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Using MDX
An introduction to MDX support in Astro showing how the @astrojs/mdx integration enables embedding JavaScript and JSX components directly inside Markdown content, with a short example importing and rendering an Astro component.
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No more white coats?!
A reaction to a UK government plan to ban the traditional white coat and restrict clothing to reduce hospital infections, arguing the policy lacks research support and that consistent hand-washing would produce far better results.
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iPhone needs
A doctor explains why the iPhone cannot yet replace his Treo 650 for on-call use due to insufficient alert volume, and offers a five-point wish list of notification improvements that would make it viable for medical professionals.
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TPA and the Trauma Patient
A cautionary case note on the dangers of using TPA in a trauma patient with a bullet wound crossing the liver, which led to three trips to the OR before Factor VII controlled the bleeding and the abdomen was finally closed about 36 hours later.
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Cuban flu Pt. 2
A follow-up citing a BBC report that Fidel Castro refused the colostomy procedure, confirming the prediction made in the original post about the root cause of his surgical complications.
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Cuban flu
A surgical analysis of Fidel Castro reported acute diverticulitis and multiple operations, arguing that skipping the standard Hartmann procedure in favor of immediate bowel reconnection was a critical error that caused all subsequent complications.
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More sed
A brief note about using sed to inject verification meta tags into the head section of a freshly rendered HTML page, with a candid admission that sed is powerful but not quick to write.
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Happy Birthday Sophie!
A warm, brief birthday greeting to daughter Sophie, noting how fast she is growing up.
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Specialty Board Equivalency
A California Superior Court ordered the Medical Board to grant the American Board of Cosmetic Surgery specialty board equivalency after it met all 19 regulatory requirements, a win that lets cosmetic surgeons advertise board certification and raises questions about future turf disputes with plastic surgeons.
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Managing Passwords Easy
A recommendation for 1Passwd, a Mac app that leverages the system Keychain to manage web passwords with support for multiple logins per site and responsive developers.
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Bachelor Time
The family has headed to the islands for the rest of the summer, leaving the author at home alone for about a month with a mix of longing and reassurance that they will have a wonderful time.
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Sorry if Your Google Ranking Slipped
A short account of being accused of harming someone else Google ranking, requiring a moment of genuine reflection before concluding that no individual blogger has any influence over how Google ranks pages.
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Medical Reimbursement
A pointer to a blog series demystifying the maze of medical coding and reimbursement for a general audience that has little understanding of how physicians actually get paid.
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Happy Birthday Jonathan!
A quick birthday note to son Jonathan on his 11th birthday, with the real celebration deferred to the coming weekend.
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So you really want to take ER call?
A reaction to a BBC report about a surgeon held responsible for the death of a self-stabbing patient, arguing that removing a penetrating chest object is inherently risky and that personal responsibility should fall on the patient, not the surgeon.
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Snowboarding aftermath
A brief recap of a great snowboarding trip to Utah where the weather was beautiful, Jonathan did well on the board, and everyone returned home thoroughly sore.
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Snowboarding
A quick note about heading to Park City for a family snowboarding weekend organized by brother Alan, bringing all the siblings and their kids together at The Canyons resort.
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Intellectual Property
A surgeon and independent contractor recounts a dispute with his former employer over ownership of a domain and website he built unpaid on his own initiative, revealing at the end that the former employer is his father.
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Hindsights
Guy Kawasaki commencement speech highlights are shared as a top-ten countdown of life lessons, ranging from cherishing family and obeying absolutes to pursuing joy rather than mere happiness.
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Flipping the switch
An announcement that the blog has been quietly switched from Radio UserLand to Squib, a Ruby on Rails replacement, with an invitation for tech-savvy Radio users frustrated with that platform to ask about the alternative.
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And then there was one.
A brief tribute to grandmother Ruth Fragen, who passed away at age 102 after years of unconsciousness following a stroke, remembered as a lawyer who never practiced and an accomplished violinist.
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Happy Birthday Sophie!
A short birthday note celebrating daughter Sophie turning five years old, with a reminder to eventually add a photo to the post.
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VoodooPad as CMS
VoodooPad, a desktop wiki application, is highlighted as a surprisingly capable CMS for static sites through its template-driven Web Export feature, while also mentioning involvement with Squib, an open-source Ruby on Rails replacement for Radio UserLand.
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Gambling in the OR
A candid pre-operative reflection on the uncertainty of relying on a nuclear medicine GI bleeding scan to guide surgery for an AVM, with fingers crossed that the bleeding stops before the operation is finished.
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Happy Anniversary!
A brief heartfelt note celebrating 14 wonderful years of marriage and expressing that he would do it all over again without hesitation.
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Breast CA for Cosmetic Surgeons
A recap of a breast cancer talk given to the American Society of Cosmetic Breast Surgery, covering three core points: refer cancer cases to specialists, investigate suspicious exam findings before any cosmetic procedure, and always obtain a screening mammogram first.
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My Trip to the Apple Store
A first visit to the Apple Store at Fashion Island results in spending more than ten times the planned budget, prompting the rueful observation that it is probably a good thing there is not one nearby.
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Happy Birthday Dave!
A short belated birthday message to Dave Winer on his 50th birthday, with thanks for the opportunity to beta test Pike years earlier.
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Interesting Precedent
Responding to Aggravated DocSurg, the author argues that the FDA advisory panel overstepped its mandate by restricting silicone implant sales to board-certified plastic surgeons only, since credentialing is a hospital responsibility, and predicts the FDA will have to back down.
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Silicone Breast Implants Are Back?
An FDA advisory panel voted 7-2 to recommend lifting the ban on Mentor silicone breast implants with strict conditions, including a board-certification requirement the author argues constitutes an unlawful restraint of trade given the varied specialties of surgeons who routinely place implants.
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Bargaining with HMOs
Responding to a surgeon colleague facing an unacceptable HMO contract, the post argues that relentlessly declining physician reimbursement will turn most doctors into salaried employees, threatening professional drive and innovation, and predicts a major US healthcare collapse before things improve.
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Happy Birthday Jonathan!
A loving birthday message to son Jonathan on his 10th birthday, reflecting on how profoundly fatherhood has changed life for the better.
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JAMA article on CPOE
A JAMA study finding that a widely used CPOE system facilitated 22 types of medication error risks is highlighted, challenging the assumption that such systems reliably prevent errors, while the author notes he has been tapped as physician liaison for a Cerner Millennium rollout at his hospital.
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Thanks Alan!
A thank-you recap of a snowy Park City ski trip hosted by brother Alan for his 40th birthday, highlighted by the kids thriving in ski school and a private chef who cooked nightly dinners for the group of seventeen.
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Consultants and Transfers
Building on a GruntDoc post about consultant rudeness, the author argues that calling surgical consults purely to spread liability -- rather than for genuine clinical need -- is neither efficient nor conscientious medicine.
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MarsEdit 1.0 Released!
A brief enthusiastic endorsement of the newly released MarsEdit 1.0 blog editor from Ranchero Software, praising it for simply working like all of Brent Simmons software.
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Surgical Education in the United States: Portents for Change
A Medscape article is highlighted that documents alarming surgeon shortage figures and argues that declining reimbursement, malpractice costs, and subspecialty migration threaten to strip general surgery of its professional identity.
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Communicate with your Consultants
A frustrating on-call experience illustrates why attending physicians must communicate their clinical concerns directly to surgical consultants before the consult visit.
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Bipartisan
A rhetorical challenge to the common assumption that bipartisanship means the majority must yield to the minority.
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It's Finally Over
Relief that the 2004 election is over, with a call to set aside anger and partisanship and a suggestion that those shocked by the results need to better understand and listen to rural America.
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Sen. Barack Obama (D-IL)
A brief note on Barack Obama handily winning his Illinois Senate seat after his breakout keynote at the 2004 Democratic convention, with a prediction that this sharp politician is worth keeping an eye on.
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Stem Cell Research
California voters approved a $3 billion bond measure for stem cell research despite the state deficit, prompting the argument that nationally beneficial medical research should be funded federally or through private money rather than state bonds.
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What This Country Needs
A note about neighbor John Kimberling and his book making the case that both major parties have failed Americans and that a new third party is needed, with a promise to share thoughts on the argument after reading it.
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Jeff Cheney's take
A reflection on a civil email debate with a friend about 2004 election issues, along with frustration at bloggers who parrot political talking points without independent thought.
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Mission San Juan Capistrano
A family visit to Mission San Juan Capistrano, prompted by a fourth-grade school project, proves well worth the trip, with a tip to arrive at opening time to beat the crowds and get better photos.
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Folder Action
An experiment using an OS X Folder Action to automate blog upstreaming reveals it only fires on direct file additions or deletions in the watched folder, not in subfolders, making its practical value questionable.
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Off to the Islands
Vacation is finally here, and the greatest anticipation is reuniting with a wife and kids who have been away for nearly five weeks.
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Rearranging the office
The practice is expanding into a new suite, and while one office battle was lost, new space was secured for both the author and his mother -- with a move of the general surgery practice under consideration once the current lease expires.
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Birthday Boy
Son Jonathan is turning eight and has been given a motivating challenge: reach reading and writing fluency and earn a new iMac connected to the home wireless network.
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Sophie Talk
At just over two years old, a daughter is forming multi-word sentences and speaking with great seriousness -- even if the actual words remain largely undecipherable to her captivated parents.
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West Virginia Surgeon's strike
West Virginia surgeons took coordinated leaves of absence from hospital practice to protest malpractice insurance rates exceeding $100,000 per year, and this post explains the mechanics of their action and why it does not constitute patient abandonment.
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The joys of being a surgeon
The final day of ER call means four Sunday operations and missing visiting family, offering a candid look at the personal costs of surgical on-call life.
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Current Medical Malpractice and Liability Environment
A recap of a compelling ACS Conference talk that challenged the widely-cited claim of 98,000 annual deaths from physician negligence by exposing flaws in the source study, and made the case that effective tort reform is essential to controlling insurance rates and preserving patient access.
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More shit
A detailed account of taking a critically ill patient back to the OR for bowel leakage, discovering interloop abscesses and a small bowel perforation, and managing the case with an ileostomy, colostomy revision, and an open abdomen using a Bogota Bag.
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Cars looted
On a birthday morning, the family discovered their cars had been burglarized overnight, with valuables including a purse, checkbook, credit cards, and a Game Boy stolen -- prompting a long day of account cancellations and a hard-learned lesson.
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Busy week
A hectic week of ten surgical cases concludes with general surgeons convening to draft a proposal to hospital administration seeking compensation for ER call coverage.
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Vacuum
A brief musing on the one-sided nature of blogging -- writing into the void with no expectation of a response, and finding that oddly therapeutic.
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What I Wanted
A frustrated venting after a radiologist performed the wrong exam without calling to confirm the order, leaving the patient with an unnecessary charge and the surgeon without the study he needed.
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Insomnia Posting
A candid note explaining how busy surgical days leave no time for writing until the house is quiet, and even then insomnia keeps the mind racing.
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Age
A brief, somber note on learning that a family friend at 101 years old is developing serious heart failure.
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Birthday One
A warm snapshot of a first birthday celebration featuring family, stuffed animals, an ignored cupcake, and the exciting coincidence of first wobbly steps.
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Busy Day
After a full day of surgeries and an evening consult, arriving home in time to read to one child and watch the other take her first steps made it all worthwhile.
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Night Owl
A charming observation on a one-year-old who refuses to go to bed because everything around her is simply too new and interesting to sleep through.