ExpedMed 2012 Brochure Available Now

Our 2012 ExpedMed brochure is now available.

If you're interested in learning more about the exciting CME activities offered by ExpedMed in the coming months, clink Here to download a pdf version of the brochure.

ExpedMed is a leading Expedition Medicine and Wilderness Medicine CME company.  In addition to the annual ExpedMed washington, DC conference, ExpedMed leads CME adventure trips to some of the most unique and remote places on earth.  

The Art of Flight...Amazing

You've got to check this out...

Below is the trailer for the new snowboard documentary produced by Red Bull, The Art of Flight.  If the movie is anywhere near as good as the trailer, I'll be reduced to a pile of twitching, hyper-kinetic nerve endings by the end of it.  I had such an adrenalin rush after watching the trailer the first time that I had to fight the impulse to fling myself off the roof of my house-- it's just that good... 

The great thing is that the movie has finally been released and is available for download on iTunes.  I've already ordered it, so I'll let you know what I think once I watch it.

In the meantime, feast your eyes on the video below and try to fight the urge to quit your job and become a professional BASE jumper.

I know it's difficult...

The Disappearing Independent Physician

In a recent post I noted the trend among physicians to sell their practices to hospitals.

The recession coupled with the passage of the healthcare reform initiatives has pushed many physicians into simply throwing in the towel and walking away from the independent practice model.

This month in Smart Money is an article entitled Say Farewell to the Family Doctor.  It's an interesting read.

The articles continues the discussion about physicians becoming employees of hospitals and describes the impact this change is having on the physicians, patients, and the economics of medicine.  

I enjoyed the article, but the last paragraph really gripped me. Here it is:

Still, Mikell acknowledges, "doctors don't want follow-the-directions, cookbook medicine." And for many physicians, the idea of following new rules triggers a much larger unease at giving up their independence—a feeling of loss, both for the businesses they built and for their patients. Back in Bozeman, Blair Erb, the sole cardiologist in town, is a picture of resignation as he prepares to sign a contract with Deaconess. "I feel defeated," Erb says, looking around at the office furniture he and his wife, Liz, chose from a catalog years ago. The weathered ranchers and bundled-up women that come through his door mostly express disbelief when they hear that this frank-talking Tennessee native will sell his practice. His staffers say they're not looking forward to the questions the hospital's medical records system will soon prompt them to ask patients. (Do you wear a bike helmet regularly? Do you have a smoke detector?) "We'll try to retain as much professional independence as possible," Erb says, gazing at the hospital building, whose bulk he can see through his window. "But the fact of the matter is, we'll have a new master."

This paragraph was especially poignant to me since Dr. Erb is a former president of the Wilderness Medical Society and an author in our Expedition & Wilderness Medicine textbook.  

Regardless of one's stance on all the healthcare reform initiatives, it is difficult to watch this generation of physicians enter the twilight of their careers with frustration and disappointment. These men and women-- and their loyal patients-- deserve better, and our society will soon feel the impact of the loss when they and  their practices are gone.  

Update on Apr 15, 7:42 AM by Greg Bledsoe MD

Note:  I wanted the readers to be aware of a correction to this post.  The Dr. Blair Erb who is mentioned in the Smart Money article is the son of the Dr. Blair Erb who was the president of the Wilderness Medical Society and an author in our Expedition & Wilderness Medicine textbook.

Crossing International Borders As A Physician

If you’ve never had the pleasure of crossing a border into a remote part of a developing country, you’re in for a real treat.  Some of the best travel stories-- both good and bad-- occur at border crossings.

While most crossings involve little more than a little eye contact and a perfunctory paperwork inspection, things can turn bad in a hurry for those who are unprepared.  Stories abound on the international travel circuit of travelers being detained—or worse—when attempting to cross a border in a less-than-appropriate fashion.  If you’re going to be traveling in remote, undeveloped regions, it’s best to have a plan for handling the crossing of national borders.

For many Westeners—especially the inexperienced physician traveler—the idea that someone in a country that they’re “trying to help” might not believe their good intentions seems preposterous.  Regardless of your intentions, however, you can run into problems.

You might be the nicest, most altruistic person in the world but look at it from the perspective of a border guard:  you’re foreign, you probably don’t speak the native language, you might appear rude due to your dress or mannerisms, and if you’re a medical officer you’re probably carrying lots of suspicious-looking pills, tablets, instruments, and other doo-dads. 

In the first chapter of our Expedition & Wilderness Medicine textbook, Dr. Howard Donner has some helpful tips for dealing with border crossings.  I’m quoting Howard here at length: 

Don’t carry white powder in zip lock bags.  As obvious as this may sound, it is amazing how tablets of all sorts tend to break down with humidity and then slowly disintegrate in zip lock bags. A poorly identified zip lock bag, with pulverized white medicine inside, presents a rather suspect impression to a customs official.  Try to be meticulous with your drugs.  Place your medicines in clearly labeled zip lock bags or medicine vials. If you choose to use zip locks, protect them from physical damage inside of a sturdy kit or case.   The more organized the kit looks, the less dubious the custom’s officials seem to look. 

Carry a copy of your medical license.  Showing a customs official a photocopy of your medical license carries a bit more credibility than stating, “but I’m a doctor, really." 

Present a letter of introduction.  Customs officials seem to love embossed stationery or letters embellished with gold seals. These blank forms can be easily purchased through most office supply stores.  Even if you’re not traveling with the National Geographic Society, you can print up your own letter on embossed stationary. Introduce yourself as the expedition doctor for the “2008 blank blank expedition”.  As long as your name is on the letter, along with a signature from the sponsoring foundation, (such as a friend of yours), custom officials seem to relax.

-Dr. Howard Donner, Chapter One: The Expedition Physician in Expedition & Wilderness Medicine

In addition to medical kit issues, another big problem with border crossing revolves around trying to exit a country with interesting items of question.  Remember that really cool “antique” the local hustler sold you outside the tourist area?  Turns out it’s a stolen artifact from the local museum.  Be wary of buying local valuables that are sold in a surreptitious manner.  At a border it will be you, not the local “entrepreneur,” who will be charged with theft and attempts to export a national heirloom. 

Also, remember that many animal products such as furs or trophies (especially of endangered species) cannot be taken home as well as most alcohol, plants, food items, and some forms of tobacco.  If there’s any question, it’s best not to attempt to transport it.  Just leave it alone and tell stories about “the one that got away” to your friends when you’re home safe and sound.

Even with all the proper documentation and appropriate behavior, frustrating things can still happen when attempting to cross a border.  Some seasoned travelers recommend having a few small "give away" items such as cigarettes, t-shirts of your favorite ball club, small candies, or other light-hearted gift items in your luggage to help sooth escalating tempers.  It's amazing what a small gift accompanied by a smile and a calm demeanor can do to improve a difficult situation.  

If things still go from bad to worse, the best advice is always be respectful, keep your eyes open and your mouth shut, and do not attempt to bluff your way through with threats or angry gestures.  Remember, this is not your home turf, you are not in charge, and you are very much at the mercy of the nearest supervisor in the area.  All your impressive credentials and academic publications won't matter at all to your cellmate in the local jail, and in this situation, Miranda rights certainly do not apply.

Border crossings are a normal part of international travel.  By keeping a few principles in mind, these events can become routine and fun rather than frustrating and frightening.

Staying Connected While Working Overseas: How Technology has Shrunk the World

In the not so distant past, a job placement overseas meant extensive time away from family and very little real-time communication with those back home. 

I remember traveling the EurRail the summer after my first year of medical school and buying prepaid phone cards to use on the pay phones in the various European cities we visited.  That was 1996. My how things have changed.

Today if you decide to take a medical post in an international location, you can almost continue relationships with friends and family back home unabated.  There’s a trick to it, of course, and you have to adjust to the time-zone differences, but with the internet and all sorts of new communication tools, the world has never felt so small.

There’s so much material in the area of international communication technology that there’s really no good way to cover it all in a single post.  For those who want a more thorough discussion of some of the unique ways communication tools are being used in medical expeditions, I would recommend the chapter entitled Communications Planning for the Expedition Medical Officer by Dr. Christian Macedonia that’s part of our Expedition & Wilderness Medicine textbook.  For the others of you who are simply interested in hearing a quick overview of how technology has shrunk the world and taken a lot of the hassle out of working overseas, I give you the following anecdotes…

In 2003, as part of my International Emergency Medicine fellowship at Johns Hopkins, I was sent to the desert of Sudan to perform a nutritional study on a people group called the Beja.  The Beja live in the northeast corner of Sudan, a very desolate, arid region where the locals live basically as they have for thousands of years.  Due to the civil war in that country, the Beja had been cut off from their natural trading routes and many were starving.  USAID had provided a grant to help feed these people and I was sent by Johns Hopkins to ensure that the food was getting to the needy and they were responding to it appropriately.

The project itself was very challenging and after three weeks in the desert I was ready to come home, but it was a great experience and one I wouldn’t trade for anything.  One of the main memories I had of the trip was simply how isolated our group was.  After crossing the border from Eritrea into Sudan, it was simply desert sand—no roads, no electricity, nothing but khaki expanses, a few distant camel trains, and an occasional burned out armoured vehicle or unexploded ordinance left behind from the war and half-buried by sediment.

Amazingly, in spite of this isolation, I was still able to talk to my family back home in the States from time to time through the use of a satellite phone, and every night, powered by a battery that had been charged during the day with solar panels, our group listened to satellite radio as if we were all hanging out together on an extended camp out.  I’ll never forget how odd it seemed to be sitting out under the immense sky of that distant desert, listening to the camels while I talked to my girlfriend (now wife) on the phone and tapped my foot to the classic rock music coming in from the stereo.  Surreal.

In another example, a few years later I took a new job and my wife and I moved to the country of Qatar.  Initially, one of our main concerns was  keeping in touch with friends and family back home.  It shouldn’t have been.  Between email, online video chats using either the Apple iChat technology or video Skype, and our Vonage internet phone, staying in touch was a breeze.  Matter of fact, when we ordered our Vonage phone, we chose a local US phone number.  That way when our friends and family from the States called, it would be a local call for them and rang our house in Qatar just like any ordinary phone line.  It was crazy to talk to our loved ones on their cell phones while they were running errands, and so convenient to just walk over and call the States just like on any other household phone.  The cost for this convenience? A whopping $20 per month.  It was a steal.

The Vonage phone system worked so well and was so easy to use, I never felt like I skipped a beat when we moved outside the US.  My writing and other projects continued without difficulty.  Matter of fact, multiple conference calls relating to the planning of our Expediton & Wilderness Medicine textbook were held while I was overseas and our first Expedition Medicine National Conference was organized and planned using the internet, email, and our Vonage phone, entirely while I out of the country.  I flew back to the States the day before the event and went back overseas when it was over.

Another great device we purchased just prior to our expatriat experience was the Vonage V-Phone.   The V-Phone looks and feels like a flash drive and is designed to be stored on a keychain.  When my wife and I would travel to other countries, we could attach this device to our laptop, plug in a headset, and the V-Phone would enable us to make calls just like an ordinary phone.  It was amazing.  Currently these devices cost around $50 US, and they are well worth it.  However, it should be noted that the V-Phone is not compatible with Mac laptops and they are blocked in certain countries.  When we traveled to Dubai, for instance, we were disappointed to learn that not only our V-Phone but also Skype and the other internet phone services were blocked by the local government there. 

One last communication device worth noting…

During our travels, the coolest member in any expat community was the guy who had a device called a Slingbox hooked up to his tv.  Basically, a Slingbox is a device that enables you to control your home television over the internet.  Savvy expats would buy the device and install it on their home TVs back in the States (or give it as a gift to a family member or friend and install it on their TVs).  When overseas, the owner could go to the Slingbox webpage, login, and watch live television while having total control over the channels and DVR.  It was a great way to follow the home ball club (even though the games were usually played at 3am) or simply get a taste of your favorite TV show from time to time.  What’s great is that now the Slingbox has an iPad ap that allows Slingbox owners to watch live TV on their iPads.  I remember being at a lunch not long ago and noticing that golfing great Phil Mickelson, just one table away, was watching a live NFL game on his iPad via Slingbox.  Slingbox is a very cool technology for those who want to say in touch with certain sporting or cultural events while living in a foreign environment.

So there’s a quick anecdotal tour of how modern technology can keep the world small and enable you to stay in touch with colleagues back home, even though you’re miles away.  An international assignment does require some sacrifice at times, but modern communication technology greatly lessens the impact of such a move these days, and allows you to stay connected no matter where you live.