Freelance MD: 7,000 Unique Readers In Month 2

Freelance MD has passed 7,000 unique monthly readers in just two months.

I thought we may have a slower month in January after our first 30 days of astonishing growth, but I was wrong. Here's a screenshot showing how quickly Freelance MD is growing traffic, from 4,100 readers in December 2010 to 7,100+ in January 2011. That 70% month over month is a staggering jump.

At some point I'll be expecting this growth curve to flatten out since we're a pretty small niche -  physicians interested in getting more control of their careers and lifestyle -

• We've added a physician jobs area that we're looking to grow. We'll be adding non-clinical jobs in the very near future.
• We continue to be sticky. This indicator—even more than the growth curve—is something to get excited about since it denotes that readers are heavily engaged.
• We continue to add new members across our network. From our LinkedIn Group to our physician members on this site. (You can join Freelance MD for free and get access to our members only areas and downloads.)
• We've got a number of new Select Partner applicatants that would like to be part of our community. With partners like Health 2.0, ExpedMed, and the Medical Fusion Conference, we're tapping in to a number of other communities and events that we can add value to.
• We're in the process of adding a number of new reports and downloads for our members and the should be up shortly.
• We've added a number of new physician authors over the last month and there are others who should be up and running in the next few weeks.

There'a more than a little going on behind the scenes as we continue to build this community as a trusted resource for docs. Please let us know how we're doing, give us suggestions, or just vent if there's information that you want but can't find. Leave us a comment.

Update on Feb 1, 9:46 AM by Jeff, Freelance MD

The final number for January was 7,260 unique visitors. ; )

Doctors in a Tail Spin - You Are What Your Record Says You Are

I’m a big football fan. However, my team, the San Francisco 49ers, aren’t doing so well this year.  They have a losing record, and it looks like that they will miss the NFL playoffs once again.  Growing up in Northern California as a kid, cheering the likes of Joe Montana and Jerry Rice during their championship seasons, It is frustrating to hear the players and coaches dole out their excuses after another disappointing loss. “We’re a lot better than our record shows”, they’re quick to point out.

I often reflect back to what famous football coach Bill Parcells used to say – No matter how rigorous the schedule, the oh-so close losses, and the bad breaks, he was unwilling to give any excuses for a loss.  He would say “You are what your record says you are”. You are exactly where you should be. Better run teams have winning records. Team in disarray with poor planning end up with losing records.

That same principle can apply  in life.

For unsatisfied doctors, a significant number point to external factors to their unhappiness – declining reimbursement, government intrusions, an overall lack of respect for physicians, from CEOS to patients. But when it comes down to it, if you are not happy in the position you are, you are ultimately responsible to where you should be. Coach Parcells would say again “You are what your record says you are.”   

I  have a relative who was involved in the burgeoning tech industry in the late 1970s. He was trained to learn a very specific computer programming technology in his corporation.  He spend years educating himself on the programming, as well as training others, and then only to find out just a short time later the technology would soon become obsolete, as was his employment, as dictated by corporate headquarters. Soon there after, he found he was out of a job, a casualty of mass layoffs. He had no choice but to reinvent himself, going back to school, with new training, and a hope not to be made “obsolete”.

As doctors many feel we lost our position as being the decision maker in healthcare. It  pains me to see an industry where over 50% want to get out of the industry, yet feel powerless, to do something about it. Yet many of us as physicians have assets and fund of knowledge that we can use and apply in different ventures besides clinical medicine, as evidenced by the numerous examples we have in Freelance MD.

Last weekend, I conducted a workshop to a group of physicians who were all at different stages of their career. I commended them for attending, and remarked that unlike many of their colleagues, because they were willing to start something new and out of their comfort zone. Many doctors aren’t willing to reinvent themselves, because what economists refer to as an “opportunity cost”. For example, many physicians feel because they have spent so much time and money in medicine anyway, that if they do something different there is an additional lost opportunity cost. That is by starting something new, it would make  the years missed and the money spent all for not, and  instead they feel forced to continue to work in their current vocation,  even to the detriment of their own happiness. There is also the feeling that they are “giving up” if they choose an avenue that the rest of their colleagues would not follow. Albert Einstein, said the definition of insanity is “doing the same thing over and over again and expecting different results". Does this quote apply to you?

If you are not happy where you are, it may be time to start taking control and reinvent yourself. If you wake up and dread going to work, it may be time to take a mini-vacation or consider a new endeavor. If you feel like you’re going through the motions in your career, and not making a difference in the world, it may be time for a new challenge. Just as a team with a losing record, it may be time for a new coach, a new offense, a new strategy.

As Coach Parcells would say, “You are what your record says you are.”

Inside Infant-Parent Mental Health Care

By Claudia M. Gold MD

Inside Infant-Parent Mental Health Care

Three-month-old Jenna sleeps peacefully in her mother’s lap. The cards seem stacked against her. Cara at 17 is struggling to finish high school. She has been diagnosed in the past with bipolar disorder, but currently is receiving no treatment. Her primary care doctor, who referred her to me, has been prescribing an anti-anxiety medication as a temporizing measure. Cara has been playing phone tag for over a month with the therapist at the community mental health center, whom she needs to see in order to get an appointment with a psychiatrist.

Cara is scheduled as my patient in my behavioral pediatric practice. I put anxiety as the diagnosis on the billing form. But in truth the aim of my work with this mother-infant pair is to protect her daughter’s developing brain from the well-documented ill effects of maternal mental illness on child development.

Cara talks in a rambling manner about a range of subjects- her older sister at 20 pregnant with her second child, but neglectful of the first, her father who abandoned the family when she was two. She is particularly focused on her difficult relationship with James’ father, Ed.  She tells of his drug use, his recent arrest for stealing, his neediness and his inability to accept his role as father.

An infant’s brain makes as many as 1.8 million neural connections per second. The way in which these connections are formed is highly influenced by human relationships. As Cara responds to Jenna’ face and voice, is attuned with her rhythms and needs, both physical and emotional, she is literally growing her brain.

Important research has shown that when a mother can think about her baby’s mind and attribute meaning to his behavior, she helps him to develop a secure sense of himself and of his relationship with her. This security helps him to regulate himself in the face of difficult emotions. As he grows older he will have the capacity to think clearly and flexibly and manage himself in a complex social environment.

When I work with mother-baby pairs like Cara and Jenna, I focus on one simple thing. I listen to these mothers with the aim of helping them to reflect on their baby’s experience of the world and the meaning of their behavior. It never ceases to amaze me that with this singular focus, meaningful communication happens even in what appears to be chaotic and dismal circumstances.

As I listen to Cara’s rambling story, I know I need to help her start thinking about how all of this affects her relationship with Jenna. I use a technique I learned from leading researcher and clinician Peter Fonagy to help a person who is stuck in this kind of non-reflective thinking. I hold up my two hands. “Wait, I say. “I want you to help me understand how you think these problems with Ed connect with your relationship with Jenna.”

She pauses for a moment and then begins to cry. “When Jenna is so needy of me, it makes me think she’s just like her father, and I get so mad. Then I feel terrible for getting angry at her.” It’s a remarkable insight. But she isn’t done. She looks down at Jenna. “See how relaxed she is when I am calm. But when I get upset, she starts to cry.” Then she tells me of a time when she felt about to lose control, but somehow had managed to make Jenna laugh. “We were having a conversation,” she says joyfully, “even though she doesn’t say any words!”

It is a small moment in one 50-minute visit. I am confident, however, that with a string of moments like this, where Cara is fully present with her daughter, there is hope that she may break the cycle of intergenerational transmission of mental illness and help to grow a healthy brain.

About: Claudia M. Gold MD is a  pediatrician with a longstanding interest in addressing children's mental health issues in a preventive model. She blogs at http://www.claudiamgoldmd.blogspot.com/

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Leadership in Non-Clinical Careers: Things You Can Do

Physicians seeking non-clinical careers can apply leadership models used in industry.

Leadership is everyone’s business—whether the constituents are in industry, government, education, or communities.  Physicians who transition to non-clinical careers may need to sharpen their leadership skills—and they can draw on the lessons learned by others. 

Here is a checklist of questions I have used in industry as part of a periodic self-assessment.  Physicians may find this useful—and can adapt it to fit their needs in other applications.  Also included is an outline of time-tested actions physicians can take in their new leadership roles. 

EXECUTIVE CHECKLIST

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Expedition Medicine National Conference

I wanted to make sure that the Freelance MD community knew that our 2011 Expedition Medicine National Conference will be this September 16th-18th at the Omni Shoreham Hotel in Washington, DC.

This is the five-year anniversary of our event in Washington, DC and it's been gratifying to receive all the positive feedback about the event from the hundreds of physicians, nurses, paramedics, and other medial professionals who have attended past conferences.  Here's a sampling of quotes we've received on our evaluation forms:

“Great conference…first class…the first CME event I have ever attended where I felt I got my money’s worth."  -Richard Knight, MD, Emergency Medicine, Ft. Worth, Texas

“Great experience…incredible speakers who have traveled all over the world and are speaking and educating from firsthand experience…lessons learned are priceless! Thank you." -Sapna Parikh, MD, Fox News Medical Correspondent, New York, New York

“Sorry, all 5s on the evaluation doesn’t help much, but it was that awesome!” -Mark Schwab MD, San Diego, CA

“This was the first conference I’ve attended where I’ve gone to ALL the lectures and looked forward to the next day! The speakers were great – knowledgeable, passionate about what they do, entertaining. I also like the historical info on the infectious diseases and the personal adventure stories.” -Alexia Gordon MD, Virginia

“This conference is truly one of the best I have attended in 50+ years of actively practicing medicine. All of your speakers were outstanding. The material was very interesting and useful to my activities.” -Joseph English MD, Pennsylvania

This year, we have an incredible line up of expert faculty and topics for participants.  For those who have never attended one of our events, we take pride in advertising our faculty as the "best in the business" for medical education.  Our experts our selected based on their demonstrated expertise in their content areas, their significant field experience, and their teaching ability.

Since this conference is about medicine in wilderness areas and on expeditions, it does you, the participant, no good to hear canned lectures from speakers who have never been "in the field." At the Expedition Medicine National Conference all our faculty have significant field experience and are teaching what they actually do when they work in austere environments (not just what they've heard works in these locations). 

Each of our faculty also are excellent communicators and many have received national teaching awards for their demonstrated excellence as educators.  Our course participants remark each year how amazingly talented our faculty are at communicating their material, and how delighted they were to hear the presentations.

For 2011, the following faculty will be teaching at our Expedition Medicine National Conference:

Dr. David Shlim, co-editor of the CDC "Yellow Book" and Travel Medicine expert from Jackson Hole, Wyoming

Dr. Michael Callahan, Infectious Disease specialist from Harvard and Darpa

Dr. David Townes, Associate Professor at the University of Washington and co-editor of Expedition & Wilderness Medicine 

Dr. Eric Johnson, past president of the Wilderness Medical Society and international expedition physician

Dr. Alan Magill, president of the International Society of Travel Medicine and co-editor of the CDC "Yellow Book"

Dr. Peter Hotez, Professor and Chair of the Department of Microbiology, Immunology, and Tropical Medicine at George Washington University 

Dr. Christina Catlett, Associate Director of the Johns Hopkins Office of Critical Event Preparedness and Response (CEPAR)

Dr. Tim Erickson, Director of Clinical Toxicology and Vice Chairman of the Department of Emergency Medicine at the University of Illinois-Chicago

Topics scheduled for our 2011 course include malaria, travel immunizations, hypothermia, high altitude medicine, dive medicine, lightning injuries, reptile envenomations, expedition toxicology, rabies, and disaster medicine among others.

All participants will receive 20 Category I CME credits and a free copy of our textbook Expedition & Wilderness Medicine (sells for $150).

Anyone interested in a possible career change into international health or simply wanting to learn more about some very cool topics (and meet some very cool faculty) is encouraged to attend this event.  I'll be there and I hope we have a good turnout of people from the Freelance MD community.

How To “Search” A Patent: USPTO Is NOT PubMed

It is often easy to spot a physician’s patent.

The “References Cited” section has a long list of peer-reviewed papers from the indexed literature. While relevant to the clinical problem, these references are almost always less relevant to the physician’s patent than the patents in the “References Cited” section. This happens because medical papers use citations for different reasons than do patents.

When we write a paper for an indexed journal, we tend to include a lot of references for a lot of reasons. We want to impress the readers and reviewers that we know the literature and it adds bulk to the paper. More legitimate reasons include supporting the Background section (do we really need to see 4 or 5 references supporting the claim that a myocardial infarction or a malignant tumor is a bad thing) and the Discussion section (you see, my results are not really different from the other papers — so they must be reasonable and printable — yet they are different enough so that this paper should not be rejected as being repetitive).

The point of citations in a patent is to list all of the references that would be material in considering whether to grant the patent. So, their purpose is almost the opposite of the references in a medical paper. The citations in a patent are referred to as “prior art” and consist of patents that are close enough to your idea that they should be considered in deciding whether to allow or reject your patent. Another difference is that both you and the patent examiner get to add citations. (The ones actually considered by the examiner have an asterisk* by them.) These citations come out of the examiner “searching” the claims in a patent application. Patent examiners usually do not go beyond searching the patent database. However, anything published anywhere can be fair game if it has a publication date before the date of your invention. (Remember, there are two sets of rules for whether something is “prior art” – the US which currently has a grace period of 1-year before the filing date of your application, and the rest of the world which generally allows anything published or publicly available before the filing date of your invention to be considered as prior art.)  If they do search beyond existing patents, they tend to go to IEEE Explore which is a very large database of technical articles.

When you think that you have a patentable invention the first thing to do is verify — with a simple Google web search — that there aren’t any existing devices “practicing the invention”.  If this initial search doesn’t turn up anyone currently practicing your idea for an invention, it is time to “search” the patentability of your idea for an invention. Go to USPTO.gov or Google Patents  and put in some key words and search on your idea. (Advantage of the Google site is that they make it easy to print out the full patent but thay appear to be missing many patents. For this reason, I never go to Google Patents first.) So, far this is just like going to pubmed.gov to search for literature references. Don’t forget to also search on published patent applications. (Inventors have the option to have their applications published 18 months after filing; this is required if any international filing is done.) A big challenge is ensuring that you have used the correct key words. Warning: the key words for a patent search may or may not be the same as those used in a Medline search. And, the Patent Office search function does not include synonyms such as provided by Medline with their fabulous MESH feature. They also have the ability to search by classifications (“art area” in patent parlance).  While this option can be helpful if you know how to use their classification system, I find this confusing.

A good trick is to do “forward” and “backward” trolling in the USPTO database until you have fleshed out the prior art. After your first key-word search you will get a list of patents.  Click on those and find the patents that are closest to your idea. Note if there are any unexpected key words, as well as alternative synonyms. In the first web-page of each patent that you found there is a section called “Referenced By” which gives newer patents that cited this one. Following that trail forward will often find recent patents that you might have missed with a simple key-word search. Study the patents you found with your forward trolling. Each of them will have a listing of older patents that were cited by the one you are looking at. You can then troll backwards to read these older relevant patents. If you do this a few times you will typically find the patents most closely related to your idea.

Don’t be tempted to ignore a patent that is close to your idea. Not only is it your legal responsibility to list the close prior art, it is a very good idea to be proactive. The patent examiner knows how to search patents better than you do and is not going to miss these.  Citing the most relevant art can give you an edge with an examiner as they can see that you have done your homework. As a bonus, you now get a chance to argue in your application why your idea is better and how the other prior art really missed the key point of your idea for an invention. Any company considering licensing your patent will certainly do a careful search long before they write you a check.

There is another — more psychological — incentive for you to carefully search and list the closest art. Some patent examiners tend to ignore the citations that you submit (possibly reasoning that your list is self-serving) and prefer to rely only on the prior art that they find (the Patent Office version of NIH – “not invented here”). Thus, some patent lawyers suggest (only half-joking) that often the best way to get a threatening reference ignored is to list it.           

If you ever get into litigation over your patent, you will quickly find that a comprehensive and brutally-honest prior art list is extremely helpful. The parties on the other side always try to “invalidate” your patent by convincing the judge or jury that someone else beat you to the invention. They will pull out the closest patent that they can find and wave that in court. However, if you have already listed that patent it is harder to overcome the presumption that the patent examiner considered it and decided that your idea was different enough to warrant issuing you a new patent.

The Health 2.0 Spring Fling In San Diego

Health 2.0 has brand new updates for the Spring Fling Conference in San Diego on March 21-22, 2010.

Even though the spring conference is quickly approaching, at Health 2.0 we are always keeping our eyes out for something new and exciting to bring to our audience. We have recently added documentaries, panels, presentations, and speakers to the agenda. You can’t afford to miss this conference. You can register here.

Health 2.0 San Diego 2011

The Health 2.0 Spring Fling Conference will focus on three themes where Health 2.0 can make a difference: making health care cheaper; the evolution of research; and prevention, wellness, exercise and food. Surrounding these three themes we have an exciting line-up of demonstrations, panel discussions, documentaries, and speakers that will both intrigue and inspire our audience.

Here are some additions to the San Diego agenda:

We have a great morning session scheduled called The Future of Research! The emergence of user-generated content, and the rise of patient involvement in Health 2.0 is radically changing research in both discovery and clinical practice. This panel may have the most impressive line-up of people changing the research process ever assembled. It includes:

• Susan Love, the pioneering cancer surgeon behind the Army of Women clinical trial recruiting program.
• George Lundberg, the former JAMA & Medscape Editor who’s now at Cancer Commons
  shaking up medical research publishing.
• Gilles Frydman, of ACOR, the Founder of one of the oldest and most research savvy patient communities.
• Josh Sommer, the young patient activist who’s building the Chordoma Foundation to accelerate specific medical research.
• Paul Wallace, Kaiser Permanente’s lead on patient engagement and board member at the Society for Participatory Medicine.
• Deborah Estrin, Professor of Computer Science at UCLA who’s leading very different ethnographic hands-on research studies in the inner city.

Health 2.0 always shows the most cutting edge technology demonstrations. A few of the demos you’ll see in the panel on Prevention, Wellness, Exercise and Food include; Keas (Linsey Volckmann), Shopwell (Brian Witlin) and Fooducate (Hemi Weingarten).

Also just added to the list, Will Roesenzwieg, Physic Ventures, investor in food & wellness start-ups, Abbe Don, health maven at legendary design company IDEO, and Arnie Milstein, famed medical director of the Pacific Business Group on Health, and now leading the new Clinical Excellence Research Center at Stanford.

We’ll also be highlighting winners of the Health 2.0 Developer Challenge.

Health 2.0 Developer ChallengeSan Francisco Bay Area Code-a-thon is January 29th at Google! This Code-a-thon is focused on making information easily accessible to individuals. All teams will have the chance to get their hands on newly opened API’s and both public and private healthcare data-sets. We’ll have technical talks from Roni Zeiger, Google, Sastry Nanduri, HealthTap, and Alex Tam, frog design. We are also happy to announce that the Lucile Packard Foundation has issued a challenge to benefit children with special health care needs.

Future Code-a-thons:

The Washington DC Code-a-thon will be on February 12th at Georgetown University’s Department of Health Systems Integration.

The Boston Code-a-thon will be on February 19th at the Microsoft New England Research & Development Center.

These events occur over the course of one day, bringing together developers, designers and raw data sets to build exciting new applications and tools for improving health care. Attendees quickly form teams and dive into the task of creatively designing new tools. Winning teams will get the chance to present their application in front of a distinguished group of judges at the Health 2.0 Spring Fling Confernce in San Diego, March 21-22, 2011. Registration is FREE!