/answer.

Alright, everything is set and we are ready to go. The magic link then is
https://docs.google.com/document/d/1oDFuaYJrOT5UJolsmgudVfdLSkeYvuTsMkmVpz7d9Ds/edit

I hereby beg the EM social-media community to spread out the link as the more we are the more powerful tool we have which benefits everyone!

---------------------------
ADDENDUM feb 2012
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Judging by Blogger statistics this post has had very many readers so I assume the idea must be something my colleges are interested in. As I had suspected the text based format is not the best one if this is to roll on, for example there is no way to "upvote" a the best answers
and just pushing answered questions further down is no good way of archiving old questions.
In the meantime I have discovered Quora which seems to fulfill all our needs of an easy, web-based Q & A tool for asking and answering EM questions by the community. Although not locked or restricted, it's tagging and grouping system would make it incredible easy to use for the EP community and being a modern social-web based tool (for example using Facebook login credentials) it has the potential to become the true tool I was looking for. The one thing we need is more EPs to sign up and start using it and as such I suggest you all go there and start following the Emergency medicine group.

IT for emergency physicians - the esoteric talk

2011-11-17T22:55:00.001+01:00

In september 2011 I was at the 6th MEMC, an international emergency medicine conference held in the small greek island of Kos - the birthplace of Hippocrates. I was given the opportunity to talk about my IT experiences in my life as an physician.

The thought of a first first time talk on international ground was comfortably stressful until the day before when I decided a trip to an Irish karaoke-bar would stabilize my nerves. And it did but the irish bartender spotted my Acchiles' heel and managed to sneek more beer on my table than I had planned for, fiddling most of my cortical senses and spinal reflexes the day after.

There was a silent nervous breakdown going on and standing in front of tens of EM docs, masters of spotting obfuscate symptoms, it was a little hard to give "the perfect talk". A faux pas for martians even. Fortunately the content of my talk was of more interest than performance and it seemed the audience forgave me stuttering words with a mixture of esoteric swedish, icelandic, english-wannabe pronunciation. I even had a short-lived crowd gathering afterwards asking for my name tag and email which I like to think was a positive sign.

And now, I give to you a "home edited" version of the same talk, with the same esoteric pronunciation for you only to feel the atmosphere of the real talk...

Keep in mind I was limited to 20 minutes and to dissect a broad topic as IT in such a short time would be utterly impossible. Instead, I give you a few eye-openers and ideas for you to step onto the IT-wagon yourself and I welcome you to follow my blog for the details.

Please feel free to ask any questions you have in the comments and I will happily reply. If you find an urge to discuss with me karaoke as stress-relief therapy, you are welcome to contact me - you will find contact info in the introduction post.

IT for emergency physicians from David Thorisson on Vimeo.

Prevent your digital catastrophe!

2011-11-08T21:23:00.003+01:00

I have just read an article about a womans' great misfortune where her Gmail account was not only hacked but all her online data erased. A chilling reminder of how vulnerable we are with our life stored in the cloud; years of correspondance, documents and personal photos. An event like this would leave me stunned for weeks as most if not everything I have created is now online. The article is a must read for everyone, it is not only a wake up call but a lesson learned how to defend your self from modern crimes - being hacked online.

Being both paranoid and proactive I have never in my years of computing had an intrusion, neither at home or online. As IT engaged doctors, defending our online forte is on of our most important tasks. Unlike other physical things that we insure because they can be replaced, the day that you are hacked is the day you can loose it all. Thus I would like to share with you my experience and techniques.

Please remember to also read the article, they are 10 minutes well spent!

1. Protect your email like if it was your cornea
A login is a combination of password and email. Thus keeping your primary email away from the Internet is a strong tactic of defense since the hacker has no way of cracking your password.

I have two Gmail addresses. The primary one I give out only to those I fully trust, thus mainly family and friends. I would even hesitate to give it out to people I am not sure about since if their email accounts are hacked, my address will most probably go to some hacker's database and thus online. The other email I use as my "shield" and I use it for registrations, postlists etc where anything can happen.
Then I use the primary Gmail account to import from the secondary one. Gmail's spam filter has then automatically removed 99% of suspicious emails and even though a few "genuine" emails get caught in the spam filter I don't care since they're not personal anyway.

In the end your email will eventually leak (in my case, my mother's email account got hacked, I never had spam emails until then) but this technique minimizes the visibility of your email. This is why I also use my secondary email for postlists or online orders, even though I trust the companies they just might get hacked one day and the hackers most surely will be looking for gmails to hack!

My inbox of 3 emails only, read but not attended to

Not entirely within the scope of this post but while we're at it... This technique is also a clever way to keep your primary inbox clean and free of clutter. I rarely have more than 2-3 unread emails, the number of unattended (not the same as unread - hence my inbox is a pseudo-todo list) emails in my inbox indicates my current 'state of business'. A tough week and there will be ca. 10 unread mails, an easy one and it is sometimes empty. I use Gmail's filter function to automatically move all mass-mails (non-personal) to a special "Postlist" folder, cutting the inbox-load even more. Finally, my smartphone plings a tone whenever I get an email but since they are merely 5-10 per day the pling is not a high-frequency disturbance and attending mail through the phone gives me much more freedom to read and reply to important emails 24/7. This helps me a lot to quickly catch and even reply to important mail. This has helped me several times to get extra shifts(=extra money) before everyone else!

2. Your password your most important forte
Hackers are not guessing your passwords today and trying a few entries until they give up. They have robots which make "brute-force" attacks on your accounts with thousands of words per second, combinations of words caught by spying your online social life (e.g. birthdays and children's names) and a pool of "most common passwords". Not only do you have to choose your password carefully but you should renew if at least every 6 months. The IT friendly site Makeuseof has a nice article on creating a password a little harder to break, if you really want to dwell (highly recommended!) into this subject I can also recommend Lifehacker's articles.

A very common mistake is that of reusing passwords. You might for example have the same password on your Gmail account as on some general news-site, say your subscription to Wall Street Journal. Hackers know this and therefor put efforts into breaking into the databases of these seemingly non-important sites to catch logins. Someone breaking into my WSJ account is utterly unimportant to me - at most the hacker will be able to read some locked WSJ articles but they will not be threatening my online world in any way. My online bank login on the other hand is a very vulnerable one obviously. With so many online logins to hold account on you need to define which ones are truly vulnerable and take special care of these. For the rest, you can ease your paranoia and reuse your password. This will also make it much easier to hold account of tens of logins as modern IT life requires us to do.

With special care I mean choosing your password wisely, renewing it on regular basis and storing it carefully. There are many nice software solutions for this, I prefer phone based ones since I have my phone always with me and thus easily used for looking up not only web-site passwords but PIN- and door codes. For this I use the highly recommended Android app Pocket - there are iPhone apps for this too.

3. Beware unsecure wireless networks
Modern hackers will not only try to pick lock your passwords - another less known method is that of sniffing network traffic to eventually find your password amongst millions of data packets. It may sound difficult but this can be done in just seconds with software easily found on the Internet. Free networks ("hotspots") are available all over, especially in caféterias where you are welcomed to sit down with a nice Cappuccino to browse the Internet and do your work. To save you from the hassle of logins the hotspots commonly offer open WiFis meaning that every single data packet coming to or from your computer is open to the public. If you are like me you most probably have accessed these WiFis with your smartphone, I have to admit I hadn't realised the danger of this until I read the article above.

Your only protection is to be truly paranoid and avoid unsecure WiFis. If you insist, minimise access to your personal sites requiring login.

This is impossible, I know. Fortunately there are less dramatic alternatives - securing browser traffic with https for example (see below) and using VPN (virtual private networks). Until you feel totally sure about your hotspot vulnerabilities I recommend you to use your laptop lightly unless you have access to a secured WiFi, some cafeterias actually do provide their customers with a password for this purpose.

And remember to check your WiFi setup at home - the once trusted WPA protocol is now easily hacked and you should only be using WPA2.

Now this is not something for the average computer user to understand from just one blogpost. Because how truly important this is I highly recommend that you give yourself some time and read more about WiFi security, here is a great website which will cover the basics in an easily read text:
http://www.nowiressecurity.com/about_wi-fi_security.htm

4. Be very afraid of malware
In the early days of PCs you were required physical actions to install software such as inserting a CD. Today the mere click of a link is enough to wreak havoc, unless your computer is well protected (Windows is especially vulnerable). Malware is tiny piece of malicious software - computer virus is one kind of these - built with the purpose of taking over your computer or parts of it for various purposes. The least scary ones just want to use some of your CPU power for a bigger project while the true beasts will record every single keyboard stroke, waiting to catch your passwords or credit card numbers. What is most frightening with malware is that they will commonly install themselves without you noticing anything, sitting in the background waiting for you to fall to it's mischiefs, like a spider in it's net.

Unfortunately there is no one solution to fight off malware but having a decent anti-virus software will do it for most of these - at the same time clogging your computers' resources (some will take up to 20% of your CPU). This is one of the reasons I am totally converted to Linux - something I will be blogging about in just a few days.

4. Pick your browser
Internet Explorer used to dominate the world of browsing thus becoming a popular target for hackers. A depressive fact considering so much of your work goes through this wonderful technology. But then, IE simply is awful when it comes to security and has caused many days of embarrassment at the offices of Microsoft. Yet another reason to switch to other browsers not only more secure but in every aspect better than IE.
You might have noticed from previous posts my love for Chrome, the fact that Google has offered $20.000 to anyone who claims it can be hacked says all that needs to be said.

5. Special tips for your Google cloud data
The article told about an unfortunate Gmail user and being a very active G user my self I want to emphasize a few points which will dramatically reduce the risk of you being hacked, in addition to those above.

* Set Gmail to use https, secure connection. This is your last forte e if you insist on using unsafe hotspots (see above).

* Activate Gmail's 2-step verification; this will disarm anyone who is even making an attempt to hack your account with the little cost of occasional verification codes.

* Activate the recovery options in case you loose your password, it will give you more confidence while picking a truly uncrackable password.

* Beware suspicious links in emails! Although Gmail's spam filter is doing a hell of a good job, an occasional email will slip through and commonly they seduce you to click a link. Which could be the beginning of your worst day of life. Be informed and you won't run into this trap.

* The spam filter works so well because it's crowdsourced - Gmail users report fraud email and the servers will automatically act when a particular email is being repeatedly reported. So it is important that you as well flag mail that you consider fraud, this is easily done with the "report spam" button.

* A backup of your cloud data on Google's servers will give you the ultimate feeling of comfort and good nights' sleep. Here is a great article on this subject and fyi there are rumours about a Google "Gdrive" coming with function simliar to Dropbox. Which would mean automatic backup of everything in Google docs - and maybe more.

Cardiology updates 2011 is out!

2011-11-05T18:25:00.000+01:00

The world of podcasts is a truly inspiring one, especially in emergency medicine where it seems there is more ambition and spirit of 'sharing knowledge with the rest of the world' than in any other field I know. Although I regularly encounter great lectures this way I decided my blog is not the right place to shout these aloud.

I will make an occasional exception and this time it's Amal Mattu's "cardiology updates 2011", an annual podcast where he reviews the most important literature of the year. It was through these exactly that I caught the podcast train a few years ago and so I see a very good reason to let you know that the 2011 lecture is out.

Put everything else aside, this is the best thing that could happen to you this week. Thanks Amal Mattu and Joe Lex for putting this online. This kind of knowledge truly does lead to better patient care!

http://freeemergencytalks.net/?p=6241

Your calcluator always at hand

2011-10-26T19:49:00.001+02:00

I've previously talked ranted about Google's web-browser Chrome and why you should master it to increase your productivity. Now here is a short tip I just picked up which will certainly save you time and mouse clicks while calculating your antibiotic dosing or critical care vital signs...

Google search is so much more than just a brainless search motor, it has built in special functions providing for semantic search (in short, semantic in this aspect means more meaningful) results, just try for example looking up your flight number, "weather xxx" for an inine weather forecast, "define:xxx" for a quick explanation of a word and it's synonyms... you get the catch. There's also a calculator so that you can throw any numeric equation at it you wish to have crunched.

The real magic lies in Chrome's address bar, as I've previously mentioned it has some amazing features making it much more than just a browser. This is what I'm talking about:

Thanks Guidingtech for teaching me this trix (well worth reading too, you can never know too much about your browser, the heart and lungs of your computer)!

Friday for fun

2011-10-21T16:01:00.002+02:00

and this I certainly find very very fun!

Today I am making a last desperate experiment using Twitter for quick answers to clinical questions, theoretically my followers of 55 should give me at least one or two feedbacks... My previous attempts attracted zero answers so I am kind of giving up on this nice but unfortunately not so giving medium. The questions are:

1) Lets try this here... Collecting tips for differentiating (regular) afib vs SVT, mine is valsalva => not slower => afib>>SVT, whats yours?

2) 40yo femal no sign diseases, asymptomatic, has incidentally hypoNa=115, hypoCa=1.14 and QTc=500... what have u say pattern recognisers?

If you think you have it please shout it out on my Twitter account;
https://twitter.com/#!/DavidThorisson

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