Goodbye, Sinai

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.

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Three tech tips for new interns

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.

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Managing photos with Transporter, Hazel, Picturelife, and Backblaze

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 budgets3. 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 data2—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 optimal4.

Which is way Backblaze and SuperDuper! keep copies of all those photos as a part of my general backup system1. 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 simple5, 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. Backblaze will back up the Transporter Library folder, since it doesn’t count as network-attached storage. It doesn’t back up NAS drives. 

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

  3. Which is why this post has affiliate links. 

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

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

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Just can’t get a break

A combination of heavy rain, bad infrastructure, and even worse emergency preparedness1 resulted in Serbia and Bosnia having the worst floods in more than a century.

Dozens are dead, and tens of thousands misplaced. Government officials are having nervous breakdowns on live TV, calling the flood “a Biblical catastrophe”—since touting vast water resources as your country’s main asset isn’t a hint as to what big disaster you should prepare for. In case you’re wondering, the Netherlands’ last big flood was in 1953.

And of course a high priest3 of the Serbian Orthodox Church blamed it on Gay Pride. Because religion2.

If you have a couple of minutes, please use PayPal to donate to floodrelief@gov.rs, the official account of the Serbian diplomatic mission in Brussels. If your bank allows international wire transfers, you can give directly to the Serbian Red Cross. While no one we know is affected, my grandparents had to leave their home twice over the past 50 years because of floods. The support they and their neighbors received from the Red Cross on both occasions was invaluable.


  1. No surprise there. This guy is the head of Serbia’s department for emergency response. 

  2. Though I shouldn’t be that sarcastic, since the Orthodox Church is, in fact, trying to help. By praying for the rain to stop

  3. Isn’t organized religion just an excuse for LARPing. 

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A podcast a day

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.
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Šta posle Stepa 1?

Da nije oksitocina i porođajne amnezije koju izaziva1—u poslednjih nekoliko decenija i epiduralne anestezije—majke bi se verovatno mnogo ređe odlučivale za više od jednog deteta.

Spremanje i polaganje Stepa 1 nije ni blizu trudnoće i porođaja, ali je efekat na pamćenje sličan-koliko je god meni i drugima čitava procedura bila stresna, gledano unazad sve to i nije bilo tako strašno. Najviše zbog onoga što dolazi posle.

Dakle, dobili ste svojih 250+ poena na Stepu 1. Čestitam! Šta sad?

Na red dolazi ono što je trebalo da planirate od samog početka:

  • nalaženje bolnice u SAD u kojoj možete uraditi clerkship (ako ste student) ili observership (ako ste diplomirali);
  • traženje pisama preporuke na gore navedenim mestima;
  • iznalaženje pisama preporuke sa fakulteta u Srbiji (bar jednog; sva četiri ako nemate uspeha sa korakom iznad);
  • spremanje i polaganje Stepa 2 CK i CS u junu i julu;
  • prijavljivanje na ERAS u septembru;
  • razgovori od oktobra do februara;
  • iščekivanje Meča u martu;
  • skupljanje dokumentacije za vizu i licenciranje od aprila do juna 2;
  • najstresniji meseci vašeg života u julu, ako imate sreće, ili nazad na prvi korak ako nemate.

Svaka od ovih stavki zaslužuje svojih petstotinak reči, a o ovoj poslednjoj su pisanje knjige3. Ako ništa drugo, iskustvo polaganja Stepa 1 je dobra priprema za ono što sledi.


  1. Oxytocin: the Great Facilitator of Life 

  2. Čiji najgori deo nije ni razgovor u ambasadi, ni popunjavanje rupa u CV-u od dana diplomiranja do danas, već Kafkaeskna iskustva u Ministarstvu zdravlja dok tražite jedan od dokumenata neophodnih za J1 vizu. 

  3. The House of God, na primer. 

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To Cuba and back

Finishing up our world tour/airplane passenger torture project1 was a trip from Baltimore to Havana, via Cancun. Before you scream Embargo!, neither my wife nor I are American citizens. Our daughter is, but it is fortunately not illegal for US citizens to visit Cuba as long as they don’t spend any money there, at least according to America’s most esteemed journal of law, medicine and gastronomy.

If for whatever reason you want to travel to Cuba from the East coast, you might find our experience helpful.

The flight

We took the United flight from Dulles to Cancun, went through Mexican customs and immigration, then took the Cubana flight to Havana after checking in again. Inbound, layover time was more than 3 hours so we could have comfortably checked a bag or two for those large bottles of sunscreen and other essential liquids. The trip back, however, was tight at 1h 55min, so we decided not to risk waisting time at baggage claim, and only brought carry-ons.

In retrospect, it was half of a good move. On the way back, going through customs, immigration, then walking from Cancun’s Terminal 2 to Terminal 3 and checking in for the flight to Dulles is barely manageable in those 90-ish minutes after leaving the plane. However, we could—and should—have checked one of the carry-ons on the inbound flight, as sunscreen, diaper cream, and other toiletries are ridiculously expensive in Havana.

NB: You can easily walk from Cancun’s Terminal 2 Arrivals to Terminal 3 Departures (or 3 -> 2 inbound). There is a shuttle that leaves every 30 minutes and goes Parking -> T1 -> T2 -> T3 -> Parking. The Cancun airport staff told us it would take us 25 minutes to walk from T2 to T3—and that it would take the shuttle at least as much since it makes those other stops—but hey! there’s this van that magically appeared which would drive us to T3 for the low low price of $20. Google maps said it’s less than a kilometer between terminals 2 and 3 so we smiled politely and walked away. It took us—three adults with a carry-on and a large shoulder bag each, plus a toddler in tow—less than 10 minutes. Kudos to United for letting us skip the long check-in line and making it to our flight without issues.

Entry

Serbian citizens don’t require a visa, but Dora had only her US passport. We got her a visa in Cancun at check-in for 20 euros.

Cuban entry stamp is bright pink. They asked us before putting one in Dora’s passport, so I can only assume they occasionally get US citizens who’d rather not have their passports stamped for whatever reason (cough, cough). The visa also gets stamped, so there is still proof of entry.

There were no issues going back through Dulles. The customs form asks you which countries you visited on the trip, so we did write we were in Cuba. The immigration officer at Dulles just asked if we were bringing any cigars back with us—of course not, we hadn’t even smoked any while there!—and finished the fingerprinting in record time.

Money

Bring euros, and bring more than you expect. You can convert USD to convertible pesos (CUC) in any exchange office, but with their rates it’s better to change dollars to euros in your own bank, then change euros to CUC once in Cuba. Also, convert some CUC to the peso nacional (CUP), if only for the ridiculously cheap ice cream you can buy on the street.

As for how much to bring, count on at least $20/person/day, not including the room or the 25 CUC exit tax. This would cover lunch, dinner, and a daily trip to the beach or a visit to a museum, monument, etc. Since you cannot use American credit/debit cards anywhere on the island, it pays to take more than you think you would need.

Homestay

The highlight of the trip! We booked this room on homestay.com, and could not be happier with how it turned out. Centro Habana, the neighborhood it’s in, is definitely not for everyone—very safe, like the rest of Cuba, but also with dog poop and open trash cans everywhere you turn2. Our casa particular was the opposite—clean, well-maintained, gaudy, but cute. Between our large air-conditioned room, the patio, and the open rooftop terrace, we could easily have spent a couple of days just hanging out there chatting with the friendly hosts.

Internet

Don’t count on being able to get online at any point. We tried checking in online a day before the trip back, but none of the Havana Vieja hotels we tried had any prepaid cards available. Even if they had, there are no printers to print a boarding pass. Unless you’re staying in a hotel, don’t even think about wi-fi. Just bring a good book or two.

So, if someone’s vacations response email tells you they’re going to Cuba, don’t count on them having any access, no matter what some self-important douche bag tells you.

Guidebooks

The only resource we used—and we used it multiple times per day—was the Havana Good Time iPhone app. Some of the information on working hours and prices is slightly outdated, but it is all still relevant, and it comes with an offline map of Havana that is—duh—much easier to carry around than the paper version.

Other DOs and DON’Ts

  • Do take the Havana tour double decker bus at least once.
  • Do go to the Revolution Museum—the clunky propagandist English translations alone are worth the 8 CUC admission fee.
  • Do try the excellent Coppelito ice cream.
  • Don’t waste an hour standing in line to pay for it with CUP—support their economy, and pay for it in hard currency like the tourist you’re pretending not to be.
  • Don’t give any CUC to street performers, especially the kind that chases you down the street with a guitar.
  • Do throw CUP at them.
  • Don’t drink the tap water.

  1. The torture device being our 19-month-old girl—or rather, her vocal cords. 

  2. I could say the same about the part of Naples we stayed in this January. In fact, with laundry out in the open and being able to peek into people’s living rooms from ground level it looked very much like Naples, just with wider streets. 

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Get a journal article through your library proxy quickly with Alfred 2

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.

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Kako ljudi u Srbiji preživljavaju teror pušača?

Rekao sam sebi da neću biti onaj gastarbajter koji posle godinu-dve van zemlje dođe na odmor, pa se čudi kako u Srbiji uopšte ima struje, tekuće vode, hleba u prodavnici… Ali—kako bilo ko može da ode u kafić, restoran, kafanu, i uz jelo i piće dobije i dobru dozu duvanskog dima? Kako da gledam decu koja sede u poslastičarnici dok im sa stola pored dolazi oblak karcinogena? Šta da kažem njihovoj majci koja puši za tim istim stolom? Zašto posle svakog izlaska u grad moram da vetrim odeću?

Ovo nije pitanje estetike i tolerancije. Gde ima pušača ima i raka:

Isto važi za kardivaskularne bolesti, bolesti pluća, šlog… Kako, onda, prioritet Ministarstva Zdravlja nije potpuna zabrana pušenja? Da li srpski budžet toliko zavisi od poreza na duvan? Ili Filip Moris i ostali toliko dobro lobiraju? Zašto država duvanskim parama ne bi subvencionisala elektronske cigarete?

Ako mi bilo koji pušač kaže da je zabrana pušenja na svim javnim mestima kršenje njegovih ili njenih ljudskih prava, pitam ih da li je i zabrana uriniranja na gradskim trgovima kršenje nečijih prava? Koja je razlika između pušenja i pišanja u javnosti?

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Why doctors shouldn’t use Google services

If you have a Google+ account—and you might not be aware that you do—anyone using Gmail 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 of patients and random strangers being able to leave messages in your personal inbox. Suing P.,,,,,,kmmmmmqmmmdoctors 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. And for a business with billions of users, doctors are a fringe group—one that hates change-for-change’s-sake, having to [re-learn an interface][ n. Nnjm interface] “just because”, and not being the true customer1.

Also, the number of people at Google who may access my data is huge. FastMail2, 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? First, I have googled enough ailments and substances, common and obscure, that the add network thought I was an elderly female recovering heroin addict with more than one paraphilia. The adds I would get were in that sense appropriate. Second, because of SEO the only valuable page-one results I would get 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 help with the first problem while not making the second one any worse.

Google calendar is the only service I would consider using. 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 circle3. This is why I use Apple’s iCloud calendar, its horrendous web interface and all.

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

Doctors’ concerns aside, Google is all set to become the network TV4 of the internet—large, bland, and largely not relevant to the people who are. It is already two-thirds of the way there.


  1. 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. 

  2. Yes, it’s an affiliate link. 

  3. crickets 

  4. Or Microsoft. 

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