Modern Doctors Bag: My Everyday Carry

Bag contents oct 2014

“There was a time when nails were high-tech. There was a time when people had to be told how to use a telephone. Technology is just a tool. People use tools to improve their lives.” — Tom Clancy

“One of the great challenges of our age, in which the tools of our productivity are also the tools of our leisure, is to figure out how to make more useful those moments of procrastination when we’re idling in front of our computer screens.” — Joshua Foer

On episode 32 of The Rheumatology Podcast, we discussed what bags we use for work, and I had promised to disclose the contents of my work bag.

I’m always drawn to everyday carry type posts and trying to figure out the optimal set of daily tools, which should have the following set of characteristics:

1. you use in your day to day life
2. a first tier level of preparedness for an unforeseen emergency
3. they need to be functional.

My current everyday carry gear (clockwise, from top left):

  • MacBook Air (13.3-inch, Mid 2013, 1.7GHz dual i7, 8GB memory, 512GB SSD). I bought the best MacBook Air available at the time refurbished from Apple, which was an amazing deal and would suggest to anyone. With the SSD, it is strikingly fast. The only thing keeping it from being the perfect machine is lack of Retina display, but everything else makes up for that.
  • iPad mini with Retina display. (64GB, Space Gray, WiFi only) with Blue Smart Case. I primarily use this for consuming longer form content using these four apps: Kindle App, Instapaper (saved articles from web), NewsBlur (RSS reader), or Documents by Readdle (for PDFs).
  • Apple Magic Mouse. 
  • Lacrosse ball. For keeping my tissues mobile at work using tricks from MobilityWOD, especially the feet or hamstrings.
  • Kleen Kanteen (27 oz, stainless steel). These are great because they’re dishwasher safe. I have a few of them. Stay hydrated my friends.
  • 3M Littmann Cardiology II S.E. Stethoscope. This is an older stethoscope that appears to have been replaced by the Classic II S.E. I have two stethoscopes: a Littmann Master Cardiology that I keep at the clinic I spend the majority of my time, and this one that I carry in my bag for when I’m seeing patients at the hospital or my weekly satellite clinic.
  • Aveeno Lotion. Because Minnesota = dry skin.
  • Small, cheap umbrella. I don’t believe in buying a big, expensive one.
  • Cocoon Grid-It. A great tool for organizing various cords and other things that end up wandering around your bag. I currently travel around with a 1 m Apple Lightning to USB cable, Apple EarPods, and a short micro-USB cable. There is also a pocket on the back that I keep a microfiber cloth.
  • Pocket size Moleskin Cahier Journal. For analog entry. Relatively cheap and widely available.
  • Uni-ball Jetstream RT Fine Point pens (black).
  • Moo.com business cards. 
  • Apple Mini DisplayPort to VGA Adapter. 
  • Apple 45W MagSafe Power Adapter.
  • Kershaw Leek Knife. Highly versatile for everyday usage.
  • IntoCircuit Power Castle 11,200 mAh USB Battery Pack. Carries enough power to recharge most of your devices multiple times. For comparison purposes, the iPhone 5S has a 1570 mAh battery, the iPhone 6 has 1810 mAh, the iPhone 6 Plus has 2915 mAh, and the iPad mini with Retina display has 6471 mAh.

Not pictured:

  • Clinic ID badge.
  • Pager. The 1990s paged and wanted this back.
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#ACR14 Social Media Bootcamp & Tweetup

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“Tell me and I forget, teach me and I may remember, involve me and I learn.” ― Benjamin Franklin

The use of social media in medicine has experienced enormous growth in the past few years, and this short blog post can’t even start to scratch the surface.

A great overview of the importance of social media in the field of rheumatology was recently published earlier in 2014 by Dr. Francis Berenbaum (@Larhumato), rheumatologist from Paris, titled The social (media) side to rheumatology in Nature Reviews Rheumatology. This paper includes discussion of the use of social media in medical education (for providers and patients), how it has affected the doctor-patient relationship (in a great way), and its role in medical research.

Twitter has become the centerpiece of social media in the medical world, and has become an increasingly important part of major medical meetings. The upcoming American College of Rheumatology Annual Meeting in Boston will be using the Twitter hashtag #ACR14.

A great resource if you’re new to using Twitter and hashtags at a medical meeting is Symplur’s Healthcare Hashtag Project, who currently has an #ACR14 Conference Hashtag page, which is helpful in getting an overview of the conference from the perspective of Twitter. In their words:

Our hope is that we can lower the barriers of entry, decrease the learning curve, and enhance the experience of new users.  But we’d also like to introduce experienced healthcare Twitter users to a fresh look, to new information, and to new people who share your passions.

Additional rheumatology hashtags to explore:

With all of this in mind, I’m extremely excited to be part of the following social media events this year in Boston:

Social Media Bootcamp

The goal of the social media bootcamp is to introduce more individuals to the core tools in social media: Twitter and blogging. These sessions are the brainchild of Dr. Ronan Kavanagh (@RonanTKavanagh), and I’m happy to be involved moderating the Sunday session and speaking on the technical aspects of setting up a blog on Monday. Also speaking are Dr. Philip Gardiner (@PhilipGardiner) and Dr. Christopher Collins (@RheumPearls).

More information about the Social Media Bootcamp was discussed in the Preview Issue of the Annual Meeting Daily News and in The Rheumatologist.

Times and descriptions:

  • Sunday, Nov. 16, 9:00–10:00 a.m.: Twitter Basics—The thoughts, opinions and ideas of your rheumatology colleagues, in 140 characters or less, shared in real time for open discussion. Learn how to tweet and engage participants in live tweet forums during the conference!
  • Monday, Nov. 17, 9:00–10:00 a.m.: Blogging for Beginners—Learn the basics of setting up a blog and how to use it effectively to communicate with targeted audiences. Blogging can be a great resource for communicating timely and relevant content in easily digestible quantities. These will include two sessions.

#ACR14 Tweetup

  • When:  Sunday November 16 from 4:30-6:00pm
  • Where: Room 150 of the Boston Convention Center

The yearly gathering of rheumatology Twitter friends from across the globe has gotten to be a bigger and better event each year. Take a look at my post on last years #ACR13 Tweetup and this post that includes links back to every prior rheumatology tweetup that I could find.

Just as last year, this event will again open to anyone who would like to attend. No need to RSVP (although I would appreciate it if you would leave a quick comment to this post if you plan on going, just to get a sense of how many people might attend).

If anyone has questions, feel free to ask me on Twitter (@psufka) or else in the comments below.

I look forward to catching up with everyone again this year.

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Speaking at HealthPartners Primary Care Update Conference

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I’m happy to be invited to speak for the upcoming conference HealthPartners Primary Care Update: Pathways to Knowledge on September 19, 2014.

I’ll be giving a presentation titled Rheumatology Pearls from 11:15-12:00, which will briefly review:

  • Common labs ordered in rheumatology
  • Differentiating inflammatory from non-inflammatory arthritis.
  • Gout: diagnosis, acute and chronic management

Download slides:

Other posts of mine that you may find helpful:

If anyone has questions before or after the conference, feel free to get in touch.

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My WordPress Setup, Plugins and Writing Tools

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“It’s best to have your tools with you. If you don’t, you’re apt to find something you didn’t expect and get discouraged.” ― Stephen King, On Writing: A Memoir of the Craft

The best way for physicians (or anyone) to control their online voice is to create their own content, and the best way for this content to be published is to have their own blog.

I am often surprised at how few physicians have what I would consider a bare minimum online presence: a simple webpage with their name and contact information. At the very least, this is necessary to take your place among the numerous physician rating websites that will show up in a search for your name.

While this may appear at first to be a more technical post, I hope that curating tips I have found helpful on running WordPress will encourage others who may be reluctant to starting their own blog.

While there are certainly more simple blogging platforms available, such as Blogger, Tumblr, or Squarespace, I specifically use WordPress given the power and flexibility of the platform, much of which comes from your choice in the additional plugins that are used.

Two ways to run WordPress

  • Free from WordPress.com. There are a number of limitations to this, such as being given a domain name (e.g. yourblog.wordpress.com) and having ads (although you can upgrade to your own domain name and to get rid of ads). The biggest downside in my opinion are the restrictions on plugins.
  • Hosting the free software available at WordPress.org on your own domain. This is the more powerful way to run WordPress, and the one I suggest. The easiest way to do this is to chose a host that supports automatic installation of WordPress (I use Dreamhost, which has been great).

This comparison chart between WordPress.com and a hosted WordPress.org site also helps explain many of the differences. If you’re worried that WordPress can get technical, keep in mind that it is the most used blogging platform, so if questions arise, finding answers is fairly easy, and the documentation is well organized.

WordPress Themes

Your WordPress theme is your template for the overall design of your page. There are a number of free options, or else you can pay for a premium theme, which is typically developed and updated by professional web designers, and will often have additional features. I use The Thesis Theme for WordPress, which has a number of simple tools for editing/managing content, and has built-in options for Google Analytics and SEO. This list of some of the most popular themes (both free and premium) can also provide some ideas.

WordPress Plugins

As mentioned above, plugins are the tools to add various function to your blog, and there are currently thousands available. The plugins that I currently use, broken into various categories are:

Security

Speeding up WordPress

  • WP Super Cache  – Generates static html files that are sent to users, which speeds up loading by reducing load on your host server (otherwise, WordPress generates a new html file each time a user accesses your site, which can be slow). I previously used W3 Total Cache, but it never seemed fast enough and has some occasional problems.
  • WP deferred javaScript – speeds up loading time of your site by deferring loading of javascript.
  • Use Google Libraries – loads any javascript libraries used on your blog from Google’s servers, which tends to be faster than loading from your own host.

SEO

  • WordPress SEO by Yoast – despite some Search engine optimization (SEO) being built into my Thesis Theme, I find that this plugin does a better job at optimizing searches for my name (which as a physician, is the result that I care most about). An alternative to consider (with overall easier setup) is All in One SEO Pack. While I haven’t compared my results with these two plugins directly, Yoast’s package seems to be more successful.
  • Google XML sitemaps – XML sitemaps are files listing your sites URLs with important information about each to search engines. Yoast’s WordPress SEO has this built in, which is likely adequate, but this plugin gives you more control.

Statistics

  • Jetpack – this is a must-have plugin that includes numerous features, but the one that I use most frequently are the site statistics.
  • Google Analytics – though not technically a plugin (Analytics is added by adding a tracking code to your site, which I do through my Thesis Theme, but could also be done through WordPress SEO), Google provides piles of free data about who is accessing your site.

Backup

Other 

  • Contact Form 7 – provides a simple but highly customizable contact form, which I like better than the one included in Jetpack.

It can also be useful to look at what plugins your favorite blogs are using with the WPThemeDetector website (although it cannot detect every plugin), or else browse the most popular plugins in the WordPress directory.

Editing Tools

While you could write blog posts directly in WordPress, it can be a bit clumsy to do so. I use MarsEdit, which connects directly to your blog and allows you to write and upload posts with multiple editing options (it even supports Markdown). By connecting to your site, it actually downloads a copy of all of your posts which acts as an additional backup. Of note, if you use Google Authenticator, you’ll have to use an application specific password, since two-factor authentication is not currently supported.

For longer or more complex writing (such as my post on Decision Fatigue), I first write everything in Markdown using Scrivener, which is an incredibly powerful writing program that local author Patrick Rhone convinced me to purchase after this tweet:

It’s like an operating system for words. Everything one would need to turn words from concept to finished product is there.

Creating content

This is the hard part. I like WordPress founder Matt Mullenweg’s post suggesting that you “write for only two people”: yourself and “a single person who you have in mind as the perfect person to read what you write”. As such, this post was inspired by Dr. Rebecca Grainger looking for tips on starting a blog via Twitter.

My suggestion for writing inspiration would be to read the book quoted at the top of this post, Steven King’s On Writing: A Memoir of the Craft.

Have suggestions regarding your own WordPress setup, especially plugins? Post them in the comments.

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The Monkeysphere: Dunbar’s Number and How Many People You Should Follow on Twitter

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“More data—such as paying attention to the eye colors of the people around when crossing the street—can make you miss the big truck.” — Nassim Nicholas Taleb, Antifragile

[Update 10/11/2014: Excellent article from The New Yorker on the topic of Dunbar’s nunber: The Limits of Friendship)

Twitter has had global impact in ways that never could have been imagined since the first tweets in March 2006. Now, with hundreds of millions of active Twitter users and tweets numbering over 500 million per day, we easily become tempted to follow so many accounts that it can become too noisy to be useful.

Looking for some guidance on a maximal number of accounts to follow on Twitter, I came across Dunbar’s number. This is a theory by British anthropologist Dr. Robin Dunbar that there is a “cognitive limit to the number of people we can maintain social relationships,” in which brain size “limits the number of relationships that an individual can monitor simultaneously” (PDF). He felt that this number was around 150 relationships in humans, although proposed numbers range anywhere between 100-230. The term Monkeysphere was coined in reference to an experiment confirming this correlation between brain size and social groups in monkeys.

Dunbar looked at whether his proposed cognitive limit also applies to Facebook, and wrote:

Facebook itself did a survey of its accounts about a year ago and found that the average number of friends was between 120 and 130.

The odd reality is that we are actually not capable of managing more friendships than you typically see on Facebook now—or more than people have traditionally maintained.

And concluded that:

If you have more than 150, it is because you are including people who have no meaningful relationship with you.

I don’t think there is a “correct” way to use Twitter, but given it has become my primary source of incoming information, I try to be thoughtful about both who I follow and how many I follow. Looking at an October 2012 study, the average Twitter user follows about 102 accounts, which is well within Dunbar’s observations. I certainly start to feel a bit of cognitive strain when the number I’m following is too high (which is most of the time).

My approach to Twitter is to generally focus on following thought leaders for topics I’m interested in, and have a low threshold to unfollow an account unless I’m finding they consistently add value to my network.

When you first start to filter your network and unfollow accounts on Twitter, you’ll be a bit nervous that you’ll miss something. Trust me, you won’t. If something is important, your well selected network is going to amplify that message and you’ll see it.

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