Physicians Unite on Twitter, Divide on Practice

From MD:

When Sevilla created Doctor Anonymous, there was a collection of prominent physicians online who posted anonymously and with a striking lack of restraint. “I was venting about bad information out there,” Sevilla says, “but also about the healthcare system, patients, and insurance companies. That was the culture back then.”

It was a matter of time before someone was outed. In 2007, Robert P. Lindeman, MD, a Boston-area pediatrician, was sued for malpractice after the death of a 12-year-old boy. Under the pseudonym “Flea,” Lindeman had used a blog to rant “at length about a trial remarkably similar” to his own, the Boston Globereported. On the witness stand, Lindeman was forced to admit that he was Flea. The case was settled the following day.

“I work in a small town and didn’t want to get fired,” Sevilla says. “I decided I wasn’t going to write about my patients, and to shift my writing from complaining to being more of an advocate. I wanted to combat the negativity that I saw on the internet.”

In 2011 he wrote a blog post unmasking himself, explaining, “Doctor Anonymous was a gimmick, and now it’s time to be more transparent.” Around that time, people on message boards began wondering why popular anonymous accounts, such as “Panda Bear” and “GutShot,” had suddenly disappeared.

Using Propofol for Difficult-to-Treat Headaches in the ED

From Medscape:

I recently came across an article by Dr Rick Pescatore in Emergency Medicine News [1] related to the use of low-dose propofol to treat headache in the ED. It immediately caught my attention because treating migraine and other types of headache is a common part of emergency medicine practice. The article led me to a June 2017 post of Dr Pescatore’s on the blog R.E.B.E.L. EM[2] that also described the use of propofol for treating headache.

Emergency physicians are not only tasked with determining which headaches may be the most life-threatening, but also with figuring out the most effective ways to treat them. The standard headache cocktail—a neuroleptic agent, ketorolac, diphenhydramine, and dexamethasone—is ingrained as the most effective first-line approach for alleviating migraine and tension headaches in the majority of patients. We often use this approach in the ED, and although it is certainly effective, another novel strategy that deserves discussion is propofol.