We Have An App

Just thought our readers might like to know that the Shrink Rappers now have their very own iPhone app! If you're tired of repeatedly checking iTunes to see if the latest podcast is up, you can now open this app and have us all right at your fingertips. It works on Android phones too. Just click on the link below and when it prompts you to "install on your desktop," do it.

The My Three Shrinks iPhone App!

WhatsMyM3?

NBC-4 News Clip from Doreen Gentzler (May 16, 2012)

What’s your mental health number?

This is the question that the Bipolar Collaborative is asking, using its WhatsMyM3 screening tool [PubMed]. “Many other illnesses have a 'number' that one can track – cholesterol, high blood pressure, diabetes. What’s the number for mental health?” asks Michael Byer, president of M3 Information, based in Bethesda, Md.

~from Clinical Psychiatry News

Today's USA Today newspaper ran a story titled, "Screening for mental illness? Yes, there's an app for that," by Michelle Healy.


WhatsMyM3 is a validated, 3-minute tool that screens for symptoms of depression, bipolar disorder, PTSD, and anxiety, and can be used to monitor changes in symptom severity over time.

One of the developers, Michael Byer, approached me about a year ago for my opinions on development and use of the screening tool. Disclosure: After reviewing the research and seeing how useful it is, I have become more involved in the organization, becoming an adviser to the group that was started nearly ten years ago by past NIMH chief, Robert Post MD. (listen to podcast #63)

It differs from other mental health screening tools, such as the PHQ-9 and the MDQ, in that these are all unidimensional -- they only measure one domain of symptoms. The M3 is multidimensional, measuring four areas of symptoms. Furthermore, when compared to results from the standardized interview tool, the Mini International Neuropsychiatric Interview (the MINI measures for 15 different mental illness diagnoses), WhatsMyM3 provides a total mental health score that is 83% sensitive in finding true positives and 76% specific in finding true negatives. In addition to the total score, there are four subscores, one each for depression, bipolar, PTSD, and anxiety.

Put another way, the negative predictive value of the total score is 89%, meaning that if you score under the threshold, there is an 89% chance that you do not have any mental health diagnosis by the MINI. As with most screening tests, you want the negative predictive value to be high so that you don't have to subject the "negatives" to more specific testing. The positive predictive value, or PPV, is generally lower for screening tests. It is 65% for WhatsMyM3, meaning that if you score positive (total score >= 33 and positive for functional impairment), the odds of you having a diagnosis is almost two-thirds. A clinical evaluation can then help to determine if you do have a diagnosis. (Note: this tool cannot give you a diagnosis; it can only describe your relative risk of having, or not, a diagnosis.)

What people have found to be most helpful is using WhatsMyM3 to monitor their symptoms over time once they do have a diagnosis. This can be done for free on the website, or for $2.99 using the iPad or iPhone apps, or the Android app. For mental health clinicians, they can download the free M3Clinician iPad app and then screen their own patients. For about a dollar per screen, they can register their patients who want to track their symptoms over time and share their scores with the clinician. Primary care providers also purchase screens, and can even obtain insurance reimbursement by billing for an annual health risk assessment. The patient reports can be viewed by logging into m3clinician.com.

A sample report for a fake patient can be viewed here.

I think this sort of tool, or app, is exactly the sort of mHealth thing that empowers consumers to better manage and become engaged in their health care needs. This is happening in other areas, like diabetes, heart disease, and obesity. Mental health is also making great strides in mHealth.

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I should also point out here that the folks at M3 Information were the only ones to take us up on our offer of a free "advertisement" on Shrink Rap in return for donating at least $200 to our NAMIWalk for Mental Health Month (we don't typically accept display ads). A logo ad will be running soon on Shrink Rap soon for two weeks in recognition of their charitable donations. It will look like this and link to the iPhone and Droid apps. [We received no money ourselves from M3 nor from NAMI. We've never accepted any money from Pharma companies, nor does M3.]

Playing with Pigs

Playing with Pigs: Pig Chase from Utrecht School of the Arts on Vimeo.


I want this game. A company in the Netherlands is working on an iPad app that will let people interact remotely with pigs on a farm. Apparently pigs like to interact with bright balls of light. This app creates bright spheres of colored light on a panel in a pig sty. The pig touches the light with his snout, which scores a point. The number of touches racks up a score, and at the end of the game the high scores get displayed on the iPad. I'm not sure if the human is training the pig to touch the screen, or if the pig is training the human to play longer with an iPad. Either way, it looks like a lot more fun than Angry Birds.

Here's the web site for the video:

Playing With Pigs

And the other amazing thing is that we already have a "pig" label on the blog. Have we really talked about pigs here before?

And for Jesse, a hamster:




And here's one from Roy with ants...

Podcast 63: The Bystander Effect

These are the topics we talk about:
The Bystander Effect and why people don't call for help when they see violent crimes.  While we don't talk about the events at Penn State, this was the inspiration for this topic.


From this we go on to talk about legislation that has been proposed to make it a crime for health care workers (including shrinks) to not report child abuse.  As is, there are mandatory reporting laws and licensing implications for those who do not report instances of child abuse.


Finally, we move on to happier techy stuff and discuss Depression Rating Apps.

Roy reviewed iTunes apps with the keyword "depression" which met the following criteria: Medical category; a rating of at least 3 stars, and at least 100 ratings. Five apps came up:

• 3D brain (9600 ratings: not a rating tool but a nice 3D map of the brain)
• Sad Scale Lite (800 ratings: uses a Zung depression rating scale)
• DepressionCheck (700 ratings: uses a 27-item validated screen for depression, bipolar, PTSD, and anxiety)
• Moody Me (600 ratings: an emoticon-based mood diary)
• Health through Breathing: Pranayama (300 ratings: not a rating tool, but a highly-rated meditation tool)

[Disclosure: Roy has consulted for M3, the makers of DepressionCheck.]

This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. 

Thank you for listening.

Send your questions and comments to: mythreeshrinksATgmailDOTcom, or comment on this post

To review our podcast, please go to iTunes.
To review our book, please go to Amazon.

Technology and The Shrink-- Hello, Siri.

Technology seems to be the theme of the moment here on Shrink Rap.  We're all playing with new toys and trying to figure out what makes them fun and what makes them useful to our work.

For this week's post on Shrink Rap News over on the Clinical Psychiatry News website, I have an article up on Siri and the Psychiatrist.  Some information that might be useful to anyone who is thinking of incorporating this technology into their practice, and oh, a little tongue-in-cheek humor there with many thanks to Dr. Bob Roca at Sheppard Pratt and Dr. Paul Nestadt at Johns Hopkins who both allowed me to quote them during their more playful moments.  There is also a techy post up on  Shrink Rap Today over on our Psychology Today Website with links to some of our past technology posts.
 
Roy is trying to figure out how to use his iPad to interface with Electronic Medical Records and wrote about it last week for our Clinical Psychiatry News SR blog, see iPad: The New Black Bag.  His last post on Shrink Rap was about Depression Apps, and he inspired me to add the Moody Me app to my own iPhone.  I haven't tried it yet, but I'll let you know how it goes, but the colorful smiley faces were more than I could resist.  Depression Apps will also be a topic in one of our upcoming podcasts. 

Okay, so if you read my post on Siri and the psychiatrist, it will make me happy:

If you comment on it, it will make me really happy:

But be nice, I don't want to be sad:

Privacy, Please?

Anon commented on my last blog post about clinical uses for Siri on my new iPhone:

"From the details in your contacts, it knows your friends, family, boss, and coworkers. "

That was from Apple's web site, regarding Siri. If you are using Siri for clinical purposes, know that Siri tells Apple everything. Siri--usly, how do you protect patient confidentiality if Siri/Apple knows so much? Sure, paper files can be stolen, so can cell phones. E files are vulnerable to all sorts of breaches. But what would you do if your iphone 4S fell into the wrong hands with all that clinical related stuff on it? Not quite the same as asking Siri where the closest dry cleaner is.

I find it kind of interesting what people worry about.  I have hundreds of contacts in my phone.  My husband is labeled no differently than my co-workers, than my friends. than my patients.  I'm not sure what it means to have one's iPhone "fall into the wrong hands."  I live in Maryland, so I'm not sure what Apple in Cupertino would do with my information, maybe send iPhone advertisements to my contacts? 


The issue of clinical information is  something I hadn't thought about.  I downloaded an app yesterday specifically for GoogleDocs, and it imported all my documents.  We wrote our book on this, so every chapter and every revision is now accessible on my phone, not to mention my posts for Clinical Psychiatry News and an unpublished novel or two.  I downloaded the app so I would have the option to dictate patient notes.  This would leave clinical information potentially accessible via a cloud or on the phone.  I'm not sure it's all that interesting.  My notes are usually pretty boring.  But I did think that I would print them and then delete, rather than have to deal with keeping charts in order in cyberspace.


I guess I find it interesting that people worry about issues of confidentiality with total strangers in places where it's hard to imagine a use for what is likely to be pretty boring information.  On the other hand, we live in a world where electronic medical records now exist in all types of venues.  I work at a large hospital.  I can access the records of any patient seen there, and if I go to a physician there, his notes about me will go onto the EMR. At this juncture, outpatient psychiatry notes are not on the EMR, just a record of the fact of the appointment (which does say "community psychiatry," and the psychiatrists add their medications, but this will change soon, I'm sure, and psych notes may well be part of the hospital's coming new system.  The patients are not asked, and the doctors they see have access to all records without getting prior permission.  There are very specific rules about whose records a healthcare worker may look at, and people have been fired for looking at their neighbor's records, but someone has to catch you.  This means that a patient would have to ask someone with access to the system to see who had accessed their records, realize that one of those people was not someone involved with their care (Hey, that's my new boyfriend!) and then complain to the hospital and initiate some type of complaint (I think).  There is nothing inherent in the system that prevents one person from looking at the medical records of their coworkers, boss, ex-husband,  or even their doctors, aside from their own conscience and the fear of being caught (and reprimanded).  At this point, and for this reason, I have chosen not to get care at the institution where I work.  


Our state is also working on a system, called CRISP, that lifts medical records from all providers to a centralized system.  You can opt out, but you don't need to opt in: do nothing and your healthcare information goes in.  I opted out, and I got a letter telling me they would keep my information in case I changed my mind.  Wait, so presumably my doctor will be feeding my information into this cloud, without asking my permission?  I don't really know how this will work-- from the shrink standpoint-- because no one has contacted me about putting my professional records into this system, and since my records are all handwritten on hard copy charts, I don't know how this would play out. 


Somehow we've come to think that electronic medical records will mean better care.  I could be wrong, but I'm not really sure why we think that.  It seems to me that the burden this will place on the physician to attend to the devices and the demands of this type of documentation, will consume time and detract from time with the patient.  As is, I've noted it takes about 5 times as long to send an e-script as it does to write a prescription, starting with the fact that the e-system my hospital uses logs me out every 7 minutes.  I'm told this can't be modified, and I'm not aware of any doctor who sees patients faster than every 7 minutes.  Secondly,  an electronic system is only as good as the information it propagates, and I've seen lots of mistakes in the electronic medical records.  The internist notes that the patient is seen by psychiatry and takes Restoril.  Wait, my patient is taking Restoril?  I didn't know this..oh, I think he meant Risperdal.  By my calculation, the number of lives saved by electronic information that is provided when the patient can't provide it himself, will about equal the catastrophes from the propagation of incorrect information.  


So I should be worried that Apple can see my contacts?  My brother, who is an original Caltech computer geek, told me recently that since I have a webcam, it's possible that someone could hack my computer and watch me through my camera.  At first, I was alarmed at the possibility, but then I thought about this for a moment and said, "Why would someone want to watch me type?"  Nothing that exciting is happening here.  Sometimes I don't wear makeup, here and there I stick out my tongue and lick my lips, and okay, in front of the computer, when I'm writing, I kind of talk to myself.  If this might interest someone...

I seem to have my own list of things to worry about.  That someone might hunt my patient information out from the cloud just hasn't yet made my list. 

How Does Siri Help the Mental Health Clinician?

Next week,  it will be my turn to write our article for the Clinical Psychiatry News website.  Over there, we try to have our writing more specifically aimed at an audience of psychiatrists.  I'm going to be writing an article on Siri and the Psychiatrist....in honor of my new iPhone 4s and the "personal assistant" function named Siri.  Okay, I'm obsessed.  Everyday, I find new things it can help me with.  Today, I asked it, "What's the meaning of life."  What, you don't ask your cell phone the finer existential questions?  Siri answered, "All available evidence suggests chocolate."  Wow!  How old is Liza Minelli?  65 years, 7 months, 20 days.  Calculate a tip? No problem.  Convert Celius to Fahrenheit?  A cinch.  And she takes dictation.  "Siri, please text Pt A 'Your lab results are fine.'"  "Siri, please email Jesse, 'Will you write a new guest post for Shrink Rap?' "  Okay, Siri flubs on this....I can't get her to learn that it's Shrink Rap and not Wrap.  I downloaded a Google Documents App so I can dictate....patient notes, my memoir, a few novels, a Shrink Rap post here and there, To Do lists for Roy....  I think I'm set.


So, I'd like your help.  What useful things are you doing with Siri?  How has your iPhone made life as a clinician better? 

Guest Blogger Dr. Jesse Hellman: What are the Limits of Psychiatry?

Recently a colleague and I were talking about a question that had been posted on our psychiatric society's Listserv. The question had to do with the age at which a parent would tell their child he had been adopted, and who the birth parents were. This question is quite complex, depending on a multitude of factors. Child psychiatrists responded, as did adult psychiatrists. Is this a question, though, for Psychiatry? One might argue that the question has nothing to do with mental illness. But does our field define itself only as addressing mental illness?

A few days ago in the NY Times there was an OP-ED piece in which the author touted brain studies as showing that we do not just "like our iPhones" but "love our iPhones." When I read it I was surprised, as the idea of whether one might "love" an iPhone (or, for me, my camera or sports car) never occurred to me: Of course I do. What was surprising was the apparent sense of discovery by the author of a phenomenon that Freud had clearly described well over eighty years ago. He invented the word "cathected" to describe that we can "cathect" or imbue any particular thing, or even idea, with erotic energy and so love it with the intensity we have for living things. He explained that that cathected energy can be withdrawn from these things as well as from people, and the formerly loved object discarded instantly.

So psychiatry, to me, includes psychology in its broadest sense as well as the complexities of human interaction. In my own practice the most difficult and important issues are not usually the questions of medication but those that have to deal with all the issues that  beset the patient that are then brought up in their sessions: getting promoted at work, the problems of a marriage, the competitive strivings within a family or its workday substitutes, the losses one faces inevitably in life, and so on. Almost infinite variety.

So how do others address this question? Just what is Psychiatry?

He's Gone

At 8:30 last night I got the news. It came from somebody who knew me quite well and knew my hardcore loyalty to Apple, enough to call me a "Steve Jobs Apple toady bootlicker." A good friend, yes. He told me: Steve Jobs was dead.

Wow. I remember when John Lennon was killed and I'll remember getting this news.

Steve Jobs has been part of my professional and personal lives for 25 years. I got my first Mac in 1986, during my second year of medical school. It was a huge decision, and even with a student discount a tremendously expensive thing to do. It was a decision I've never regretted. I still have that machine.

The day I went to pick up my new machine they held a special event at the university hockey stadium. The whole place was filled with aisles of Macs stacked six feet high. People were lined up around the block to pick up their new machines. The only time I've seen anything like that was at the opening of the first Apple store in 2001. I was standing in line at Tyson's Corner, fortunately not at the end which curled around the second floor and down the stairs. The waiting time to get in was rumored to be three hours, and there was security in place to make sure the store stayed below the fire marshal's limit of people in the store.

The Apple years without Steve Jobs were grim. A series of five CEO's successively drove the company into the ground. The quality of the machines dropped, there were recalls for broken parts, bad monitors, stuff that never would have happened under Steve. (OK, the Apple Newton eventually became the prototype for the Palm Pilot---using an operating system designed by former Apple engineers---but it never quite got it right.)

Then he came back. Just in time, like Superman coming back just as the bomb is about to explode, to save the world. We got that weird-looking first-ever all-in-one pyramidal iMac. We got OS X, one of the most stable operating systems I've ever used. We got iPods and iPhones and iTunes (without which our My Three Shrinks podcast would never have happened). We got the iPad. We got the software. It just happened.

So here we are. We three Shrink Rappers all use Apple products. We edit podcasts with Garage Band, have iPhones, use MacBooks. Our iPhone edition of Grand Rounds was one of most popular posts (complete with clickable iPhone buttons). Technology for non-geeks.

There's not much else to say. If there is, the Twittersphere has it covered---it's been nothing but mourning for hours after the news broke.

He's gone.

Goodbye.

And thanks.

Vacation Dreams

It's warm and sunny here. The sand is blue, the water is green, the Dinah is pleasantly pinkish. The Ravens are losing at half time.

I had this dream last night that begs to go on the blog, so here I am.
I was walking down the street with ClinkShrink, and Roy was with us too, but walking a bit slower. We came across a body in the road, face down, and we went to help, Clink and I right there at the scene. It was a woman, and someone else was there, looking for a pulse. She moved, and then she got up. I asked a few medical questions, and we decided it was okay to leave. Roy thought I should have asked different questions.

Then we were in Boston. We'd flown and I had to get back the same day. I asked Roy if he'd bought my ticket, since I hadn't bought it myself and thought I might owe him money. He hadn't. I also didn't recall ever seeing a boarding pass---how did I get on the plane?

We were at a meeting and there was another psychiatrist there as well as some of my neighbors. I sat down and tried to figure out how I was going to get back to Baltimore that day. I pulled out my iTouch and tried to download an AirTran App.

By the time I'm dreaming about i-Anything apps on vacation, well that's when I know that Roy has gotten to me.

Electronic Hair Records!

Roy has Electronic Medical Records on his mind lately and if you'd like to hear him, oh, he'd love to tell you his thoughts. Or read his last post here. I'm still not sure how I feel about Electronic Records-- I worry about confidentiality and the propagation of incorrect information.

So why are medical records oh so important? What about making other important things into Electronic Records so that information can be shared and referred to? Never mind Electronic Medical Records, what I need are Electronic Hair Records!

Hair, you ask? Hair! Let me tell you about my hair. I am a user of hair chemicals and it's no picnic when I'm away and need an emergency procedure. What could electronic hair records do?
Well there was the two year period where I saw a very nice hair dresser and somehow my hair was always too light. I had her switch chemical brands, but to no avail. Finally, I switched salons, and my hair is darker. There was the time that I wanted to have a chemical procedure done with a gift certificate at another salon and was told that if I'd had a certain process done previously, my hair might break off or fall out. If there was an EHairR, my hair dresser could have checked this-- instead we had to call my home salon and determined that it wasn't safe....my hair, indeed, could have fallen out. Oh, and because of all the processes, I must use a sulphate-free shampoo. No EHairR: I have to be the one to remind the shampoo person of this issue each and every time. No one even asks.

So what could an Electronic Hair Record do?

• Keep track of all chemical processes, brand names, colors, and dates of application.
• Coordinate dates of chemical processes to prevent interactions.
• Include panoramic photos of all haircuts so that patron could walk in and say, I liked the way it looked after the last cut and that cut could be reviewed.
• Include standardization of lengths: bangs to a half inch above the eyebrows would be precise.
• For those with thinning hair or balding, track hair loss.
• Include computer generated growth photos to help schedule haircuts with important life events.
• Download onto a iPhone app so the patron could, at last, own their own EHairR!
• Compare costs and ratings for different salons and hairdressers.

I think I'm on to something here.

Stuff. Like iPhones. For Peacocks.

It made me think about Roy, this article I read today in The New York Times. Roy is at APA in San Francisco. I miss him. My inbox is practically empty. He texts, and he left me a voicemail, but it's not the same. I want him to come home to be with me and ClinkShrink.

Okay, so the article, it was about stuff, and why we buy it and why we care about brands. Stuff, like iPhones. Roy loves his iPhone. He can talk about "apps" for hours.

In Message in What We Buy But No One's Listening, John Tierney writes:
Instead of running focus groups and spinning theories, he says, marketers could learn more by administering scientifically calibrated tests of intelligence and personality traits. If marketers (or their customers) understood biologists’ new calculations about animals’ “costly signaling,” Dr. Miller says, they’d see that Harvard diplomas and iPhones send the same kind of signal as the ornate tail of a peacock.

Is My Techno-Life Making Me Crazy(-er)?

In case you haven't heard, Roy is on vacation. He's blogging us the day-to-day update, complete with photos and mishaps -- starting with the flat tire on Day #1. ClinkShrink is also on vacation. In fact, her vacation was inspired by Roy's photos from his vacation last year. Greetings to all from Baltimore where the remaining co-blogger.... remains.



Okay, so last week I had a 36 hour getaway to the beach where I was hosted by my good friend the Judge-in-Curlers. My three hour drive was punctuated by a text photo that ClinkShrink sent to my phone of her car packed for vacation (bikes on the back), and a lengthy discussion with my shrink friend, Camel. As I arrived at my destination, my cell phone battery died. Dead. Completely dead. Oh, and "bring phone charger" (I have three, plus one for the car that doesn't work) was the last thing on my packing list, and the one thing I forgot. Ugh! I felt anxious inside, borrowed a Blackberry to check my voicemail and call home, and I figured my first trip out in the morning would be to get a 4th charger.



The morning came and it was a lovely beach day. Breakfast, a walk on the boardwalk, and I suddenly realized I felt so much better with a dead phone. And no email access. This is what was meant by Zen. Whatever that means.... I checked my messages periodically with the borrowed Blackberry and reminded myself that no patient had ever called from a bridge ledge only to say they would have jumped had it not been for my brilliant and immediate intervention.



A break from technology-- I think it was a good thing. I often think it makes it hard for us ever to fully relax when the urge is there to glance at the phone, make sure there are no messages, hit the "inbox" button.

Okay, I confess, "I don't have a phone" was my first thought when I was rear-ended on the return trip (no injuries, no dents), but I came home vowing to take it easier on the technology. We'll see.

And just so you know, I've set Roy's new 3g iPhone so that it barks when I call.

iPhone 3G Activation Blues

I thought I'd share my iPhone experience, not that it has anything to do with psychiatry, but I know a lot of our readers and listeners are Apple fanfolks, including yours truly. (Full disclosure: I own a whopping 9 shares of Apple stock, so assume some bias.)

As you may already know, Apple released it's 2nd version of its cell phone, the iPhone 3G (not a third generation phone, but the "3G" refers to its use of a third generation cellphone network) on Friday, July 11, 2008, at 8am local time 'round the world. Our Grand Rounds post on June 24 foreshadowed this release. Unfortunately, Friday's release was a disaster, and the dust has not even settled yet.

Apple ran out of its old iPhone in stores over a month ago, so demand has been building, as well as interest in the 3G's upgrades, which include a faster cell network, a regular-size headphone jack that does not require carrying around an adapter, and a price that is about half that of the first phone.

The usual Apple build-up and mystique contributed to people starting to get in line for the iPhone a full week ahead of release date (this is insane). Even my going to stand in line at 7am was a bit much, as I'm sure I could have gone the next day, walked in and got one.

Anyway, on the left is a picture I took with my Treo (I've had Palm devices since the original Palm Pilot way back in 1996) after getting in line, with about 100 people in front of me. Two hours later, by the time I reached the front of the line to get into the store, there were another 150 or so people behind me. Note that there were two other line opportunities at the mall... the AT&T store and the AT&T kiosk.

The ratios of people standing in line went like this: Apple:AT&T:Kiosk::25:5:1. The buzz in the line related to guesses about how many 16GB iPhones the Apple store had in stock versus the other two stores. It would be interesting to find out if the line proportions mirrored the stock proportions... you know what they say about the wisdom of crowds. Unfortunately, none of the stores' workers would tell us how many they had in stock, which is not very smart, as there were many reports of pissed off AT&T line standers getting upset when the manager later emerged, predictably telling them that they had no more of the precious phones in stock.

As we got closer to the front, I measured the pace of people leaving the store at about 1 person every 2 minutes. Nine people away from entering the store, and then people stopped coming out of the store (and we stopped going in). We found out that the same thing happened at the AT&T store (which we could see from where we were). Soon after, an Appler came out to tell us that the servers handling the phone activations were down, apparently crashing under the heavy load.

After a bit more waiting, a gush of people came out, iPhone bags in hand. But they didn't have that gleeful look on their face. One of them told us that the servers were still down, and that they'd have to activate their phones at home via iTunes. (This is how it was done with the first iPhone, but AT&T insisted on in-store activations this time to reduce the number of phones that get sent internationally to get unlocked later, so they can be used with any cell network.)

We started moving again and the rest of the experience was uneventful (fortunately, given that my bladder was extremely full by then). I walked out with an unactivated iPhone and was able to get it activated later that evening.


So, what went wrong?

It looks like that someone woefully miscalculated the combined effect of the following things happening all on the same day:

-a zillion in-store iPhone activations
-the release of an update to the iTunes software, version 7.7 (a 50MB download)
-the release of a firmware update (iPhone 2.0) to the 6 million first-gen iPhone and iTouch devices
-the release of a new iTunes App store (as in Application Store)
-the conversion of Apple's .Mac service to the new Mobile Me service

On top of all that, existing iPhone users who tried to update their firmware found that their iPhone was now as useful as an iBrick.

The postmortem analysis points to iTunes, not AT&T, as the Achilles heel in the fiasco. Apple has traditionally provided excellent service, so this experience has been particularly painful for many Apple watchers. Hopefully, they will do better next time.

He Got It!!!

Four hours in line, with details along the way.  The power went out, the biology of it all got a bit uncomfortable (or so I'm told).  The fear that they might run out....it was intense.  Oh, Roy will say I'm exaggerating, overly dramatic, catastrophic even.  After all, it's just a cell phone.  And apparently there were, indeed, lines.

Now where is Roy with his new iPhone?

I asked if takes pictures?  So far no answer.

I called, got the same old message.  Is Roy one person or does he now have two cellphones?  Does he have a new number?  Will I ever hear from him again, or is my Samsung slide (with no internet capability) no longer in his league?  Mine does have a camera.  I think I'll send Roy a picture of my feet.   I got my toes to smile.

I want to see it!  Is it bigger, better, more more more than last year's model?  Someone I work with has the old iPhone, can I introduce them, do side-by-side shopping?

----

Finally, while I'm rambling silliness on such a serious topic as the new iPhone, I want to take this opportunity to thank ClinkShrink for staying with Max and teenager the last few days so I could have a mini-vacation.  I'm recharged and so happy that everyone here is alive and well.  I am sorry that teenager ate the Reeses Puff cereal that Clink likes.

Shrink Rap Grand Rounds: The iPhone 3G Edition

[47] . . . [48] . . . [stay tuned for #49 in Dec '09] . . . [All]

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Also known as Podcast #48 ...CLICK to listen while you read

Tuesday, June 24, 2008

[HOVER or CLICK on any of the above icons to go to the post, or to use the functions at the bottom]

Welcome to Grand Rounds, Volume 4, #40 (see future GR schedule). If you missed our first Grand Rounds last year, with our amazing Clicky Brain, then feel free to pause and enjoy.

This year, since the anticipated release of the Apple iPhone 3G is just around the corner (July 11), we asked for submissions to have some connection to the iPhone, no matter how twisted the logic is to make the connection. The medical blogosphere obliged. So we are including, free of charge, our Clicky iPhone, which will let you visually navigate this week's Grand Rounds submissions (yes, the buttons on the phone really work).

Of course, below that is the regular text for you old-schoolers. And if you have low vision or prefer to LISTEN to your Grand Rounds, you can get our PODCAST of it HERE.

We'll start off with the posts which most closely held to our iPhone theme. Why an iPhone theme? Well, besides the fact that Roy is the resident Apple fanboy and Clink the fangirl, the iPhone has a lot of potential as a flexible and easy to use tool for today's health care professional. Sure, Roy wrote a tongue-in-cheek post about using it as a multi-faceted psychiatric tool, the iShrink, complete with breathalyzer and tremor-diagnosing imaging software, but the fact that its standards are open for third-party development means that we will see a tremendous amount of software written for it and available in the App Store. Joshua from Tech Medicine reviews some of the coming medical applications. Oh, and if you're already tired of hearing about the iPhone, you may as well just close your browser window now, because it only gets worse (better?).

EDIT: Yikes! It's already into Wednesday and I found out that I missed two Grand Rounds submissions... just left them off completely. Sorry about that. But here they are right at the top, so please check them out...

1. Social worker Still Dreaming writes about "Why I Don't Care About the New iPhone." I know what you're thinking... I really did just overlook her. (She actually like the iPhone.)

2. Midwife With a Knife has an excellent, scholarly post about restrictions on work hours for residents. Wish there were restrictions on hours for producing Grand Rounds!

Here's the rest...

Jeffrey from Monash Medical Student also points out some other medical applications for the iPhone.

Annie from Home of the Brave writes about a growing body of evidence which demonstrates that nurses, physicians and psychologists have been used by the government as agents of abuse and torture.

JeffreyMD notes that "Apple has long been considered to be a company that strives for excellence in their products." Which brings us to his post on The Pursuit of Excellence on a personal level. [Good reach.]

What if Apple was no longer deemed to be a computer company? Am from the Cockroach Catcher (yum) speculates about what if anorexia nervosa was no longer deemed to be an illness.

David from Mariana's Eye is still recovering from Grand Rounds last week.

In addition to detecting intoxication, doing your laundry, and filling out your clinic paperwork, the iPhone can play videos to reduce your pain, according to How to Cope with Pain.

How do you prevent neck pain from talking on your phone too long? Jolie from Fitness Fixer teaches us how to use your neck correctly.

Does the Joint Commission have standards for iPhone use in hospitals? Kim from Emergiblog has a humorous script for them when they show up unexpectedly. (Scroll down past the part about smoking.)

PCPs, watch out! "The ascendancy and final triumph of the doctor-nurse is as inevitable as that of the iPhone. Except that, unlike the iPhone (which only has Apple and ATT behind it), doctor-nurses have the undying support of the entire federal-industrial-medical complex (not to mention the formidable Mary Mundinger)," so says Dr Rich from Covert Rationing Blog. [Who's Mary Mundinger?]

Tinyshrink from Why Am I Still Here reminds us to heed HIPAA while using our iPhone on the elevator.

Louise from Colorado Health Insurance Insider says that the iPhone 3G will be the most convenient place for doctors to find and display information about the benefits of breastfeeding to women in hospitals or in remote locations.

Hypochondriac? Jenni from Chronic Babe thinks her always-sick relatives would love the internet connectivity of an iPhone.

Second Life on the iPhone? Bertalan from ScienceRoll wonders if it's possible (this is a Medicine 2.0 carnival).

Inspired by the design innovations in Apple's iPhone 3G (see her Open Letter to Steve Jobs), Amy from DiabetesMine ran a design challenge to encourage innovations in diabetes care. The response was amazing: check out the winners. And, you can listen to the winner on out Grand Rounds Podcast.

Should your 7-year old get an iPhone? Will it cause ADD? See what Mother Jones has to say at Nurse Ratched's Place.

Sandy at Junkfood Science notes that a group in Santa Fe fear getting fried by cell phones and wi-fi, so are trying to get these banned from public buildings. Next thing you know they'll be using iPhones to pop popcorn.

Drooling over the iPhone 3G? Tony from Hospital Impact is. It's a doctor's next best thing.

Laurie at A Chronic Dose eschews the new iPhone and other new medical treatments, finding that what's old is new again. (She gets the gold blogging star for sending me her post while waiting to be seen in the ER. Who needs an appendix, anyway?) FYI, Laurie's new book, Life Disrupted, comes out this week.

Using the web (even on an iPhone) to interact with your doctor improves satisfaction of the patient and the provider. Check our Graham's post on Canadian Medicine, where he describes patients who are happy to pay a small fee for the privilege. Listen to Graham on our Grand Rounds Podcast.

Dr Shock reviews the latest Cochrane evidence-based medicine on the use of omega-3 fatty acids for bipolar disorder, noting that the little iPhone clownfish here are one of the highest in omega-3's.

What if, when you got to the front of the line, the Apple guy gave you a Blackberry instead of an I-Phone? After all, they do essentially the same things, right? Henry at InsureBlog has the disturbing story of a pharmacy chain that pulled that trick on its customers.

David from HealthBlawg also writes about the "evil" pharmacy benefit managers, and noted readers of Paul Levy's column chastised Paul for using the term "medication compliance", which has become a bit of an un-PC term to use. David dutifully points out the the iPhone is as "un-PC" as the come.

[un-PC... get it?... lol]

NOW MOVING TO THE iPHONE ON THE RIGHT...

Will that shiny new iPhone help you remember things? Maybe, but don't expect the Motrin to help. Mona from the Tangled Neuron reviews research from our Hopkins colleague, Constantine Lyketsos, showing that NSAIDs don't help with cognition once Alzheimer's dementia begins. Aspirin doesn't help either, but it helps in other areas.

Walter from Highlight Health has seven ways to get in touch with them. I'm sure that all of them can be done from... you guessed it... an iPhone.

Patient chart out of labels? DrCris from AppleQuack snaps a pic with her iPhone. And be sure to check out her excellent post on branding oneself.

Zoe Brain has a long post about cross-gender brain differences. Somehow I doubt she typed all that on her iPhone (yes, I'm getting tired now of the iPhone references). You can also hear Zoe on our Grand Rounds Podcast.

Speaking of brains, why do smart brains make bad decisions (like paying $599 for a phone last summer that is available for $199 now)? Alvaro from Sharp Brains tells us about how our minds get swayed (and is offering 1,000 bonus points!).

Sham patients? The Samurai Radiologist discusses the reasons behind this fake-out trend on Not Totally Rad.

Paul from Medicine for the Outdoors addresses the important issue of why health care providers, and in particular physicians, should understand environmental issues and their impact upon human health.

Finally. Peter from Medical Pastiche has put his thumb on why we doctors like devices like the iPhone so much.

Dr Penna brings us yet another list of medical applications for the iPhone 3G.

Dean from the Back Pain Blog thinks the only excuse for not getting your mitts on a new Apple iPhone 3G would have to be coming down with a severe case of sciatica, which he addresses in Sciatica and Epidural Injections. Steroids anyone?

Give an Hour. DrVal from Dr Val & the Voice of Reason describes on our podcast an effort to get at least 10% of mental health providers to provide one pro bono hour per week helping our returning veterans and their families, because our government won't provide adequate access to treatment for PTSD and traumatic brain injuries.

In case some of you are struggling with violent thoughts against the iPhone lovers in you, Nancy from Teen Health 411 reviews a book about people who intentionally injure themselves.

ZXC, a family doc from Canadian Medical Blogs, thinks that the sorting hat from Harry Potter could be placed on patients with psychiatric complaints and it would tell him their diagnoses. Looks like the DSM-V will have some competition.

This one is a bit different, being a cartoon. Holly sent this one in from Candorville. I think he's not a shrink, but from Homeland Security. (There's a real Canada theme going through these posts; notice that?)

MJ from Interested Participant notes that the many in the US are pointing to the uninsured as reasons to move to a single-payer system, while folks in Canada are using similar rationale to argue for more private pay options. Maybe the grass is always greener.

The Snarky Gerbil is waiting for her anti-iPhone while talking about Biederman's fall from grace and peer review for journal articles.

Barbara from In Sickness and In Health writes about having hard conversations.

Kerri from Six Until Me writes about trying to get coverage for a diabetes device (Dexcom CGM) that insurance companies routinely decline. Also, congrats on the new hubby (how'd you get that one authorized?).

Are you feeling like a second-class citizen without an iPhone G3? Are you wondering if people will treat you the once you're relegated to the land of Nokia? Doc Gurley wades into the treacherous waters of discrimination of all kinds when she looks at a cluster of recent data about whether or not doctors discriminate when treating patients based on their - not phone - but race/ethnicity.

Zagreus from The Physician Executive got this in way late, but we got it into the post (we weren't able to get these last few on to the podcast).

And, that's the end of Grand Rounds for this week folks. Next week's Grand Rounds is hosted by The Covert Rationing Blog. If you'd like a recap of this week's GR, listen to our podcast as Dinah, Clinkshrink, and Roy take a light-hearted dip into this iPhone Edition of GR.

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And, a final note of caution by Dr. Pink Freud (which I read on the podcast):

Dear colleagues,

The new Apple iPhone 3G must be stopped! I first recognized the potential dangers of the device whilst perusing Apple's description of the product:

Consider Apples assertions: "(The) iPhone already gives you mobile multitasking. But 3G technology lets you multitask in more places — without connecting via Wi-Fi. Since 3G networks enable simultaneous data and voice, you can talk on the phone while surfing the web, checking email, or using Maps. All from your 3G cellular network."

My appeal is based on the foundation of simple biology. To date, the data from numerous studies supports strong gender difference in the area of multi-tasking, consistently demonstrating that women's brains, though smaller (apparently size doesn't matter here) are inherently better suited for multi-tasking. The Apple iPhone 3G takes multitasking to heretofore unrealized levels! Simply put, the male gender is not cognitively equipped to handle such technology safely. The implications are dire. Overloading of neuronal circuitry could lead, at a minimum to temporary cognitive impairment. Worst case scenario: What if men attempt to drive and use the new iPhone 3G at the same time? Seizure activity might result, leading to increased traffic accidents. The human toll would likely be catastrophic.

Apple should, at the very least conduct research to assess the short-term effects of the iPhone 3G's multi-tasking capacity on the male gender. Until such time as the effects can be determined, in the interim, Apple could market a less dangerous product to men; perhaps, the iPaper-Cups-With-A-String-Between Phone. As mental health professionals, we need to come together on this issue and be heard as one gender-neutral voice. Who know, maybe someday, perhaps with the aid of cognitive enhancing psychotropic medication, men will be able to handle the iPhone 3G. But for now, this may just be a dream.

Regards,

Christopher Bush, Psy.D.
(A.K.A. Dr. Pink Freud)

And finally, some eye candy at the end. The image below is our word cloud for this post, compliments of wordle.net.

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