Spending two hours each day on the train, offline and without distractions, gives me an excuse to go down various rabbit holes that a couple of months ago I would’ve thought nothing but time wasters. Starting to read the Dark Tower series—I’m almost done with the Gunslinger—is one of them. Re-learning vim—if dabbling with it in high school 15 years ago counts as having learned it—is another.

This episode of the Technical Difficulties podcast is what started it, followed by a blog post or two (nay, three) on the perfect setup. Now, I may or may not continue using vim as my primary writting tool—I would have to figure out how to integrate it into my workflow—but several things I picked up will always be useful:

  • git is an amazing tool for tracking changes that researchers should use more

  • don’t blindly edit stuff—dotfiles in this particular case—on your computer without understanding what those edits mean

  • Solarized should be your default color theme for anything

  • use your macro/keyboard shortcut app of choice (mine is Keyboard Maestro, you can just as easily—but not as prettily—use Better Touch Tools) to quickly position windows into quadrants, halves, thirds, etc.

  • there might not be much difference between bash and zsh if you are a beginner, but zsh has the cool customizable prompts

Yes, I am writing this in vim, previewing and exporting in Marked, then posting it manually to Squarespace. The only thing standing between me and a fancy-pants static website engine powering this blog is there being no internet access on MARC trains, and me being too cheap to get a $20-a-month personal hotspot from Spring. That is probably for the best.

Posted
AuthorMiloš Miljković
  • 4 books read: Ocean at the End of the Lane, Tenth of December, The Golem and the Jinn, Ubiq
  • 2 books re-read: Getting Things Done, Mindfulness in Plain English
  • 1 book half-way through: Embassytown
  • 2 computer games completed: To the Moon, Bastion
  • 3 tabletop games played: Dixit (3 sessions), Pandemic (2), Eldritch Horror (4)
  • 1 used minivan purchased
  • 1 article, 1 abstract submitted
  • 61 km ran
  • 1000+ toddler photos taken
  • 0 tedious field trips made

NIH orientation started today. My commute is 90-plus minutes each way, and the first four months are mostly inpatient. I will have to wait until retirement for another run like this.

Posted
AuthorMiloš Miljković

Four years ago today was my first day as an intern at Sinai. Yesterday was my last on Sinai's payroll. I will miss it.

Won't miss the fake flash mobs of Lifebridge Health, though.

Posted
AuthorMiloš Miljković

The new intern class starts in less than a month. It’s easy enough to find advice on how to be well-organized, efficient, and likable. Here are some more tech-oriented tips I wish I knew back when I started.

Take photos and videos, with permission

Get an iPhone. Turn off Photo stream, or download a camera app that doesn’t automatically upload to it, like VSCOcam. When a physical exam finding is rare, stumps you, or is just cool to see, ask the patient about recording it. If you see an interesting or rare radiography image, save it. But please remove all personally identifiable information.

Useful for: appearing smart on rounds, observing disease course, creating informative slides, posters, and written case reports.

Keep track of things you are interested in

Your EMR will have a way to create custom patient lists. Use it. If you are into hematologic malignancies, eosinophilic esophagitis, MODY—or anything, really—keep track of all your patients who have it. If you don’t yet know what it is, keep a list of all the patients you found interesting and try to find a pattern.

Useful for: getting ideas for research and quality improvement projects, figuring out your career path.

Do not copy forward, copy/paste, or use templates and macros

I started my internship in 2010 so I can’t believe I’ll write this, but—back in the day before EMRs, we wrote our progress notes and H&Ps by hand. This meant reviewing the med list, vital signs, and labs each morning and writing down only the important stuff; completing and recording just those parts of the physical exam that had to be done; and writing a new assessment and plan each day. Well duh, isn’t that what interns should do?—you might naively ask, until your second or third day on the job when a helpful senior resident shows you how to shave minutes—minutes!—off your note-writing time by using some variant of copying forward, templates, or macros.

These tricks are a mental crutch, and a known cause of documentation errors. They might help your handicapped intern self the first few months on the job, but will then prevent you from thinking about what you are doing and writing. A thoughtful daily review of everyone’s medications and labs will turn into a quick glance over a two-page long list of 10-point single-spaced Courier New. Also, your typing speed will never improve if you only document by clicking.

Useful for: being a good, thoughtful doctor.

Posted
AuthorMiloš Miljković

In the olden days, back when I could keep all my photos on Facebook, photo management was simple. I didn’t have that many to begin with; the ones I did have were grouped around events—birthdays, vacations, etc—and easily organized into albums. I also didn’t care much for privacy, or backups.

Then two things happened: iPhone 4S, and Dora. Every day became a photo-op, with two cameras in our pockets ready to shoot. The DSLR was still there for big trips and Dora’s modeling yet another outrageously expensive dress. This gave us:

  • hundred of new photos and hours of video each month coming from four different sources (our two iPhones, a Nikon DSLR, and friends with their own cameras);
  • no time to sort them;
  • more respect for privacy, but at the same time a need to share baby photos with everyone;
  • panic attacks whenever I thought about having to organize the mess of file names, formats, storage, and backup solutions.

We needed a good method to collect all the photos, organize them for easy access, retrieve them quickly for show-off purposes, and back them up both locally and in the cloud.

Having children usually comes at a point in your life when you care less about money and more about your time—though your progeny will do their best to relinquish you of both. The willpower-depleting effects of a toddler’s tantrum are also well-documented. No surprise then that many of the tools listed below have at some point sponsored a certain Mac-centric podcast that has destroyed many family budgets[1]. No regrets, though—it all works.

Collecting, with Transporter Sync

For simplicity’s sake, I like systems with multiple inputs to have one central gathering node. Unfortunately, our only desktop computer is a ridiculously noisy four-year-old Windows PC which sits in a usually occupied guest bedroom. The fans that buzz with the sound of a thousand bumblebees instantly disqualify it from a job as a media server, so I had to use my Macbook Pro. Thanks to Transporter Sync, that was easier than I thought possible for an SSD-only machine.

Transporter, similarly to Dropbox, has an iOS app that automatically uploads new photos to a predetermined folder. Unlike Dropbox, there is no monthly subscription—you pay once for the device, and keep using it as long as the hard drive is working. It can also act as a NAS-lite—having access to the folders kept only on the remote hard drive without them occupying the limited space of an SSD, through a Transporter Library folder.

Organizing, with Hazel

A folder full of unsorted cryptically named JPEGs and RAWs is less than useful when your parents want to see all the photos from that trip to Naples back in January.

Enter Hazel, the Swiss army knife of file automation. With the rules I’ve set up, it renames photos based on the date and time taken, tags them according to the device that took them, and moves them to the proper Year/Month subfolder. It does the same with our DSLR’s RAW files, placing them in a separate folder. Since the laptop only has 256 Gb, it moves any files older that three months to Transporter Library, the “special” folder kept only on the external hard drive.

We therefore have the last three months’ worth of photos and videos organized by year and month on the laptop, and our entire collection on the external Transporter hard drive.

Access, with Picturelife

In theory, we could get to all those photos using the Transporter iOS app, but we’re not a masochists. It’s slow, ugly, and not meant for browsing media.

Thank FSM for Picturelife! It sucks up all our new photos and videos from the Transporter—though we’ve excluded RAW files since we do have to pay for all that data[2]—presents them in a nice web and mobile app interface whenever we want it, and can pass them on to Facebook, Shutterfly, Flickr, or wherever else we choose. It will also, from time to time, send you a “this day in the past” email, with photos taken years ago. When you have as many unprocessed photos as we do, it is a great discovery mechanism.

Did I mention it can send photos to Shutterfly with just a couple of clicks? I still have flashbacks of the last holiday season, progress bar dragging glacially, the upload finishing just in time for me to miss the shipping deadline. Good times.

Backup, with Backblaze and SuperDuper!

Keeping everything on the Transporter and Picturelife as on-site/off-site backups would probably be enough for some. Unfortunately, counting on a VC-backed company that might at any point pull an Everpix to hold all our photos does not seem optimal[3].

Which is way Backblaze and SuperDuper! keep copies of all those photos as a part of my general backup system[4]. If you have a Mac and an extra external hard drive, you should also turn on Time Machine. This way, there are three local copies of all the photos, RAWs, and videos (Transporter, SuperDuper! image, Time Machine), a cloud backup of the same (Backblaze), and an easily-accessible collection of JPGs and videos (Picturelife).

Setting this up is neither cheap nor simple[5], but it gives you quick and easy access to all your photos, has several levels of backup, and—most importantly—requires little effort to maintain.


  1. Which is why this post has affiliate links.  ↩

  2. We keep RAW files in a separate folder, one that’s not on Picturelife’s monitor list  ↩

  3. That being said, Picturelife is the best of its kind and I strongly recommend it.  ↩

  4. Backblaze will back up the Transporter Library folder, since it doesn’t count as network-attached storage. It doesn’t back up NAS drives.  ↩

  5. I thought about illustrating it with a diagram of a Rube Goldberg machine.  ↩

Posted
AuthorMiloš Miljković

Fun fact: The average Maryland to DC commute is the second longest in the US, right after New York. I should know. Mine will be 90+ minutes, come July 1st. Last week, while I was finishing paperwork at my new employer’s Bethesda offices, the looks people gave me went from incredulity to pity on seeing the Baltimore address on my driver’s license and hearing my explanation that no, since my wife is still at Sinai and usually just walks to work, we won’t move. It’s better for me to take one for the team, I’d say, than have both of us suffer hellish beltway traffic from some midway point.

I could write an essay on how taking one for the team is not entirely true, but the title of this post says “podcast”, and it’s already the second paragraph, so here is my point: My commute will be long. I will need to fill that time with something. Sometimes, that will be strangers talking into my ear about things I don’t understand. Here is my list of strangers, carefully curated after ten years of listening.

Monday: Mac Power Users

Comes out every Monday morning, like clockwork. Great for learning about new hardware, productivity apps, etc. but podcasts are not the best medium for going into the minutia of somebody’s workflow.

Tuesday: Back to Work

Go read this. Having Merlin Mann talk for an hour all by himself would be good enough, but Dan Benjamin—the other half of BTW—is the best podcast host in the business. By using a simple formula, it is easy to mathematically prove that their show is the best podcast ever created.

The first 30 or so minutes are laden with inside jokes and obscure references, but even that is fun after you are several episodes in.

Wednesday: Wait, wait…

It airs each Saturday, but I like alliteration, and there is nothing else good on Wednesdays. I was in Chicago once while it was being taped, but was too late to get a ticket. Now that Carl Kasell is retiring, it’s unlikely I’ll ever be at a live show. So it goes…

Thursday: The Talk Show

Daring Fireball is a better blog than TTS is a podcast—John Gruber and some of his guests tend to ramble—but you can get good insights on baseball and bourbon.

Friday: ATP

One word: Siracusa. There are two other co-hosts, whose main job is not to screw up too badly. They do it well.

Saturday: The Alton Browncast

The John Siracusa-slash-Bret Terpstra of food. Yes, Alton Brown is a national treasure.

The Sunday potpourri

This is the time for irregular shows, or ones that don’t always have something of interest. In order of preference:

  • Radiolab • Fact: this is the best radio show ever created, and an even better podcast.
  • The Incomparable • For geeks, by geeks. Or is it nerds?
  • This American Life • Any co-production with Planet Money is a must-listen. Otherwise formulaic.
  • Systematic • Hit-and-miss, though usually a hit.
  • Technical Difficulties • A tech DYI show with show notes better than some books.
  • CMD+Space • I only listen to it when an interesting guest is on, which is once every couple of months.
  • The Pen Addict • A podcast about pens.
  • JOP podcast • The only oncology podcast worth listening to; the medical podcast landscape is dreary.
Posted
AuthorMiloš Miljković

It is always a pain clicking on a link to a journal article only to hit a paywall. It’s doubly painful when I know I have institutional access via my library’s proxy server, but have to jump through hoops to get it: go to the library website, log in, copy and paste the article name or PMID into its PubMed search box, and finally download the PDF. Arduous, and—turns out—unnecessary.

Enter Alfred 2 workflows. Here’s a nice article I found on Twitter today. The NEJM link in the top right corner leads to an abstract, but I need a special archive subscription for the full PDF. No matter—I can just highlight the PMID and hit my special Alfred 2 keyboard combo:

Since I’m not already logged into the Welch library proxy, I hit a login wall. It’s nothing 1Password can’t solve, but you can also just type in your username and password yourself, like an animal.

And Bam! The ugly but magic button is where it should be. Your institution might have a prettier one.

To make it clear—this simple workflow will do a PubMed search of any selected text anywhere in OS X, all through your institutional proxy server. Finding an interesting reference while reading an article, highlighting its title, and hitting ^⎇⌘P to get to the PDF always feels like magic.

You can download the workflow here.

Posted
AuthorMiloš Miljković
Why doctors shouldn't use Google services

Anyone using Gmail or Google+ can now email you without knowing your address. You can disable this “feature” in the settings, but having it be opt-out shows yet again how little Google cares about privacy.

Not that there’s anything wrong with that—privacy is a relatively modern invention that younger generations might not care for as much as we do. But you should understand the implications when patients and random strangers start leaving messages in your personal inbox. Suing doctors is not a modern invention.

This is why I stopped using all Google services—search included—years ago. The company has become so large, with so many users, that it doesn’t need to cater to fringe interests. Yes, when a business has billions of users, doctors are a fringe group—one that hates change-for-change’s-sake[1], having to re-learn an interface “just because”, and not being the true customer[2].

Also, the number of people at Google who may access my data is huge. FastMail[3], my email provider of choice, has fewer than 10 employees. Gmail alone has hundreds. Not that anyone would be interested in me in particular, but if I ever inadvertently send or receive private patient information through my personal account, I’d rather as few people as possible see it.

Email is fine, but why abandon search? Because I had at one point googled enough ailments and substances, common and obscure, that the add algorithm thought I was an elderly female recovering heroin addict with more than one paraphilia. The adds it served me were, in that sense, appropriate. In addition, the only valuable first-page results I got were Wikipedia entries. Everything else was a hodgepodge of useless Livestrong, Huffington post and five-pages-per–500-word-article-AND-behind-a-login-wall Medscape links. Duckduckgo and, yes, Bing at least eliminate the first problem while not making the second one any worse.

Google calendar is the only service still standing. It is fast, reliable, omnipresent and easy to use. There is, however, that constant nagging fear that they will find some way to integrate it with Google+ and yet again sacrifice functionality to force people into its circle[4]. This is why I use Apple’s iCloud calendar, its horrendous web interface and all.

Also: Reader. I use FeedWrangler now, but man.

Physicians’ concerns aside, Google is all set to become the network TV[5] of the internet—large, bland, and largely not relevant to the people who are. It is already two-thirds of the way there.


  1. I like change and think a certain amount is necessary to make life interesting, stave off dementia, etc. But I get enough just keeping track of the latest JNC, ATP, USPSTF, and—coming soon—NCCN guidelines. I’d rather not have to remember where a random designer decided to put the Forward button this time.  ↩

  2. This one in particular, as it keeps reminding me that doctors are second-class citizens in the tech world. Electronic health records are made with the billing departments in mind—we are there to provide content. Google services are created to sell adds—we are there to provide eyeballs.  ↩

  3. Yes, it’s an affiliate link.  ↩

  4. crickets  ↩

  5. Or Microsoft.  ↩

Posted
AuthorMiloš Miljković

Marco Arment has just discovered an old article in The Atlantic pronouncing the triumph of New-Age medicine. It’s been a while since I’ve read it, but the introduction reminded me of what I thought was its biggest fault in reasoning:

… But now many doctors admit that alternative medicine often seems to do a better job of making patients well, and at a much lower cost, than mainstream care—and they’re trying to learn from it.

Alternative medicine does not make patients well. It makes them feel well. The difference is huge.

Here are two graphs from an excellent free-to-access NEJM article that compared four methods of treating asthma: conventional medicine, placebo, sham acupuncture, and doing nothing[1]. The first one shows how well the patients in each group felt after 2–4 weeks of treatment.

nejm1.001.jpg

Ah ha! Albuterol was no better than placebo medicine or sham (sham!) acupuncture. Alternative medicine wins! Or did conventional medicine lose? At the very least it’s a draw.

Not so fast. The second graphs shows the amount of objective improvement, measured in FEV1—the volume of air you exhale during the first second of breathing out:

nejm2.001.jpg

If this were the common cold, it wouldn’t have been a big deal. But asthma is not the common cold. People die of it every day, not because they didn’t feel well—though being unable to breathe is doubtlessly uncomfortable—but because their airways were too tight to get any air out of the lungs.

This is why alternative medicine can be dangerous in the wrong hands, with the wrong patient. Improving quality of life is important, but so is curing disease.


  1. Adding real acupuncture to the interventions would have made the study perfect. Some other time, perhaps.  ↩

Posted
AuthorMiloš Miljković

January 1st seemed to be a good day to install Brett Terpstra’s Slogger. Every night, its army of gnomes will go over my tweets, blog posts, completed to-dos, etc. and record them in a Day One journal entry. Not a replacement for a real journal, true, but better than anything I could do on my own.

It’s a Mac-only app that runs from the command line—not user friendly at all. Even so, the installation instructions are straightforward, with some caveats for the not-too-bright, like me:

  • Plugin configuration is done in each individual plugin.rb file, not slogger_config.
  • All config strings (URLs, file paths, usernames…) should be in quotes (“…”), even when in an array (i.e. in square brackets). The Twitter plugin instructions wrongly give an example without quotes.
  • The Instapaper plugin doesn’t work since RSS feeds for folders are no longer supported. I’m still not switching to Pocket.
  • You will need an IFTTT account to log your Facebook posts, using this recipe.
  • Instructions for logging RunKeeper activity are convoluted, but work.

Slogger’s default time for sucking in your data is 11:50pm, when my laptop is usually in sleep mode. The scheduler should still be smart enough to start the app on wake-up. Nevertheless, it’s one more reason for me to get a used Mac Mini. In 2015, perhaps.

Posted
AuthorMiloš Miljković

In the last two months, two of my must-listen podcasts, Systematic and Mac Power User, have had medical professionals on as guests. I don’t usually listen to medical podcasts—Twitter and saved PubMed searches are big enough firehoses—so I thought it would be interesting to hear how my more experienced colleagues use technology. Two of the three episodes were underwhelming, one was stellar.

It started with Brett Terprstra and Dr. Pamela Peeke on Systematic. She has several books targeted towards lay public, and the episode went in the same vein—broad advice on nutrition, well-being, etc. I cringed more than once, but that was to be expected—public health information relies on overplaying the risks and simplifying facts to the point of absurdity[1]. The one thing I could agree with was how important meditation can be, as mindful meditation might decrease physician burnout. Negative points for not mentioning Mindfulness in Plain English as essential reading, though I haven’t read Dr. Peeke’s own recommendation, The Miracle of Mindfulness.

I had higher hopes for Episode 169 of MPU, since Katie Floyd’s and David Sparks’s guest, Dr. Jeffrey Taekman, has an excellent productivity blog. Alas, McSparky spent more than half of the show being fascinated by the minutiae of what doctors do. Which is better than what followed—long periods of uncomfortable silence while the unprepared guest clicked through every app in his menu bar to see if there is anything worth mentioning[2]. There wasn’t.

Then another episode of Systematic came on, with Dr. Don Schaffner, a microbiologist[3]. It was outstanding. Brett was a better interviewer than David, and avoided getting too side-tracked by his guest’s interesting work. But ultimately, the show was good because Dr. Schaffner had useful tips and app recommendations that did not simply regurgitate the latest round of MPU/Mactories/Macdrifter/etc. sponsors. His paper review workflow gave me several ideas I will work on during the holiday downtime. He also suggested a promising contender in my quest to find headphones that will survive more than 8–12 months of intensive use.

One more thing for me to do during the downtime: promote Zotero. Between the developers fumbling Papers 3 and Mendeley being taken over by an evil corporation, Zotero coupled with a few extensions is the best reference manager on any platform. Coming in 2014.


  1. Much like weather forecasts.  ↩

  2. OK, it was not total silence. You could hear Katie fuming in the background.  ↩

  3. PhD, not MD. Wonder if that explains why the show was better.  ↩

Posted
AuthorMiloš Miljković
Ten common residency idioms and phrases
  • I don’t feel comfortable doing that.—I don’t know what you’re asking me to do (nurse to intern); I’m too lazy to do it (intern to resident); I think it’s a stupid idea and there’s no way you can make me do it (resident to attending); You’re not paying me enough to do this --- (attending to administration).
  • It’s a light elective—You don’t need to show up.
  • Needs to read more. (on a written evaluation)—I have no idea how much medicine this person knows. I barely know any myself.
  • The family is reasonable.—Family members don’t ask too many questions and will agree with anything you say.
  • The patient has xyz.—I’ve read in an old discharge summary that the patient has xyz, but have no idea how they established the diagnosis, what stage it is in, or what the hell xyz even is.
  • The head is normocephalic, atraumatic. Pupils are equal, round and reactive to light and accommodation. Sclearae are nonicteric.—If I were to report the physical exam I actually did it would take five nanoseconds, so take these fillers to make it seem like I’ve put in some effort.
  • Thank you for the thorough presentation.—Why did you waste my time with all that useless information?
  • That’s an outpatient work-up.—Administration is already breathing down my neck because of this patient’s length of stay and you’re worried about a mild anemia and a positive hemoccult!?
  • That’s her new baseline.—Her disease is worse and we don’t know why, so I guess she’s stuck with it.
  • Please let me know if you have any more questions.—This is the end of our conversation, so please stop talking. I shall now leave.
Posted
AuthorMiloš Miljković

…to me, this looks flaky. Yes, Scott Adams (of-Dilbert-fame) is right in saying your best bet for success in life is being pretty good in several skills rather than trying to be the best ever in only one. So, a plan like this:

  1. Step one: become a decent entrepreneur
  2. Step two: become a decent MD
  3. Step three: ???
  4. Step four: profit!

might indeed be a good idea. However:

  • Medicine implies altruism. Entrepreneurship implies greed.
  • Programs want their residents to be 100% dedicated to medicine in general and the program in particular. Can you do that with a small business on the side?
  • Physicians in academia, i.e. those who conduct residency interviews, forgo 300k+ salaries so they could dedicate themselves to research and education. Are you sure telling them about your latest money-making scheme is a good idea?
  • As a resident, do you look at each patient as an opportunity to help them and learn from them, or to figure out how to build a business around them?

Residency programs exist to train physicians, not CEOs. Residency slots are already in short supply. Would program directors give a position to someone who is more likely to end up not practicing medicine at all?

Posted
AuthorMiloš Miljković

After 18 months of intensive use, here are some of the apps left standing on my iPad 3, sorted by category. I like to think I’m a semi-advanced user, so for some of them I have also listed simpler alternatives. It goes without saying that you should download all the free iWork and iLife apps.

Medicine

MKSAP 16

  • For: all medicine residents
  • Recommendation: strong
  • Price: free (if you bought online MKSAP access)

MKSAP question bank. No-brainer if you are studying for your internal medicine board or MOC exam. Less page-flipping and instant gratification. Unfortunately, it doesn’t allow you to highlighting or annotate the explanations. Also, it can’t make custom quizzes, can’t review unanswered/wrong questions, and doesn’t allow you to copy any of the text to your notes. Lot’s of cants, but it’s the only MKSAP app available. Free if you purchase the electronic version of MKSAP 16.

Download MKSAP 16 from the app store here.

ACP Guidelines

  • For: all interns
  • Recommendation: ok, sort of
  • Price: free

It seems like a good idea, and the content is great, but it is more of a branded PDF reader than anything else. Doesn’t have search or favorites, and you have to download each recommendation one by one. The download is fast, but good luck getting what you need without internet access. So, good for night-time reading, particularly if you’re an intern, but not a good POC tool.

Download ACP Guidelines from the app store here.

Stanford 25

  • For: everyone
  • Recommendation: just OK
  • Price: free

If you haven’t heard of Stanford 25 before, see this TED talk and see the blog. It’s another good, if ugly, night table app.

Download Stanford 25 from the app store here.

Productivity

Things for iPad (or Omnifocus)

  • For: everyone
  • Recommendation: strong
  • Price: $19.99 for Things, $39.99 for OmniFocus

Whether you’re a GTD fan or not, this or it’s more powerful and more expensive sibling OmniFocus are a must-have for anyone shuffling between more than two areas of responsibility. It still hasn’t been updated for iOS 7, but is very functional. Only two missing features for me, really: there are no nested tasks/dependencies, and you can’t filter by more than one tag.

I’ve been thinking about switching to OmniFocus, but this works well enough for me that the hassle of complete overhauling my system wouldn’t be worth it. Not to mention the >100$ price tag.

Download Things for iPad from the app store here. You can find OmniFocus for iPad here.

Boxer

  • For: everyone who gets more than 5 emails/day
  • Recommendation: strong
  • Price: $0.99

The best mail client on the iPad. Apple’s Mail.app was OK until I realized I spent way too much time scrolling through my list of 20 IMAP folders whenever I wanted to move an email. Boxer works with Gmail, IMAP and Exchange accounts, has smart email sorting, and integrates with Sanebox.

Download Boxer here

Dropbox

  • For: everyone
  • Recommendation: strong
  • Price: free

If you use Dropbox on your PC—and you must—then this is a no-brainer.

Download Dropbox for iOS from the app store here

iThoughts HD

  • For: nerds
  • Recommendation: OK
  • Price: $9.99 for either

I found Tony Buzan’s book on mind mapping as a first-year medical student and used the hell out of it for my biophysics, chemistry and genetics coursers. As the material got more complicated, shuffling huge stacks of A3 paper became unwieldy, so I went back to plain old Cornell notes for biochemistry et al. This app is what got me back to making maps, this time when writing review articles and planning out other research. Also good when contemplating the GTD 50,000 ft view.

Download iThoughts HD for iPad from the app store here. It’s prettier new cousin Mindnode 3 is available here

Calendars 5

  • For: all busy overachievers
  • Recommendation: ok
  • Price: $6.99

The default calendar used to be ugly and impractical. With iOS 7 it’s just the latter. This is a good replacement. Fantastical for iPad would be nice, though.

Download Calendars 5 from the app store here.

Drafts

  • For: advanced users
  • Recommendation: strong
  • Price: $3.99

Quick note-taking and automation rolled into one. I use it as the default inbox for anything and everything, mainly by appending a dump.txt file in my Dropbox. There is a separate iPhone version that is just as useful.

Download Drafts for iPad from the app store here.

Pinner

  • For: pack-rats
  • Recommendation: ok
  • Price: $1.99

Pinboard is an excellent almost-free bookmarking and discovery service. There are plenty of iPad clients available, but Pinner seemed to be the most cost-effective. I haven’t regretted the purchase.

Download Pinner from the app store here.

GW Mail

  • For: anyone who is forced to use GroupWise
  • Recommendation: meh
  • Price: $9.99

I have to use GroupWise email for work. This is the only decent client I found for iOS. Stopped looking for a replacement since my last day of residency is less than six months away.

Download GW Mail here

Reading

Reeder 2

  • For: serious feed readers
  • Recommendation: strong
  • Price: $4.99

I’ve been using RSS feeds since the days of Bloglines (circa 2001) and switched to Google reader after the first big redesign. It’s sad that Google decided to murder it instead developing its potential as a social service. Feed wrangler is a good replacement, Feedly is a free one. Reeder 2 is the best iPad feed reader there is, and works well with both.

Download Reeder for iPad from the app store here.

Instapaper

  • For: everyone who reads
  • Recommendation: strong
  • Price: $3.99

If you read any text that’s longer than 500 words with any regularity, you need a service that will keep track of the articles and remove all the annoying cruft surrounding the text. Instapaper is the first one of its kind, and the best way to read articles on it is on an iPad.

Download Instapaper for iOS from the app store here.

NextDraft

  • For: everyone
  • Recommendation: strong
  • Price: free

Ten good articles hand-picked by an expert hand-picker and delivered (almost) every weekday. My only source of news for the past six months.

Download NextDraft from the app store here

ReadQuick

  • For: dabblers
  • Recommendation: ok
  • Price: $4.99

The second book from Tony Buzan that I read was on speed reading. This app will flash words from any article you find online or in your Instapaper/Pocket queue one-by-one at a set rate. Good for those who are too lazy to swipe.

Download ReadQuick from the app store here

Writing

Day One

  • For: everyone
  • Recommendation: strong
  • Price: $4.99

A journaling app. I don’t use it for the Dear-Diary types of texts—though I have no doubt it would be perfect for that. Instead, I use it to keep an archive of meeting and lecture notes (usually started in Drafts and sent to Day One), with an occasional milestone in between. Feature request: multiple journals.

Download Day One for iOS from the app store here

Byword

  • For: beginner iPad writers
  • Recommendation: ok
  • Price: $4.99

If you want to write a long text on an iPad and don’t need automation, text expansion et al. then this is the app for you.

Download Byword for iOS from the app store here

Editorial

  • For: advanced users
  • Recommendation: strong
  • Price: $4.99

If you want to write a long text on an iPad and like mucking about with workflows, text snippets and Python scripts—which I most certainly do—this is your only choice on any platform. This will become essential next July when I start my long commute.

Download Editorial from the app store here

Social

Twitterific 5 or Tweetbot

  • For: everyone
  • Recommendation: meh… you might want to wait for the newest version of Tweetbot to come out
  • Price: $2.99 for Twitterrific, $2.99 for Tweetbot

If you are on Twitter—and if you are a physician you really should be—please get a decent iOS client. The official one is definitely not it. Tweetbot used to be until iOS 7 came and made it look and feel ancient. Twitterrific is a good—if slightly annoying—substitute, with the added benefit of being universal (i.e. iPhone and iPad with the same purchase). I’m using the old version of Tweetbot and waiting for the new one, since Twitterific tended to make a mess of my position in the stream.

Download Twitterrific 5 here and Tweetbot for iPad from the app store here

Facebook

  • For: everyone who uses Facebook (why?)
  • Recommendation: my wife likes it
  • Price: free

OK, I guess, if you’re into that sort of thing.

Download Facebook for iOS from the app store here

Skype

  • For: everyone away from family
  • Recommendation: OK
  • Price: free

This is the international default for long-distance communication, I guess. It gets choppy and drains the battery, but it’s the only thing my mom knows how to use so I’m stuck with it.

Download Skype for iPad from the app store here

Games

Letterpress

  • For: everyone who can spell
  • Recommendation: strong
  • Price: free (with in-app purchase)

An excellent turn-based word game. The only multiplayer game I play with any regularity. You need an in-app purchase if you want to play more than two games at the same time, but it’s well worth it. I have five going on right now.

Download Letterpress from the app store here

10000000

  • For: nerds
  • Recommendation: strong
  • Price: $1.99

Bejeweled meets a 2D RPG. Hours of fun, even when you get to 100000000000 or however many points.

Download 100000000 from the app store here

Aquaria

  • For: adventure gamers
  • Recommendation: strong
  • Price: $4.99

A 2D side-scrolling action-adventure game set under the sea. At my pace I will finish it in about two years, but it’s great even in 15-minute increments.

Download Aquaria for iOS from the app store here

Shopping

Deliveries

  • For: serious shoppers
  • Recommendation: strong
  • Price: $4.99

Forward an email containing a tracking number to a special email address. Boom, you can now track your package through this app, with push notifications if you’re into being interrupted whenever a case of -diapers- Wild Turkey is delivered to your front door.

Download Deliveries for iOS from the app store here

Eat24

  • For: serious eaters
  • Recommendation: OK
  • Price: free

Good app for ordering food in the Baltimore area. Don’t know about rest of the country.

Download Eat24 for iPad from the app store here

Hipmunk

  • For: world travelers
  • Recommendation: strong
  • Price: free (you pay for the plane ticket, though)

The best flight comparison engine there is. Find the most affordable and least annoying plane route. Also does hotel rooms, which I haven’t tried.

Download Hipmunk for iOS from the app store here

Entertainment

Netflix

  • For: everyone with a Netflix subscription
  • Recommendation: OK
  • Price: free

I have used this app exactly once, to watch a couple of episodes of Buffy the Vampire Slayer while waiting for an Amtrak train. Well worth it, though.

Download Netflix for iOS from the app store here

AppleTV Remote

  • For: everyone with an Apple TV
  • Recommendation: strong
  • Price: free

I don’t have my original remote any more. We assume Dora ate it. This app is even better, since you don’t have to muck around with the tiny remote buttons when entering your wifi password or searching Netflix.

Download AppleTV Remote from the app store here

comiXology

  • For: everyone who reads comics
  • Recommendation: strong
  • Price: free (the app, not the comics)

The only way to read comics on an iPad.

Download comiXology from the app store here

Posted
AuthorMiloš Miljković

From people at Press Ganey:

Reliably providing evidence-based clinical care is essential to reduce patients’ suffering — but it is not the only way.  Indeed, excellent clinical care is “necessary but not sufficient”. As discussed, care givers must also build trust and relieve anxiety.

Skeptics may wonder if qualitative improvement in the control of anxiety, confusion, and fear is possible. In fact, such improvement is already well underway, as demonstrated by patient experience data collected from patients receiving care from hospitals, ambulatory groups, and other providers.  This progress seems to be driven in particular by improvement in nurse communication, pain control, and care coordination.  Nevertheless, these data also demonstrate marked variability among providers in these measures, and opportunities for improvement for all.

Don't want to throw the baby with the bathwater, but the whole area of patient satisfaction scores being tied to reimbursement is one very filthy bathwater that has a lot to do with the recent opioid abuse epidemic.

Source: http://blogs.hbr.org/2013/11/a-framework-f...
Posted
AuthorMiloš Miljković
Using only one device isn’t liberating; it’s just the opposite. It means putting yourself through unnecessary discomfort and friction, even though a better option is available.

 

Posted
AuthorMiloš Miljković
The total number of applicants to medical school grew by 6.1 percent to 48,014, surpassing the previous record set in 1996 by 1,049 students. First-time applicants, another important indicator of interest in medicine, increased by 5.8 percent to 35,727. The number of students enrolled in their first year of medical school exceeded 20,000 for the first time (20,055), a 2.8 percent increase over 2012.

Nice, but two questions come to mind: how many of these were students who would have gone to Caribbean schools anyway; and if some of them are indeed brand new future doctors, where will they get their specialty training in four years? CMS doesn't seem likely to open up any more residency spots.

Also, FMGs are slowly getting pushed out. For better or worse. 

Posted
AuthorMiloš Miljković

They let us peek into the sausage factory last week.

Nominally, the lecture was about RVUs1. An accountant type in a pinstripe suit explained why the government came up with the concept and how more RVUs translate to mo' money for the hospital. Then he showed us a table. This is how much RVUs an average ophthalmologist makes in an hour. Here is an orthopedic surgeon. See here at the bottom? That's an internist. This is how much you're worth to us, scum2.

Then there was a chart. This is the last fiscal year. This solid line here are monthly RVUs for an average hospitalist. The dotted line is for a single physician in the practice. See how it's always above the solid line? That's good. We love that person.

We had medical students and interns just three months into training listen to this. It was blood-curdling.

Not because the hospital organized the lecture, mind you. It is a very good thing they did it, and it is good for doctors in training to realize as early as possible in what kind of a healtcare system they are expected to work. What is frightening is that there needs to be an entity, let's call it administration, which views the hospital as a production plant and physicians as line workers who need to maximize outputs, optimize efficiencies and do other newspeak claptrap.

Administration usually lies—appropriately—on the ground floor, far removed from that other sausage factory of actual patient care. It looks at pie charts and histograms and RVU tables and keeps coming up with new and exciting ways to increase production while wondering why those bumbling doctors at the bottom of the list can't do whatever the top performing docs are doing to keep the hospital in the black.

It's modern medicine, it's complex, it's expensive, it requires that level of organization and detachment—you might be tempted to say. Yes, you could indeed say that, if not for the lonely example of every other country in the developed world which does it differently than the US.

But never mind that. With all the shenanigans the Congress has been up to this week, that end of the equation is unlikely to change. What administrators should do—and I understand the banality of the following advice—is see real physicians interacting with real patients for at least and hour each week. Interns being bombarded by page after page—from critical to comical—while trying to figure out a 15-minute window to eat, get coffee and use the restroom3. Residents finishing a 24+ hour ICU shift that started with three codes and ended with a difficult end-of-life care discussion, with central lines placements and intern supervision—but no sleep—sprinkled in between. Attendings getting yelled at while trying to explain to family members why they need to pay for the medications out of pocket or bring their own4.

One hour. Each week. Mandatory. To put things in perspective.





  1. Relative Value Units


  2. Not his actual words. Actually, he sounded very apologetic when explaining it. Still stung though. 


  3. At the same time? — a thought will come to them, to be quickly dismissed. 


  4. Hello, observation status. 



Posted
AuthorMiloš Miljković