Tuesday, April 26, 2016
Tuesday, April 19, 2016
I’ve been out of clinical practice for about 17 years. On the other hand I have a current license and I did well on my board exams a few months ago. I believe I could do above average work, but I’d want a few months of supervision. I can think of a few ways to manage this, including designing a mini-curriculum and following the post-employment path of a fresh physician assistant.
A formal program for physician reentry would be interesting, but there aren’t any in Minnesota. Which sort of suggests we don’t have a serious shortage of primary care docs. We do have some local fellowships that might be interesting reentry paths, but they currently fill well with post-residency candidates.
I haven’t decided to pursue this direction, but at a recent meeting I asked the Minnesota Medical Association’s president what he knew of. Their policy counsel made up a short list, and as I’ve not seen it online I’ll share it here:
- Center for Personalized Education for Physicians (CPEP). Denver, CO
- Physician Assessment and Clinical Education (PACE) Program. San Diego, CA
- Affiliated Monitors. Boston, MA
- Cedars-Sinai Medical Center Physician Reentry program.
There’s a longer list in a Federation of State Medical Boards PDF, many of the programs deal with “ethics”, “boundaries”, “disruptive behavior”, prescribing controlled substances, and “anger management”, but a few simply focus on “reentry” (though, on visiting the web sites, even they seem mostly to deal with what we call “disciplinary issues”). The Cedars-Sinai program seems closest, but it’s primarily focused on hospital privileges.
I haven’t decided to go down this path, but it’s helpful to know the landscape.
Monday, April 18, 2016
Early in my post-corporate days I wrote a detailed post on how I expected to do project management going forwards. Since then I’ve experimented with various tools and services.
Today I updated a Simplenote/nvAlt  summary of my project management tools including how I archive completed (or abandoned) projects. All of these tools have multiple substitutes on iOS, Android, Windows and MacOS so I’m hopeful this toolset approach should work for years to come. Sometime I’ll write an update on my methodology, it basically shifts between Agile-Kanban and Agile-Scrum. Lately more Kanban than Scrum, but I go back and forth.
- minimize proprietary data formats and data lock (or at least tool lock) - always have an exit strategy
- archived indexable by Spotlight
- easy backup and restoration [Trello fails here, it’s the tool I’m most likely to replace.]
- integrated with Google Calendar
- scales to single person or team projects
- formal project archiving process
- create a folder in Project hierarchy
- in some cases also have a shared Google Drive folder
- I don’t make much use of Tags in MacOS at this time.
- Mac file folder has aliases to nvAlt Simplenote, Trello (URL), MindNode (in iCloud Drive), may contain Scrivener files if a writing project, presentation files, etc.
Simplenote/nvAlt (iOS, Web, MacOS)
- Create a simplenote entry for the project, tag it with project.
- Simplenote title has prefix “Project: “
- Describe the project and where things are
- Define project tags: use tags in OS X file system
- project tags have prefix p_
- save as text file in project folder when completed
Trello - Agile Project Management (iOS and Web) (review)
- create Board for Project
- 2 lists: Queue, Active
- when Task/Card Done archive it
- Milestone Cards have dates
- Cards can have checklists
- Subscribe to Calendar on gCal
- Print as PDF when completed and export JSON
MindNode (MacOS and iOS)
- release planning, hierarchy, overview of project (alt OmniOutliner)
- store in iCloud drive but create shortcut
- export to PDF when completed
- for writing projects
Google Calendar (Trello project calendar, iOS, MacOS)
- scheduling and time/capacity management
- project calendar to PDF when completed
Google Drive (iOS, MacOS)
- for collaborative file sharing projects
Email (iOS, MacOS)
- Gmail with web interface and MacOS Mail.app IMAP client.
- Drag and drop selected emails from Mail.app to desktop (creates standard file) to a folder in MacOS project (“Mail Archive”)
- Careful use of Subject lines to optimize search, typically I don’t file emails or use tags with emails.
- fn -
 nvAlt is post-maintenance but it still works on El Capitan. Simplenote still has active development, but search has been broken on the Mac app for over a year. I’m not worried because I keep all my notes in plaintext; I have multiple exit strategies. (Not including Apple Notes.app, it needs an exit strategy, a backup strategy, and significant updates. None of which I expect from Apple in its current state).
- Trello - an orientation review 11/2013, updated 4/2016
- Tools: emulating (Rally) Agile work using Appigo ToDo.app and ToDo Cloud: 7/2015, includes extensive links to productivity posts, Getting Things Done and so on.
Sunday, April 17, 2016
Cyclists are supposed to ride ‘commando’ — nothing between cycling short padded lining and the butt.
Me, I don’t like to wash my cycling shorts that often, and sometimes I just ride with regular shorts. I prefer to wear synthetic fabric boxer shorts without seat area seams. I have a few pairs I’ve picked up over the years, but they’re no longer sold. I’ve had a hard time finding seamless shorts. Web sites generally show the front, not the back.
Today I searched harder. After digging past the typically useless few pages of Google pay-to-play-adsearch results here are the options I found, mostly in comments on a Lazy Randonneur blog post
- BOSS cyclist stretch cotton boxer briefs. These are cotton unfortunately. $28 for 3.
- ExOfficio Give-N-Go Boxer Briefs 1241-0020: Blog post. Designed for easy wash/dry, supposedly no seams in contact zone. $23 each. Top selling mens boxer briefs on Amazon. (Amazon has several versions of this underwear, but only one appears on the ExOfficio site. I think a number may be counterfeit, this one is sold by Amazon itself so probably genuine.)
- MEC merino briefs/T1 boxer briefs: Canada only alas.
- Devold multi sport boxer briefs: Blog post. Expensive Norwegian merino wool briefs sold by Rivendell cycle. About $40.
- Bent Scivvies: no longer sold as far as I can tell, once a Target store brand label. These sounded ideal
I ended up ordering one pair of ExOfficio and the set of 3 BOSS underwear. I’d love to find a Target or Walmart equivalent…
PS. I have a vague memory that back in the 70s male cyclists used to wear seamless women’s panties? Probably a false memory. Was a long time ago. I never had the nerve to try.
Monday, April 11, 2016
I thought Apple had given up on HealthKit, but recently we learned that it’s been rebranded as CareKit and it seems to be going forward.
Since my professional work is in “health informatics”, specifically medical knowledge applications, I was curious what “ontology” (data dictionary, terminology, etc) Apple was using for it’s CareKit work. The concept set is somewhat hidden within Apple’s HealthKit Constants Reference documentation. I auto-expanded the symbols (nice web app Apple!) and make a quick pass at organizing the strings.
For someone like me it’s a fascinating set. The discussion of privacy and FDA device identifiers is noteworthy — in an early implementation it was apparently possible to trace HealthKit data to an individual device (not good, obviously - bold below).
I liked the use of Fitzpatrick Skin Type instead of trying to describe ethnicity/race.
It’s a fun list to scan:
HKBiologicalSexNotSet = 0
HKBloodTypeNotSet = 0
HKCategoryValueCervicalMucusQualityDry = 1
HKCategoryValueMenstrualFlowUnspecified = 1
HKFitzpatrickSkinTypeNotSet = 1
HKWorkoutActivityTypeAmericanFootball = 1
HKWorkoutSessionLocationTypeUnknown = 1
Wednesday, April 06, 2016
The experimental results are in. Under optimal conditions I can do a CrossFit WOD 4 times in five days and not be obviously injured.
That’s no trick for under 30, but over 55 there’s a fuzzy border between enough and too much. Shoulders, knees, wrists (again), butt tendons and backs take turns being funky. Not to mention errant barbell strikes. And the unrelated arthritis.
Yeah, that does sound kind of grim, but the body does some of that just sitting around. The knees were from mountain biking, and the piriformis problem was hockey. With my genes, being old* and active is experiential sports medicine.
I like it though. I even like putting a toe over that fuzzy border once in a while.
I don’t want injuries to bench me though, so here’s my year 3 of CrossFit recipe for staying more or less out of trouble.
- 3 “Workout of the Day” (WOD) every week. Sometimes 4, but I was pushing things this week.
- My WOD target is “Women’s Rx”. I can do that for some movements and weights. This tends to be close to the men’s “master’s Rx” of competitive CrossFit. Muscle fatigue is my main weakness, I think that’s true of most 40+.
- I listen to my coaches. They have good advice.
- 1-2 Open Gym workouts - a light version of a WOD or a special movement or muscle group. Like $*&^% double-unders or bar muscle ups or handstand pushups.
- I started taking one of those whacky protein supplement powders after my big workouts. You can blame that on a recent publication that showed it helping in a small trial of exercise and weight loss. It includes magical arthritis supplements that I’m supposed to take anyway (though they probably don’t do anything)
- Hockey and/or Mountain Biking 1-3 times a week (sub Nordic Skiing**, road biking, swimming, running, underwater hockey, etc)
I think I can keep that going for a few years more, depending on what surprises age brings. I’ve learned that the researchers are right, the body adapts to exercise by increasing energy efficiency — diet is still a challenge. I can’t survive doing CrossFit at the frequency needed to balance my calorie intake, so it has to be supplemented by calorie burning activities that are easier on the old body (bicycling, hockey, etc)
It really is fun.
* 50 is not the new 30. Sorry. Don’t talk about 80. Please.
** Nordic Skiing was my all-time favorite exercise. I’m not a global warming fan.
- On knee pain and the state of medical knowledge (updated) 9/2015: turned out to be partly chondromalacia, but weirdly it went away.
- Fixing a painful wrist with high frequency weightlifting and wrist hyperextension. WTF 10/2015: bodies are weird
- Deep Burning Butt Ache review: Piriformis syndrome, sciatica, deep gluteal syndrome, sacroiliac syndrome, deep buttock syndrome: 2/2016. The stretches worked!
- CrossFit at 54 8/2013. I stopped seeing tattoos. That’s odd.
- Growing old grudgingly: The CrossFit Inversion: 12/2015: But this week I had a new record bench press weight.
- Anecdote - exercise and weight control. It takes a lot 12/2014: You can out-eat almost any amount of exertion.
- Exercise on the exit ramp - the 30 year plan: 11/2014 - scaling with age, ending with golf
- Exercising hard as an old person - one year of CrossFit: 4/2014. Then I did 70-80% of women’s Rx.
- Why geezers hit the gym 3/2014