Irvine ultrasound videos

If you have in some way been involved in ultrasound you surely haven't missed hearing Chris Fox mentioned and his awesome ultrasound lectures. The Ultrasound podcast has made him appear as a god-like figure and judging from the work he's been putting into ultrasound teachings, I think they're absolutely right. You will not find any better ultrasound video tutorials in the Milky way!

Maybe this is how Youtube got a concussion?
Not only is his work great but he has shared them all for free. They have been available on Youtube and iTunes. Youtube got a concussion recently and thinks they're infringing copyrights and iTunes is not for all. That leaves one final option for downloading the lectures directly to your computer - the torrent system.


First of all, using torrents to share content is 100% legal, it is sharing copyright content which is not. Using torrents you will download from multiple sources instead of a single one, giving you much faster download speeds. A whoppy 10 gigabyte collection like Chris' ultrasound videos thus can easily be downloaded in 30-60mins.

First you'll need a torrent software client. uTorrent has a good reputation and has all the features needed, it's free so go and install it.

Then you need the torrent file which has the description of the contents and where to look for it. You could google something like "irvine ultrasound torrent" but there are some other similiar torrent files out there which do not include the whole 10gb package. Also, there are many bad torrent websites forcing ads and even bloatware on your computer, thus I recommend www.isohunt.com which I find better than the others and have used for a while. You can also download the file directly from my Dropbox here
 http://dl.dropbox.com/u/484919/Ultrasound%20Video%20Lectures%202011-2012-Uni%20of%20cal.torrent


That's all there is to it. Open the torrent file in uTorrent and it takes care of the rest. Remember, torrents live only as long as those who have already downloaded continue sharing them. Please keep your connection open, you can set a max upload rate in the torrent program so that your Internet connection isn't clogged.



A few shoutouts for productivity

These are some very interesting discoveries I've stumbled upon the recent weeks which I think may be useful to you.


Stereomood
http://www.stereomood.com
Stereomood is one of many Internet radio stations, providing free, streamed music. What makes Stereomood different is that you can choose the music channel appropriate for your mood. Thus you can listen to ambient background music for paper-work, inspiring drummy tunes for an energetic hour or just dreamy instrumental music while taking a nap. If you suddenly feel like jumping to the "opposite mood" there is a button for that, for example when returning to work after napping!

The mood tags are collaboratively done by the listeners so they are pretty natural and music rightly tagged most of the time.

Everytime you hear a tune that impresses you more than others you can "favorite it" for playing later. For all music there's a link to buy the tune or whole CD if you like the artist.

Finally, there's a smartphone app for both iPhone and Android.

TalkTyper
http://talktyper.com
Image from http://paulhami.edublogs.org/tag/talktyper
Here is a little gem that caught me by surprise as I didn't realise how easy it has become to translate speech to text now a days. Well, TalkTyper, does that exactly and it does it amazingly well. As you talk to the microphone sentences are converted to text almost instantly and collected in a mini-notepad.

You can select input language and all major languages are provided for and I expect the list to grow quickly as the web is in the background using a Google based speech to speech server. On a technical level, it is a built in Chrome feature (version 11 and above) being decorated with additional tools.

An excellent productivity tool worth knowing about!

Online XPS to PDF converter
http://xps2pdf.co.uk
Internet Explorer is notoriously stubborn, refusing to implement features users need. Printing a document to PDF file is one such feature, whereas Chrome allows you to just select "Save as PDF" as target printer. Explorer has a similiar feature but uses a Microsoft only technology called XPS instead of PDF. And most institutions force us to use Explorer. Thus, an online XPS to PDF converting tool was very much welcomed in my productivity link/tool collection.


Image from http://www.thegeeksclub.com
Pixlr
http://pixlr.com
This is the web-application of the century and should be topmost in this list but I've mentioned it already a few times. It's the one web-app I use almost everyday and is indespinsible while working with images or photos. It has all of Photoshop's most used features, it's free, it can sync your images with Google Drive or Picasa... its' totally amazing. If you haven't used it, you should now!



Finally,  a few IT tips
I love keyboard shortcuts as they make computer life so much easier - these are the latest I've discovered and definitely worth sharing!

Middle-mouse-clicking a link in your web-browser (Chrome and Firefox at least) will open it in a new tab. Also, middle-clicking an open tab closes it. So lovely!

While doing a Google search, you can anytime start writing again if you want to change your search - just start typing. No need to move mouse pointer to input field!

Impatient while scanning a Youtube video? There's a button for changing playback speed, you can play up to 2x times faster, great for example to quickly browse through a ultrasound tutorial you've seen before. Notice this works only in the HTML5 player, switch here if you're still using Flash.

A shocking blood gas!

A healthy young man comes to the ED after having being chased by the police, they say he'd ran for his life at least 1km after which they found him lying down, presumably unconscious. With all systems intact and stable vitals he's presumed to be faking (pseudocoma).

A quick glance in the ED reveals nothing new to refuse this theory - the patient has closed eyes and is extremily resistant to pain stimulation but has all reflexes intact (eg. gag, cornea-) and with eyes forced open he's looking straight forwards (to contrast with eg. roving eye movements if true coma). ECG comes in normal.

The police officers are informed that patient can return to police station as soon as blood results have been seen. And here they come...


With a hefty metabolic acidosis and lactate of 12,9 there's a minute of silence and doctors start thinking if there's a red herring in the room...

Could the patient be intoxicated after all?

Alcohols maybe?

He doesn't smell - but do all alcohols smell?

That's an anion gap of 18 - is it all explained by lactate?




With a presumed intoxicated patient fluids are ordered and patient is prepared for admission. Just that 45mins later the policemen come to let know that the patient is now awake and feeling well and ready to leave the ED with the officers. So a new blood gas (venous of course, who's sticking arteries these days anyways!) is drawn and voila;


All results normal... So the lactate acidosis turns out to be caused by strenous physical excercise. Now howzaaat!



To the audience
My learning points from this case;

  • Lactate can be very high after exercise! I remember a study where alpine ski-ers had 6-7 after coming down a slope and I've heard experienced clinicians state it may temporarily reach 20 after seizure). But you can even get disturbing pH levels from it!
  • Ethylene-glycol and methanol are odorless!

And my question to the audience: can I somehow calculate presumed anion gap from lactate levels, so that I can exclude other agents?

Five IT skills every doctor should learn and master

IT is not very sexy term for doctors' ears despite having potential to boost productivity and clinical skills. I find it hard to convince my colleagues that IT could be one the hopes for battling rising costs and burden of modern healthcare. Productivity and effective work is the one most important factor today - a doctor who is highly educated and trained is a much too valuable resource to be seen wasting time fighting a computer or software. Computers are everywhere today and can't be dodged - we are practising desktop medicine instead of bedside medicine. Same goes for the information tsunami, you have to ride it instead of being drowned in it.

So I would like to share with you what IT skills I think every doctor today should learn and master!

Doc wrote a coffe and drank some email
1. Touch type writing
Doctors write text all day long and no single skill is as underestimated as writing fast, many doctors picking the keyboard with one finger for same typing speed as Stephen Hawking.



Words per minute:

Stephan Hawking 15
Slow writer 20
2-3 days training 60
Professional writer 90
Reading aloud 150
World record 216


Training for 2-3 days will give you 300% gain in writing speed - such a number in the NNT world would normally be a breakthrough article in the medical journals!

=> Tame your computer - mastering mouse and keyboard

2. Google Docs (Drive)
A doctor's office does not need to be like this today!
I have surrendered to my brain and admit that however I try I will not be able to remember everything. My brain is a powerful processor of information but for organizing and storing it I need an online, easily accessible notebook. Google Docs is exactly that and has become an indispensable tool in daily clinical work. Everything I have learned the years - tips, links, references, quotes, statistics - I have noted in a well organized collection of text and images for easy retrieval bedside or at computer.

Besides being a huge personal notebook, Google Docs will forever change the use you approach information and data - ultimately leading to the 'mobile, paperless office', essential for organizing and accessing your work from wherever you are.

# A vodcast/post about Google Docs in clinical practice is just around the corner - stay tuned! #

3. Social media
Social media for doctors is essentially
1) Great educational material coming online (and free) through blogs and related technologies.
2) Communications platforms (Twitter, Google+ etc) for expanding your contact network - where your colleagues sharing their most valuable learning points and lessons.

Learning to use social media is not about any one technology, like starting Twitter, it is a new lifestyle. It may not be for all but for those who master it I can promise doors opening to a completely new world of e-learning, yielding clinical skills not possible before. Almost every day I find my self implementing something learned from my social media network to patient care. Learning ultrasound would have been impossible for me without social media as it has provided me with teaching material to support me.

=> Social media for doctors - where the brains meet

4. The web browser
Software installed locally on your hard drive is becoming a thing of the past as data cloud and web-applications take over. The heart of this revolution is the web browser and it is the one software you really have to know inside and out. Tabbed browsing, using the Omnibar (for Chrome), knowing the keyboard shortcuts, working with text (special copy & paste functions), synchronized preferences etc... Mastering these will give you maximum performance while doing your work. And for a busy doctor, productivity is everything!

=> Chrome - your single most important software decision


5. Genuine interest!
Just as the best doctors are those who are genuinely interested and active in their field - the same goes for IT skills. Strive to always become better and have open eyes for improvements, acknowledge that your way of doing things today may not be the most efficient one. Most of your daily tasks involve IT in one way or another and you will find lots of colleagues, especially younger ones who're born with IT at their hands, who are willing to teach you and help you.



An everyday example of IT in use!
Finally, an example from work - a serbian patient who repeatedly came to the ED with mostly non-compliance based problems because he didn't understand his medication list. Problem solved with a simple IT tool, Google Translate!

The ultimate Google+ widget for microblogs – help needed!

Ok this is a medical blog, so what is this discussion doing here you will ask? Well - many visitors here are (medical) bloggers and this is a very practical scenario that needs to be solved. So I'm asking the blogger community for advice, stay tuned and you'll learn some!


So you have a blog and you are using social media also for microblogging - ultrashort comments for quick interactions with your community, "Twitter" style. You want these microblogs to appear on the side bar of your blog - we have all seen the Twitter widget streaming recent tweets. Great for the small stuff that you don't feel like making a lengthy blog about but still want to share with your followers.

Well Twitter is all great but being minimalistic I want everything under the same roof and for me that's Google. I prefer using Google+ for microblogs because of convenience - no extra login or external website to browse to as everything is easily done from the Gmail interface or via my Android. Besides, Twitter is limited to a frustrating few 140 characters and Google+ provides for an excellent platform for professional networking and communications. Twitter is lacking for me.


So a Google+ widget is needed to display these microblogs. That's where the issues start, let me explain.

Google+ is based on Circles which are primarily thought as a layer of privacy. You can post something privately to your colleagues through a "Doctors' only" Circle so that your other friends and family members don't read that. It's tempting to think of Circles as a "channel" or "group" feature - a little like #hashtags are used to categorize posts - but first and foremost it is for privacy. Thus, your Circled posts are not open to the Internet as Public posts are and there is and will never be any RSS stream from these, it would simply defy the function of Circles.

A hack might be to use email forwarding; add an email to the doctors only Circle so that the post is forwarded to some service which adds it to a stream. Sounds good but the details are fuzzy - I will have to work on this. IFTTT might be the platform providing this.

So why not just post Public all the time and stream that to a widget? Well that's no good either - my blog followers would never want to read my non-medical posts. And vice versa - posting Public all the time on Google+ would drown my other followers in topics they are not interested in. Public posts using #hashtags seems like a nice intermediary solution but again I would be overflowing my followers as a whole and there is no way to make a stream from hashtags in Google+.


So I started a Google+ Page as a social-backend for my blog. All posts there are public and thus easily streamed to a widget. There are two major drawbacks with  this way;
1) Notifications on Google+ Pages cannot be forwarded to my personal Google+ or email. I'm too lazy to login to Page just to check for notifications. I like to follow up posts through comments and it's too cumbersome from a seperate Page. Remember a Page is designed to be managed by one or more individuals.
2) How do I choose if I should post a microblog with my personal Google+ profile or the blogs' Page? My  'librarian oriented' brain cannot have my posts disseminated all over in an unsystematic way!


Best of all thus would be if I could post on my personal profile and these then were forwared to the Google+ Page as a public post from where it is then displayed on the gadget. Again I'm looking into the email forwarding possibility but it seems to me there are no options currently available.



So a call out to 'bloggers united' - do you have any suggestions?

Trying to grab that text? Use OCR!

Copy & paste - a docs best friend!
Every now and then you will encounter situations where you can't use the copy & paste technique. Indispencible in the hospital to quickly write consultation texts, letters etc. - nothing is more frustrating as when the medical record system (in an hilarious attempt to stop data theft) cripples the copy/paste function.

Other scenarious where you might need to quickly get some text in electronic format is that when you get a medical letter from a foreign patient. It has happened to me a several times and once in the middle of the night where the patient had acute dyspnea.

Here is what you need to do to do online OCR; Optical Character Recognition:

1. Convert the text to image
If the text is on your computer you can use any screen grab app to just capture a screen image while having the text open. A favorite of mine is Lightscreen, a portable app thus allowing you to install on USB drive or within your local folder without administration rights.

Text on paper needs to be scanned of course - easily done in modern offices. Make sure the new image is in high quality, PNG is a lossless (no pixels lost while compressing) format highly recommended.


2. Remove patient identifying information
As we are going to use an online application we need to delete any information that might identify the patient. Not that I distrust the website used, just a good habit "just in case".
Open www.pixlr.com - a free, online Photoshop mimic where you can easily manipulate your new image. Just remember to save it back to PNG format agin.


3. Convert to text
So here's the magic ingredient in the cake; www.onlineocr.net is an online tool which takes an image and converts all text it can find to electronic format. Why this one stands out from the other lots out there is that you can even select which language to use! Now that wasn't so difficult!


And now you can do what you want with your text. If you're translating a medical letter just take it to Google translate.

Signs and syndromes in the emergency department

This guy surely did beat the feeling
You remember the ad "you can't beat the feeling"? What they didn't know is that there actually is one thing that does beat the feeling of a fresh Cola can - eliciting a sign you've learned in medical school, glued to your cortex years ago and finally making sense! Just like fresh blood on a CT can't lie about subarachnoid hemorrhage, a positive sign can verify a diagnosis you're having in mind. And that is indeed a feeling of excitement and victory. Even drugged Dr House can't hide his wide nostrils of joy as he's hit the nail on the head.

Therefore I decided to learn more signs and even syndromes I might encounter in my emergency department. And it has already made wonders - recently I learned about Rovsing sign and what do you know - next patient coming in with ambulance was a comatose elderly man having fluctuating, horizontal eye movements caused by uremia, a positive Rovsing sign... HOWZAT!

But that's what wise masters have been telling us all the time, doctors or not - what you go looking for, you will find. It's an universal law - and a Russian proverb!.

So I decided to make a list of signs and syndromes I could expect to encounter in my emergency department. In the spirit of social media I want to share this list with you, in hope that it will also increase your skills of diagnosis and pattern recognition. As most of my notes in Google Docs (now Drive) the list is a dynamic one which I am constantly editing to make better. Please feel free to use the comments for feedback or additions if you have some favorite sign or syndrome that has helped you in the ED.


To complement this list I also have a special collection in my Picasa web album where I collect medical images representing signs or diagnostic clues in the same manner as a picture says 1000 words.

In case you are interesting in more of these there are even more detailed lists on the Internet although I find many of the entries there not so relevant to the ED;

http://medical-dictionary.thefreedictionary.com/disease
http://medical-dictionary.thefreedictionary.com/syndrome



Finally, credit must be given to some sources I have used extensively to make the list;
  • Wikipedia 
  • Whonamedit.com 
  • fpnotebook.com 
  • gpnotebook.com 
  • and others who I haven't been able to identify (just old notes from med-school)

Signs and syndromes in the emergency department

This guy surely did beat the feeling
You remember the ad "you can't beat the feeling"? What they didn't know is that there actually is one thing that does beat the feeling of a fresh Cola can - eliciting a sign you've learned in medical school, glued to your cortex years ago and finally making sense! Just like fresh blood on a CT can't lie about subarachnoid hemorrhage, a positive sign can verify a diagnosis you're having in mind. And that is indeed a feeling of excitement and victory. Even drugged Dr House can't hide his wide nostrils of joy as he's hit the nail on the head.

Therefore I decided to learn more signs and even syndromes I might encounter in my emergency department. And it has already made wonders - recently I learned about Rovsing sign and what do you know - next patient coming in with ambulance was a comatose elderly man having fluctuating, horizontal eye movements caused by uremia, a positive Rovsing sign... HOWZAT!

But that's what wise masters have been telling us all the time, doctors or not - what you go looking for, you will find. It's an universal law - and a Russian proverb!.

So I decided to make a list of signs and syndromes I could expect to encounter in my emergency department. In the spirit of social media I want to share this list with you, in hope that it will also increase your skills of diagnosis and pattern recognition. As most of my notes in Google Docs (now Drive) the list is a dynamic one which I am constantly editing to make better. Please feel free to use the comments for feedback or additions if you have some favorite sign or syndrome that has helped you in the ED.


To complement this list I also have a special collection in my Picasa web album where I collect medical images representing signs or diagnostic clues in the same manner as a picture says 1000 words.

In case you are interesting in more of these there are even more detailed lists on the Internet although I find many of the entries there not so relevant to the ED;

http://medical-dictionary.thefreedictionary.com/disease
http://medical-dictionary.thefreedictionary.com/syndrome



Finally, credit must be given to some sources I have used extensively to make the list;
  • Wikipedia 
  • Whonamedit.com 
  • fpnotebook.com 
  • gpnotebook.com 
  • and others who I haven't been able to identify (just old notes from med-school)

Social media for doctors – where the brains meet

Now and then...
A whole lot has been written about social media but not so much for doctors and many of my colleagues still are confused what all the fuzz is about, still excited to try it out but tiptoeing around it like a cat around hot pot of milk as some stigmata is tied to it. As an emergency physician with many years of interest in IT and social media I would like to share with you my thoughts and help you to start a rewarding journey, an odyssey, you will not regret. It is definitely not a one day travel but it is exciting and fun from the first moment and will leave you with new contacts and educational sources changing  your way of practice forever. Personally it took me weeks to get the full grasp of it but everyday brought a new exciting discovery. So let's dig into this strange new technology everybody is talking about.

Part 1: Why should doctors care?

The one most important question doctors will ask about social media is "what's in it for me, why should I put time and energy in this?".
  • You will meet new smart and interesting colleagues from around the world, broadening your horizon by far as you expand your contact network. They will be your new source of wisdom, feeding you with interesting journal articles and reading material, podcasts and vodcasts (video recordings of talks) to enjoy and learn from right from your laptop. They will summarize articles, leave you clinical pearls or tips from cases they have learned from, all having the power to change how you practice.
  • Your new contacts will also provide you with answers to your critical questions, aka crowdsourcing!
  • Speakers or authors of articles you are inspired by are now reachable as easily as your local colleagues , giving you opportunity for direct feedback and conversations.
  • You will discover and learn to use the most important online learning material; websites and blogs which are slowly but steadily becoming the new textbooks for many emergency physicians. Emergency medicine written by emergency physicians!
  • When you meet your new e-contacts on the conferences you will already have been introduced so that you can go directly to business.
  • While sitting the conversations; use Twitter to stay awake and suck in more learning points than before
We are just seeing the beginning of what social media has to bring to us as individuals and corporations are jumping the train and then a new generation of doctors is coming to practice who was raised with computers and the Internet from the beginning. Social media may only be a part of a bigger IT revolution but it's something you have too much to gain to pass it by.

=> LITFL recently had a interesting discussion in the comments section where people were asked to mention if and how social media had changed their practice in some way, check out for some great real-life examples.

Part 2: Debunking some myths

As for every new technology, some skepticism and stigmata is surrounding social media and we'll start by addressing these.

#1 "I don't have time for that"
It's true that getting to know social media requires investing some of your time but there is a high return of investment (ROI). There are some websites and technologies you need to get comfortable with but going through that learning curve is a journey which can easily be enjoyed as it's path is through a jungle full of life. And you will do that journey with your new e-friends who will be glad to help you.
That is the whole point with social media; meeting new people and discovering new, valuable information. In the end, social media will save you time as you will learn more by new, more rewarding methods than before.

#2 "It will only bring me patients breathing down my throat"
Using social media to connect with your patients is a totally different story than the one I am putting through in this blogpost. Social media is the people's revolution leading to better communication and access to information and obviously a tremendous potential for patients and some doctors who have long-term contact with their patients. Social media for patient contact is obviously irrelevant for emergency physicians but most certainly you will want to encourage your patients to use it to connect to other patients and be better informed (the 'e-patients').
As you go online with your profile it is totally up to you how much of yourself you want to disclose. You can be invisible if that is what you want or you can go 'Full Monty' and patients will be able to discover you and contact you online. Privacy settings is something you will learn as you go along and you can always fine tune these afterwards. Fear not, your patients will not be on your doorstep in cyberspace unless you want them to.

#3 "I will get fired if I say something wrong"
Certainly if you're not careful. But this only holds true for doctors who are posting sensitive information with details tying them to a specific patient or touching hospital policies you would normally only discuss with trusted colleagues. There are lots of good articles to teach you the silent etiquette of posting online, see below in the 'more reading' section.
It has been said "don't post what you wouldn't say in the hospital elevator". Respect your patients, respect your colleagues and your hospital and you will not have anything to fear.

Part 3: What social media really is - a brief history

If you google "what is social media" you will get lost since the definitions and answers are in the count of thousands. So you will sit there wishing you had a colleague to ask directly instead.

With that, you have actually learned the basics of social media: it's all about people and contact networks.

The Internet boomed about year 2000, by which social media was an unknown concept. Fancy webpages popped up everywhere but  the information they contained was created by a few who web programmers or those hiring them. The content was the same for everyone since you browsed the web as a guest. Logins and user accounts evolved and set the stage for browsing the web as an active user, a person with a name and profile. Now you could interact with the pages, leave comments and see what others had to say.

Web 2.0: the Internet created by the people
Suddenly, average Joe was creating big part of the Internet without knowing web-programming or mastering IT tools. The concept of a "e-friend" was born as you could meet people you never met physically and follow their activities, almost like in real life. This silent milestone in the development of the Internet has been called Web 2.0 and marks the the era where the Internet was created by the people and thus, social media. A blogpost would be written about some article and in the comments, the author of the article would now appear and leave his or her feedback!

Almost overnight, hundreds of platforms were started with different approaches to how people profiled themselves online and created content. Many of these have drowned in  fierce competition while a few have stood up as the giants, we'll be back to these later. Now that you know the history, let's see what social media is really about.

Part 4: Why social media matters

Doctors browsing the Internet are there to find facts and answers relating to real-life patient scenarios. Let's take as an example that you want to know the prognosis for type A dissection.
Traditionally we use the search engines and browse through a swarm of results but there is a huge random factor deciding if we ever find what we are looking for. After all, we are being answered by robots who despite clever algorithms and genuine wish to give us the best possible results don't have the human factor; knowing who is behind that question and molding the answer accordingly. The robots don't know if we want to know the mortality number or how patients surviving this disaster fare after discharge. If we had a colleague to ask, he or she would give us much better answers by knowing our interests and background. Our colleagues at work, our contact network, is and has always been our most important resource. Long before the Internet, we asked and learned from our colleagues because they are doing the same things as we are and provide us with an environment which stimulates us to learn more and stay up to date to provide best possible patient care.

Your contact network is your one most important resource
When it comes down to it all, your contact network is your primary source of information, discoveries and opportunities. Every doctor relies on a good contact network. Ergo, this is where social media is changing it all by providing for new technology to expand your contact network and thus access to valuable resources and knowledge. In the old days your network consisted mainly of colleagues from your workplace and a few you met in conferences - with social media you will discover colleagues from all over the world, sharing same interests as you do in providing best possible patient care.

Part 5: The different platforms

As said previously there are too many social media platforms today to know them all. Fortunately only a few stand out and knowing these is an important step for embracing social media. Today, there are three main social media networks worth putting effort into, each with their own characteristics.


Twitter (140m users)
One simple technology, thousands of platforms
Twitter is the 'short and convenient', limited by 140 characters the stories are straight to point and rich of content. With Twitter it's very easy to follow people you think are interesting for the first 'e-contact', any communication more than that needs to be done on more sophisticated platforms like email or Facebook/Google+. In short, great for discovery. It also works great the other way around that is if you want to attract attention to your product (like blogs).

Facebook (900m users)
Facebook is the biggest social network and has a critical mass to do powerful things. Facebook started as a small network for colleague students sharing their acts of heroism or stupidity to make impressions. This background overshadows Facebook as users' privacy are a low priority and interesting posts tend to disappear in a pool of useless information. Facebook is good for keeping contact with family and friends and even reviving old relationships but as a professional network there better alternatives.


Google+ (170m users)
Google was a late to enter the game but with monstrous muscle power and anticipation to give Facebook some real competition it's launch of Google+ in 2011 was welcomed all over the world, breaking records as new users flocked in. Despite great user interface, innovative and aesthetic, only a few users have stayed because of lack of activity, compared to Facebook (a true Catch 22) - thus G+ being called the ghost town.
Google+ has a completely different approach to privacy than Facebook. The Circles method invites you to categorize your contacts for complete privacy control and minimal distractions while browsing. Google+ is stratified; you don't read everything from everybody but decide for yourself what you want to read, giving you breathing space to socialize.
Thus, many are expecting Google+ to see first time users coming back because it has turned out to be a great platform to discover new people and follow hobbies and interests, without being bombarded by the uninteresting clutter prevailing on Facebook.

=> Why Google+ is better than Facebook as a professional social media platform

It has been said "Twitter is people I don't know posting interesting stuff, Facebook is people I know posting uninteresting stuff". I'd like to add "that's why I Google+". I've tried out them all and Google+ is the one I'm staying with. For me, it brings me great way of creating contact networks, filters information flow to me to fit only my interests and giving me complete control over the visibility of my own posts. It just needs the masses so please do try it out!

Part 6: How to get started with social media

There is only one thing you need to get started, genuine interest. Let curiosity drive you deeper and deeper into the jungle, enjoy every part of the journey and before you know it you'll be an expert. What you need to learn is not sophisticated or else there would never have been the social media revolution (the people's revolution, remember).

Here are a few starting points to start your journey:

1) Create a Twitter account and spend some time to learn the 'Twitter way'. On the Twitter help page there is an excellent tutorial for beginners explaining the basics. Start with updating your profile so that people can get to know you, take care to reveal your full name and some highlights of your current position. Just as you would while giving your name tag on a conference. Don't worry about being followed by people you don't want to connect to - you can reject followers and even change the default settings so that you have to accept each request. Remember though, all tweets are public (there are no private groups or channels) it's just much more difficult (almost impossible) to find your posts amongst the 5-10.000 tweets created per second.
Then start looking for your soon-to-be e-colleagues, a good starting point is the #emergencymedicine or #acep channel (enter that string exactly in the search bar). Follow the people you think are writing interesting posts. As you start following more and more colleagues your main stream (the first/home page on Twitter) will be filled with posts from these, that's you sitting in a cafeteria with your new friends, listening to what they're chatting (tweeting) about. Sometimes there will be conversations, other times flow of random posts about this and that. The more interesting people you find to follow the more interesting posts you will be seeing on your main flow.

For a real kickstart, check Ivor Kovic's list of emergency physicians on Twitter and even see recent activity from this group to pick some.

As you scroll through the tweets you will stumble upon all kinds of exciting blogs containing interesting articles,  podcasts (audio) and vodcasts (video). This is the first crop from your new contact network.

...and RSS to join them all
2) Learn to use a RSS reader to collect your favorite blogs in one place. Here's a great post to learn about RSS. I use Google's RSS reader, a powerful yet intuitive tool for free with your Gmail (Google) account.

3) Start collecting blogs. It's been said that emergency physicians are the most active medical bloggers and as this list from Life in the fast lane (the mothership of EM blogs!) confirms, there are great many blogs existing and you will never be able to follow them all, even with RSS. You should still take some time to go through them and pick a few favorites to follow since these are going to be your complementary reading material in the future.
In the future we all hope to see the great material dispersed on diverse blogs collected to a one single place but until then you could try using Google custom search to search your collection of blogs instead of doing the standard Internet search where you will commonly get guidelines for treating horses as well as your patients.
The LITFL list is a very good one to start from but for a more detailed description of the blogs you have my list of EM blogs where all of the big blogs (the ones you really should follow) are listed.

If you want to cheat you can have others do all the work for you, there's the LITFL Review, a weekly episode where highlights from all the major emergency medicine blogs are concentrated in one heap. A great way to sense what's going on in the emergency medicine world.

4) Start your own blog!
There is nothing as rewarding and as writing about your discoveries and pearls you have to share. It's easier than you think!
 => Dr. Steve Smith tells about how his now renowned ECG blog started and what he has achieved

Part 7: How I and social media met

As a practicing emergency physician the last 10 years I can boldly state that few if any advances have impacted my learning curve as social media has done but it may have to do with my background. I specialized in southern Sweden, our emergency medicine program being one of the first of its kind in Scandinavia. With no long-time experienced specialists and limited educational resources we have been pretty much on our own.

This changed a few years ago when I was Googlin' to find something more than the traditional teachings in the textbooks. I needed something more than guidelines and tables; I needed clinical pearls and tips, pragmatic, real-life descriptions of how to handle the difficult scenarios not described in the textbooks. What started with small victories ended up as a whole new world of online learning material, finally I'd found my way home. From Life in the fast lane (the best EM blog ever) to free video recordings from great speakers on All LA Conference. I learned about Mel Herbert and his awesome products like EM Rap and USC Essentials. I found Free emergency talks and now Amal Mattu was in my headphones while out jogging, revealing to me pearls about difficult ECGs in the ED. And Stuart Swadron with his endless wisdom and medical knowledge. Scott Weingart on EM Crit entertained me with his amazing rants about advanced trauma and sepsis care in the ED, suddenly I felt like I knew at least a little about vasopressors. Then HQ MedEd arrived on the scene with amazing video recorded ultrasound cases, they got me at hello.

By commenting on the blogs or through Twitter I could now correspond directly with the authors of all this fantastic material and suddenly I was not alone any longer. And my interest in emergency medicine exploded as I felt much more in power of my specialty, being part of a network of great doctors and stimulated by them to learn more and never give up.

=> What a wonderful (IT) world
=> Video learning in emergency medicine
=> E-learning in emergency medicine


Today, I learn in a totally different way than before. I learn mostly online and with the help of all my note-taking system in Google Docs, I consider my self a much better doctor today than before.

Part 8: The future of social media

With social media, physical barriers are no more and we now have unlimited access to colleagues all over the world and richer learning material with the possibility to interact with it. The coming years are even more exciting as this revolution comes to practice and we eventually witness a new generation of doctors who are better informed and better connected.

In my mind there are two special issues which wait to be addressed with the new recent revolution.

1) We need real-time consulting service; every doctor has a dream of being able to connect to their network in the middle of the night to ask for advice with the difficult patient. Or just that damn difficult case in daytime where expert opinion is needed. The current platforms like Twitter and Google+ are worth a try but we need an organized framework to make this happen.

2) We need a centralized database of guidelines/links. As huge amount of high quality text and multimedia about every possible clinical scenario occuring in the emergency department is being published online, it's getting painstakingly difficult to know where to look for what. Even with Google custom search as the amount of results are just growing.
We need all this in one place, categorized, tagged and easily searchable with not only text but photos, videos and links to articles or blogposts for further reading. Such a big project needs joint effort from lots of emergency physicians and should therefor be collaboratively edited, supervised by selected individuals to ensure maximum quality.

Actually LITFL has already begun some of this work with their amazing databases of cases, blogs, podcasts and what ever you can think of but (I hate to say but about LITFL!) I think we still need a A-Z page for each of the clinical scenarios we have in the ED with text, multimedia and links.

Emergency physicians have already shown they are geeky and smart with IT tools. I think we ought to make this a pioneer, exemplary project, in the hands of many it is an easy task. We have the technology, we have social media to get us connected - we just need it to be started, somehow.

I am all open for discussions and more than willing to help out so if any one out there is thinking the same, feel free to contact me!

More about social media

[Mashable] The infographic history of social media
excellent and detailed history of how it all started...
E-learning in emergency medicine
a detailed description of my top educational resources I use.

Emergency physicians give answer to the question if and how social media has changed their practice.
[Boston.com] As Facebook grows, millions say, 'no, thanks'
It's not just me who thinks Facebook is overwhelming!
The birth of Steve Smith's ECG blog and The birth of the Ultrasound podcast
two great stories of how a blog/podcast is started and what it has given done for their authors.
Doctor reprimanded after patient privacy breached on Facebook
There are two sides of the story, interesting discussion also in the comments.
Distilling the essence of medicine using Twitter
A rheumatologist describes how he uses Twitter to stay learn more from conferences.

Social media for doctors – where the brains meet

Now and then...
A whole lot has been written about social media but not so much for doctors and many of my colleagues still are confused what all the fuzz is about, still excited to try it out but tiptoeing around it like a cat around hot pot of milk as some stigmata is tied to it. As an emergency physician with many years of interest in IT and social media I would like to share with you my thoughts and help you to start a rewarding journey, an odyssey, you will not regret. It is definitely not a one day travel but it is exciting and fun from the first moment and will leave you with new contacts and educational sources changing  your way of practice forever. Personally it took me weeks to get the full grasp of it but everyday brought a new exciting discovery. So let's dig into this strange new technology everybody is talking about.

Part 1: Why should doctors care?

The one most important question doctors will ask about social media is "what's in it for me, why should I put time and energy in this?".
  • You will meet new smart and interesting colleagues from around the world, broadening your horizon by far as you expand your contact network. They will be your new source of wisdom, feeding you with interesting journal articles and reading material, podcasts and vodcasts (video recordings of talks) to enjoy and learn from right from your laptop. They will summarize articles, leave you clinical pearls or tips from cases they have learned from, all having the power to change how you practice.
  • Your new contacts will also provide you with answers to your critical questions, aka crowdsourcing!
  • Speakers or authors of articles you are inspired by are now reachable as easily as your local colleagues , giving you opportunity for direct feedback and conversations.
  • You will discover and learn to use the most important online learning material; websites and blogs which are slowly but steadily becoming the new textbooks for many emergency physicians. Emergency medicine written by emergency physicians!
  • When you meet your new e-contacts on the conferences you will already have been introduced so that you can go directly to business.
  • While sitting the conversations; use Twitter to stay awake and suck in more learning points than before
We are just seeing the beginning of what social media has to bring to us as individuals and corporations are jumping the train and then a new generation of doctors is coming to practice who was raised with computers and the Internet from the beginning. Social media may only be a part of a bigger IT revolution but it's something you have too much to gain to pass it by.

=> LITFL recently had a interesting discussion in the comments section where people were asked to mention if and how social media had changed their practice in some way, check out for some great real-life examples.

Part 2: Debunking some myths

As for every new technology, some skepticism and stigmata is surrounding social media and we'll start by addressing these.

#1 "I don't have time for that"
It's true that getting to know social media requires investing some of your time but there is a high return of investment (ROI). There are some websites and technologies you need to get comfortable with but going through that learning curve is a journey which can easily be enjoyed as it's path is through a jungle full of life. And you will do that journey with your new e-friends who will be glad to help you.
That is the whole point with social media; meeting new people and discovering new, valuable information. In the end, social media will save you time as you will learn more by new, more rewarding methods than before.

#2 "It will only bring me patients breathing down my throat"
Using social media to connect with your patients is a totally different story than the one I am putting through in this blogpost. Social media is the people's revolution leading to better communication and access to information and obviously a tremendous potential for patients and some doctors who have long-term contact with their patients. Social media for patient contact is obviously irrelevant for emergency physicians but most certainly you will want to encourage your patients to use it to connect to other patients and be better informed (the 'e-patients').
As you go online with your profile it is totally up to you how much of yourself you want to disclose. You can be invisible if that is what you want or you can go 'Full Monty' and patients will be able to discover you and contact you online. Privacy settings is something you will learn as you go along and you can always fine tune these afterwards. Fear not, your patients will not be on your doorstep in cyberspace unless you want them to.

#3 "I will get fired if I say something wrong"
Certainly if you're not careful. But this only holds true for doctors who are posting sensitive information with details tying them to a specific patient or touching hospital policies you would normally only discuss with trusted colleagues. There are lots of good articles to teach you the silent etiquette of posting online, see below in the 'more reading' section.
It has been said "don't post what you wouldn't say in the hospital elevator". Respect your patients, respect your colleagues and your hospital and you will not have anything to fear.

Part 3: What social media really is - a brief history

If you google "what is social media" you will get lost since the definitions and answers are in the count of thousands. So you will sit there wishing you had a colleague to ask directly instead.

With that, you have actually learned the basics of social media: it's all about people and contact networks.

The Internet boomed about year 2000, by which social media was an unknown concept. Fancy webpages popped up everywhere but  the information they contained was created by a few who web programmers or those hiring them. The content was the same for everyone since you browsed the web as a guest. Logins and user accounts evolved and set the stage for browsing the web as an active user, a person with a name and profile. Now you could interact with the pages, leave comments and see what others had to say.

Web 2.0: the Internet created by the people
Suddenly, average Joe was creating big part of the Internet without knowing web-programming or mastering IT tools. The concept of a "e-friend" was born as you could meet people you never met physically and follow their activities, almost like in real life. This silent milestone in the development of the Internet has been called Web 2.0 and marks the the era where the Internet was created by the people and thus, social media. A blogpost would be written about some article and in the comments, the author of the article would now appear and leave his or her feedback!

Almost overnight, hundreds of platforms were started with different approaches to how people profiled themselves online and created content. Many of these have drowned in  fierce competition while a few have stood up as the giants, we'll be back to these later. Now that you know the history, let's see what social media is really about.

Part 4: Why social media matters

Doctors browsing the Internet are there to find facts and answers relating to real-life patient scenarios. Let's take as an example that you want to know the prognosis for type A dissection.
Traditionally we use the search engines and browse through a swarm of results but there is a huge random factor deciding if we ever find what we are looking for. After all, we are being answered by robots who despite clever algorithms and genuine wish to give us the best possible results don't have the human factor; knowing who is behind that question and molding the answer accordingly. The robots don't know if we want to know the mortality number or how patients surviving this disaster fare after discharge. If we had a colleague to ask, he or she would give us much better answers by knowing our interests and background. Our colleagues at work, our contact network, is and has always been our most important resource. Long before the Internet, we asked and learned from our colleagues because they are doing the same things as we are and provide us with an environment which stimulates us to learn more and stay up to date to provide best possible patient care.

Your contact network is your one most important resource
When it comes down to it all, your contact network is your primary source of information, discoveries and opportunities. Every doctor relies on a good contact network. Ergo, this is where social media is changing it all by providing for new technology to expand your contact network and thus access to valuable resources and knowledge. In the old days your network consisted mainly of colleagues from your workplace and a few you met in conferences - with social media you will discover colleagues from all over the world, sharing same interests as you do in providing best possible patient care.

Part 5: The different platforms

As said previously there are too many social media platforms today to know them all. Fortunately only a few stand out and knowing these is an important step for embracing social media. Today, there are three main social media networks worth putting effort into, each with their own characteristics.


Twitter (140m users)
One simple technology, thousands of platforms
Twitter is the 'short and convenient', limited by 140 characters the stories are straight to point and rich of content. With Twitter it's very easy to follow people you think are interesting for the first 'e-contact', any communication more than that needs to be done on more sophisticated platforms like email or Facebook/Google+. In short, great for discovery. It also works great the other way around that is if you want to attract attention to your product (like blogs).

Facebook (900m users)
Facebook is the biggest social network and has a critical mass to do powerful things. Facebook started as a small network for colleague students sharing their acts of heroism or stupidity to make impressions. This background overshadows Facebook as users' privacy are a low priority and interesting posts tend to disappear in a pool of useless information. Facebook is good for keeping contact with family and friends and even reviving old relationships but as a professional network there better alternatives.


Google+ (170m users)
Google was a late to enter the game but with monstrous muscle power and anticipation to give Facebook some real competition it's launch of Google+ in 2011 was welcomed all over the world, breaking records as new users flocked in. Despite great user interface, innovative and aesthetic, only a few users have stayed because of lack of activity, compared to Facebook (a true Catch 22) - thus G+ being called the ghost town.
Google+ has a completely different approach to privacy than Facebook. The Circles method invites you to categorize your contacts for complete privacy control and minimal distractions while browsing. Google+ is stratified; you don't read everything from everybody but decide for yourself what you want to read, giving you breathing space to socialize.
Thus, many are expecting Google+ to see first time users coming back because it has turned out to be a great platform to discover new people and follow hobbies and interests, without being bombarded by the uninteresting clutter prevailing on Facebook.

=> Why Google+ is better than Facebook as a professional social media platform

It has been said "Twitter is people I don't know posting interesting stuff, Facebook is people I know posting uninteresting stuff". I'd like to add "that's why I Google+". I've tried out them all and Google+ is the one I'm staying with. For me, it brings me great way of creating contact networks, filters information flow to me to fit only my interests and giving me complete control over the visibility of my own posts. It just needs the masses so please do try it out!

Part 6: How to get started with social media

There is only one thing you need to get started, genuine interest. Let curiosity drive you deeper and deeper into the jungle, enjoy every part of the journey and before you know it you'll be an expert. What you need to learn is not sophisticated or else there would never have been the social media revolution (the people's revolution, remember).

Here are a few starting points to start your journey:

1) Create a Twitter account and spend some time to learn the 'Twitter way'. On the Twitter help page there is an excellent tutorial for beginners explaining the basics. Start with updating your profile so that people can get to know you, take care to reveal your full name and some highlights of your current position. Just as you would while giving your name tag on a conference. Don't worry about being followed by people you don't want to connect to - you can reject followers and even change the default settings so that you have to accept each request. Remember though, all tweets are public (there are no private groups or channels) it's just much more difficult (almost impossible) to find your posts amongst the 5-10.000 tweets created per second.
Then start looking for your soon-to-be e-colleagues, a good starting point is the #emergencymedicine or #acep channel (enter that string exactly in the search bar). Follow the people you think are writing interesting posts. As you start following more and more colleagues your main stream (the first/home page on Twitter) will be filled with posts from these, that's you sitting in a cafeteria with your new friends, listening to what they're chatting (tweeting) about. Sometimes there will be conversations, other times flow of random posts about this and that. The more interesting people you find to follow the more interesting posts you will be seeing on your main flow.

For a real kickstart, check Ivor Kovic's list of emergency physicians on Twitter and even see recent activity from this group to pick some.

As you scroll through the tweets you will stumble upon all kinds of exciting blogs containing interesting articles,  podcasts (audio) and vodcasts (video). This is the first crop from your new contact network.

...and RSS to join them all
2) Learn to use a RSS reader to collect your favorite blogs in one place. Here's a great post to learn about RSS. I use Google's RSS reader, a powerful yet intuitive tool for free with your Gmail (Google) account.

3) Start collecting blogs. It's been said that emergency physicians are the most active medical bloggers and as this list from Life in the fast lane (the mothership of EM blogs!) confirms, there are great many blogs existing and you will never be able to follow them all, even with RSS. You should still take some time to go through them and pick a few favorites to follow since these are going to be your complementary reading material in the future.
In the future we all hope to see the great material dispersed on diverse blogs collected to a one single place but until then you could try using Google custom search to search your collection of blogs instead of doing the standard Internet search where you will commonly get guidelines for treating horses as well as your patients.
The LITFL list is a very good one to start from but for a more detailed description of the blogs you have my list of EM blogs where all of the big blogs (the ones you really should follow) are listed.

If you want to cheat you can have others do all the work for you, there's the LITFL Review, a weekly episode where highlights from all the major emergency medicine blogs are concentrated in one heap. A great way to sense what's going on in the emergency medicine world.

4) Start your own blog!
There is nothing as rewarding and as writing about your discoveries and pearls you have to share. It's easier than you think!
 => Dr. Steve Smith tells about how his now renowned ECG blog started and what he has achieved

Part 7: How I and social media met

As a practicing emergency physician the last 10 years I can boldly state that few if any advances have impacted my learning curve as social media has done but it may have to do with my background. I specialized in southern Sweden, our emergency medicine program being one of the first of its kind in Scandinavia. With no long-time experienced specialists and limited educational resources we have been pretty much on our own.

This changed a few years ago when I was Googlin' to find something more than the traditional teachings in the textbooks. I needed something more than guidelines and tables; I needed clinical pearls and tips, pragmatic, real-life descriptions of how to handle the difficult scenarios not described in the textbooks. What started with small victories ended up as a whole new world of online learning material, finally I'd found my way home. From Life in the fast lane (the best EM blog ever) to free video recordings from great speakers on All LA Conference. I learned about Mel Herbert and his awesome products like EM Rap and USC Essentials. I found Free emergency talks and now Amal Mattu was in my headphones while out jogging, revealing to me pearls about difficult ECGs in the ED. And Stuart Swadron with his endless wisdom and medical knowledge. Scott Weingart on EM Crit entertained me with his amazing rants about advanced trauma and sepsis care in the ED, suddenly I felt like I knew at least a little about vasopressors. Then HQ MedEd arrived on the scene with amazing video recorded ultrasound cases, they got me at hello.

By commenting on the blogs or through Twitter I could now correspond directly with the authors of all this fantastic material and suddenly I was not alone any longer. And my interest in emergency medicine exploded as I felt much more in power of my specialty, being part of a network of great doctors and stimulated by them to learn more and never give up.

=> What a wonderful (IT) world
=> Video learning in emergency medicine
=> E-learning in emergency medicine


Today, I learn in a totally different way than before. I learn mostly online and with the help of all my note-taking system in Google Docs, I consider my self a much better doctor today than before.

Part 8: The future of social media

With social media, physical barriers are no more and we now have unlimited access to colleagues all over the world and richer learning material with the possibility to interact with it. The coming years are even more exciting as this revolution comes to practice and we eventually witness a new generation of doctors who are better informed and better connected.

In my mind there are two special issues which wait to be addressed with the new recent revolution.

1) We need real-time consulting service; every doctor has a dream of being able to connect to their network in the middle of the night to ask for advice with the difficult patient. Or just that damn difficult case in daytime where expert opinion is needed. The current platforms like Twitter and Google+ are worth a try but we need an organized framework to make this happen.

2) We need a centralized database of guidelines/links. As huge amount of high quality text and multimedia about every possible clinical scenario occuring in the emergency department is being published online, it's getting painstakingly difficult to know where to look for what. Even with Google custom search as the amount of results are just growing.
We need all this in one place, categorized, tagged and easily searchable with not only text but photos, videos and links to articles or blogposts for further reading. Such a big project needs joint effort from lots of emergency physicians and should therefor be collaboratively edited, supervised by selected individuals to ensure maximum quality.

Actually LITFL has already begun some of this work with their amazing databases of cases, blogs, podcasts and what ever you can think of but (I hate to say but about LITFL!) I think we still need a A-Z page for each of the clinical scenarios we have in the ED with text, multimedia and links.

Emergency physicians have already shown they are geeky and smart with IT tools. I think we ought to make this a pioneer, exemplary project, in the hands of many it is an easy task. We have the technology, we have social media to get us connected - we just need it to be started, somehow.

I am all open for discussions and more than willing to help out so if any one out there is thinking the same, feel free to contact me!

More about social media

[Mashable] The infographic history of social media
excellent and detailed history of how it all started...
E-learning in emergency medicine
a detailed description of my top educational resources I use.

Emergency physicians give answer to the question if and how social media has changed their practice.
[Boston.com] As Facebook grows, millions say, 'no, thanks'
It's not just me who thinks Facebook is overwhelming!
The birth of Steve Smith's ECG blog and The birth of the Ultrasound podcast
two great stories of how a blog/podcast is started and what it has given done for their authors.
Doctor reprimanded after patient privacy breached on Facebook
There are two sides of the story, interesting discussion also in the comments.
Distilling the essence of medicine using Twitter
A rheumatologist describes how he uses Twitter to stay learn more from conferences.

Why Google+ is better than Facebook as a professional social media platform

So many social media platforms, so many decisions...
From the battle of social media platforms have come three giants we all know; Twitter, Facebook and Google+, all very likely to stay for a while. Twitter, restricting posts to 140 characters, has a different approach and has turned out to be an excellent medium to discover new, interesting information. It's also good for making new contacts but minimal profile information and communication features makes it limited for anything more than that. And thus it isn't even considered to be a competitor to the other two giants, Facebook and Google+.

Many have said that Google+ is nice but it isn't making the expected impact and I see most my colleagues ignoring Google+ because it lacks the critical mass of users to have any power. I think this is a pity since Google+ has some powerful tools and features and in my opinion is a much better network for professional networking, unlike Facebook which still today has reminders of it's roots in a network for college students. As I learn more about Google+ I find my self leaning more and more towards it and actually stepping away from Facebook as it is becoming just too much nonsense. Let me explain why.

Google+ enters the scene and breaks records
Facebook has been around for years while Google+ is the new kid on the block but it has Google's enormous back-end with complimentary IT tools- and services not to be undermined. Integrated with Gmail, Picasa and Google Docs (now Google Drive) amongst others it is so much more than just another social media platform and has many tools to be more than an entertainment platform. This along with excitement, as people were eager to see Google's implementation of a social media network, made Google+ welcomed as it was launched in July 2011. Records were broken in just a few days as users flocked in to try it out but the sunshine story faded as most users didn't return. What else was there to expect, it was like coming to a banquet full of food but with only a few attending. Google+ newbies got lonely.


Facebook is not a professional playground
Facebook was started as an online network for college students. Nobody could have foreseen the tremendous growth Facebook was to go through in the coming years but this growth spurt has also turned out to be Facebook's Achilles heel. As a network for college students, privacy was never an issue - the kids wanted to see their classmates doing heroic or stupid things and seeing someone dead drunk in a bush on the schoolyard was simply cool. Posts were open to everyone and as Facebook opened to the rest of the world this non-privacy approach lived on until new users started crying out, asking for fixes. Major issues were plastered and privacy settings introduced but too complicated for users to grasp. Still today, the average user has no idea how much of his or her posts are visible to other contacts or even rest of the world through the search engines. The fact remains; on Facebook, you mostly read everything from everyone. Not only is it a privacy concern but also you are easily overwhelmed by useless information like 'Joe just ate a meatball yesterday' and 'Jane Liked it'. A little like a kids playground if you ask me.

Google's approach: Circles
Google+ Circles
This is not the kind of media I want as my professional platform (nor for private purposes!) and Google was smart as they recognized the problem and came up with a solution: Circles. For each friend (contact) you add on your Google+ account, you define what circles your friend should belong to. A little extra work compared to Facebook's way of just adding a friend, but this way yields a high ROI (return of investment) as you, through your Circles, define not only who can read your posts but also what you want to read on your wall (called Stream in Google+). So when I want feedback from my emergency medicine colleagues I will post that post only to that circle and if it's personal family photos my colleagues will not have to read that. It is very important you understand this is not only a major leap for privacy but also a way to have your wall fed only with what you are interested in, you will not read about your friends Like-ing the meatballs somebody else ate.

To Facebook's defence, they have actually added the 'Lists' feature to try to achieve the same results and even a mute button for individuals - but these were introduced too late. Nobody has time or energy to go through their hundreds of contacts and group each and everyone to a list. Google+ does this right from the beginning and even does it with an intuitive and graphical drag 'n drop interface to make the task of circling friends an easy one to do, almost fun even.

Hashtags for discovery
Social media is a great tool for discovering new content, you can do that either by watching posts from your contacts or follow a particular channel. The hashtag (#) is a simple technology for the latter; using #emergencymedicine as a search pattern on Twitter or Google+ will show you in real-time what people or posting, relating one way or the other to emergency medicine.

Notice the 'Sparks' on the top for easily selecting
your channel
You can also save hashtag searches (Google+ calles these Sparks) for fast access later (your saved searches also affect what is displayed on your main Steam ('wall'). This is yet another feature to minimize the clutter you are confronted with on your wall (said a little rougher; cut the bullshit) as you can easily select what 'channel' you want to read from. So when I don't feel in the mood to be fed with random clutter I click the Emergency Medicine Doctors and read only posts from these. Or I click #Linux and read only what's going on in the Linux world. It's a feature you will love once you've met!

Facebook lacks this feature and actually returns a rather awkward, cluttered list of search results if you search 'emergency medicine' without the hashtag. Google+ returns a more intuitive list of results and even attempts to prioritize them to fit your interests.


Google Hangouts for easy video-conferences
In 2011 a few lucky ones got to speak directly with
Barack Obama using Google+ Hangout
 
Many have tried to provide for a decent interface for video-conferencing and most have failed, succumbed to technical challenges or just lack of users (in todays competitive climate you literally have to give gold to attract users). With Google+ the Hangout was introduced as a easy and quick way to start a video conversation with up to 10 users simultaneously. This is a tool companies would have paid thousands of dollars for only few years ago and is now available for free.
Add to this how easy it is to discover and contact interesting people on Google+ and you should realize the potential. Online discussion panels or debates about hot topics in emergency medicine... and you can participate from your living room - how awesome is that!

Other minuscules I like about Google+
  • Google+ integrates very nicely with the mothership, Google's search engine, for smooth and easy publicity of your posts on the Internet (if you wish so). Defining posts as public or confined only to your selected circles is very intuitive and hard to do wrong. Facebook has had years of criticism for this as the settings were introduced late and are cumbersome to use. 
  • Your posts can not only be deleted if you regret but also edited, something that Facebook amazingly doesn't allow.
  • Google+ is tightly integrated with Picasa, Google's excellent photo & album manager. With Google+ you can instantly edit and arrange your photos stored on Picasa and those you add through Google+ are instantly accessible through Picasa. With the Android app (I don't know about the iOS or Win versions, anyone?) you can ask for all photos to be automatically uploaded to your Google+/Picasa account, sparing you the hassle of plugging the phone to a computer to get your photos. 
  • On Google+ you don't get the feeling that you are a puppet being used to create treasure for money makers in the market. Advertising is minimal and I don't expect Google+ to disgust me with the idea of asking for money for prioritized status updates as Facebook has just introduced.
  • Finally, this is what had me come back repeatedly to Google+ for good laughs and inspirations: animated GIFs. Just try the #GIF channel for yourself, be warned - you are going to have a hard time stepping away from your computer!
Animated GIFs make life beautiful!



Further reading
Google+ is better than Facebook - and this is coming from PC Magazine, a journal that usually promises Microsoft products above all
Graphical Google+ features intro
Great introduction to the major features of Google+
Quick guide to Google+ basics (aka Help / Welcome Kit)
From Google+ users to newbie Google+ users!
This Is Why You Fail At Google Plus
A popular and well written article for Google+ newbies wanting to learn from others' mistakes.
The difference between Facebook and Google+
Facebook helps you keep in touch with the people you already know, Google+ helps you get in touch with the people you want to know.

Why Google+ is better than Facebook as a professional social media platform

So many social media platforms, so many decisions...
From the battle of social media platforms have come three giants we all know; Twitter, Facebook and Google+, all very likely to stay for a while. Twitter, restricting posts to 140 characters, has a different approach and has turned out to be an excellent medium to discover new, interesting information. It's also good for making new contacts but minimal profile information and communication features makes it limited for anything more than that. And thus it isn't even considered to be a competitor to the other two giants, Facebook and Google+.

Many have said that Google+ is nice but it isn't making the expected impact and I see most my colleagues ignoring Google+ because it lacks the critical mass of users to have any power. I think this is a pity since Google+ has some powerful tools and features and in my opinion is a much better network for professional networking, unlike Facebook which still today has reminders of it's roots in a network for college students. As I learn more about Google+ I find my self leaning more and more towards it and actually stepping away from Facebook as it is becoming just too much nonsense. Let me explain why.

Google+ enters the scene and breaks records
Facebook has been around for years while Google+ is the new kid on the block but it has Google's enormous back-end with complimentary IT tools- and services not to be undermined. Integrated with Gmail, Picasa and Google Docs (now Google Drive) amongst others it is so much more than just another social media platform and has many tools to be more than an entertainment platform. This along with excitement, as people were eager to see Google's implementation of a social media network, made Google+ welcomed as it was launched in July 2011. Records were broken in just a few days as users flocked in to try it out but the sunshine story faded as most users didn't return. What else was there to expect, it was like coming to a banquet full of food but with only a few attending. Google+ newbies got lonely.


Facebook is not a professional playground
Facebook was started as an online network for college students. Nobody could have foreseen the tremendous growth Facebook was to go through in the coming years but this growth spurt has also turned out to be Facebook's Achilles heel. As a network for college students, privacy was never an issue - the kids wanted to see their classmates doing heroic or stupid things and seeing someone dead drunk in a bush on the schoolyard was simply cool. Posts were open to everyone and as Facebook opened to the rest of the world this non-privacy approach lived on until new users started crying out, asking for fixes. Major issues were plastered and privacy settings introduced but too complicated for users to grasp. Still today, the average user has no idea how much of his or her posts are visible to other contacts or even rest of the world through the search engines. The fact remains; on Facebook, you mostly read everything from everyone. Not only is it a privacy concern but also you are easily overwhelmed by useless information like 'Joe just ate a meatball yesterday' and 'Jane Liked it'. A little like a kids playground if you ask me.

Google's approach: Circles
Google+ Circles
This is not the kind of media I want as my professional platform (nor for private purposes!) and Google was smart as they recognized the problem and came up with a solution: Circles. For each friend (contact) you add on your Google+ account, you define what circles your friend should belong to. A little extra work compared to Facebook's way of just adding a friend, but this way yields a high ROI (return of investment) as you, through your Circles, define not only who can read your posts but also what you want to read on your wall (called Stream in Google+). So when I want feedback from my emergency medicine colleagues I will post that post only to that circle and if it's personal family photos my colleagues will not have to read that. It is very important you understand this is not only a major leap for privacy but also a way to have your wall fed only with what you are interested in, you will not read about your friends Like-ing the meatballs somebody else ate.

To Facebook's defence, they have actually added the 'Lists' feature to try to achieve the same results and even a mute button for individuals - but these were introduced too late. Nobody has time or energy to go through their hundreds of contacts and group each and everyone to a list. Google+ does this right from the beginning and even does it with an intuitive and graphical drag 'n drop interface to make the task of circling friends an easy one to do, almost fun even.

Hashtags for discovery
Social media is a great tool for discovering new content, you can do that either by watching posts from your contacts or follow a particular channel. The hashtag (#) is a simple technology for the latter; using #emergencymedicine as a search pattern on Twitter or Google+ will show you in real-time what people or posting, relating one way or the other to emergency medicine.

Notice the 'Sparks' on the top for easily selecting
your channel
You can also save hashtag searches (Google+ calles these Sparks) for fast access later (your saved searches also affect what is displayed on your main Steam ('wall'). This is yet another feature to minimize the clutter you are confronted with on your wall (said a little rougher; cut the bullshit) as you can easily select what 'channel' you want to read from. So when I don't feel in the mood to be fed with random clutter I click the Emergency Medicine Doctors and read only posts from these. Or I click #Linux and read only what's going on in the Linux world. It's a feature you will love once you've met!

Facebook lacks this feature and actually returns a rather awkward, cluttered list of search results if you search 'emergency medicine' without the hashtag. Google+ returns a more intuitive list of results and even attempts to prioritize them to fit your interests.


Google Hangouts for easy video-conferences
In 2011 a few lucky ones got to speak directly with
Barack Obama using Google+ Hangout
 
Many have tried to provide for a decent interface for video-conferencing and most have failed, succumbed to technical challenges or just lack of users (in todays competitive climate you literally have to give gold to attract users). With Google+ the Hangout was introduced as a easy and quick way to start a video conversation with up to 10 users simultaneously. This is a tool companies would have paid thousands of dollars for only few years ago and is now available for free.
Add to this how easy it is to discover and contact interesting people on Google+ and you should realize the potential. Online discussion panels or debates about hot topics in emergency medicine... and you can participate from your living room - how awesome is that!

Other minuscules I like about Google+
  • Google+ integrates very nicely with the mothership, Google's search engine, for smooth and easy publicity of your posts on the Internet (if you wish so). Defining posts as public or confined only to your selected circles is very intuitive and hard to do wrong. Facebook has had years of criticism for this as the settings were introduced late and are cumbersome to use. 
  • Your posts can not only be deleted if you regret but also edited, something that Facebook amazingly doesn't allow.
  • Google+ is tightly integrated with Picasa, Google's excellent photo & album manager. With Google+ you can instantly edit and arrange your photos stored on Picasa and those you add through Google+ are instantly accessible through Picasa. With the Android app (I don't know about the iOS or Win versions, anyone?) you can ask for all photos to be automatically uploaded to your Google+/Picasa account, sparing you the hassle of plugging the phone to a computer to get your photos. 
  • On Google+ you don't get the feeling that you are a puppet being used to create treasure for money makers in the market. Advertising is minimal and I don't expect Google+ to disgust me with the idea of asking for money for prioritized status updates as Facebook has just introduced.
  • Finally, this is what had me come back repeatedly to Google+ for good laughs and inspirations: animated GIFs. Just try the #GIF channel for yourself, be warned - you are going to have a hard time stepping away from your computer!
Animated GIFs make life beautiful!



Further reading
Google+ is better than Facebook - and this is coming from PC Magazine, a journal that usually promises Microsoft products above all
Graphical Google+ features intro
Great introduction to the major features of Google+
Quick guide to Google+ basics (aka Help / Welcome Kit)
From Google+ users to newbie Google+ users!
This Is Why You Fail At Google Plus
A popular and well written article for Google+ newbies wanting to learn from others' mistakes.
The difference between Facebook and Google+
Facebook helps you keep in touch with the people you already know, Google+ helps you get in touch with the people you want to know.

The cryptic abdominal pain

I really love the thrill of evaluating the patient with abdominal pain of unknown origin. True abdominal pain is a symptom, not just a complaint and an underlying pathology should be sought. Emergency physicians have a critical role in diagnosing what can and should be treated and sending home everything else. They are the gatekeepers and must know uncommon diseases presenting as common symptoms.

I recently had an interesting case of abdominal pain which had valuable take home lessons for the EP, I would like to present it for you to share my learning points.


A 50y/o male who was treated three years ago for non-Hodgkin lymphoma and was cured. He now comes to the ED with two day history of sudden onset, aching pain in left lower quadrant. It was worse when he was lying on his left side. No fever/chills, nausea, diarrhea or other symptoms. Despite pain been able to eat and is not generally sick or affected by his pain.

Patient is worried that this might be his lymphoma coming back since at that time he had a similar diffuse central, upper abdominal pain going on for 5 weeks until he finally had his diagnosis.

On examination the patient has normal vital signs and is afebrile. Abdomen is non-distended, soft on palpation with localized pain about 5x5cm in left lower fossa. No muscle guarding. No palpable tumors. Lab tests all normal (WBC, CRP, hemoglobin, electrolytes, LFTs).

A clever surgeon temporarily working in the ED has a theory and asks for a CT abdomen which reveals this diagnostic image:
Hint: look in LIF!





The radiologist says no pathological lymph nodes in abdomen/pelvis, normal colon with and without contrast but notices "stranding of fat near colon descendens and nearby an enclosed capsule containing fat". Bull's eye for the surgeon: epicloic appendagitis it is indeed.

Patient is sent home on NSAIDs to expect full recovery within 1-2 weeks.


Now this is certainly a rare condition but definitely worth knowing as we are working with abdominal pain all the time in the ED. The patient was indeed very sensitive in exactly that 5x5 area but unaffected otherwise. It was tempting to send him back home but it just didn't make sense, there had to be something explaining his pain. So in the future it will be on my ddx list of unexplained abdominal pain.


Then there was another take home lesson from this particular patient. It turns out he had a long and worrisome period of pain for 5 weeks until he screamed at the doctors to make a CT. And he was right... His epigastric/thoracal pain was at first diagnosed as 'gastritis' (the all too commonly used trashcan for unspecific symptoms!) and treated unsuccessfully with PPIs and later Tramadol. When the patient couldn't sleep any more and caught fever even he comes back and gets a CT which shows a 17x15x12cm big retroperitoneal monster tumor!


So what are the take home lessons?

First of all, we need to suspect lymphoma to find lymphoma. The lymphomas are after all a relatively common disease (about 5% incidence), highly curable but presenting in many different ways. All medical textbooks describe unexplained abdominal/chest pain as one of the presenting symptoms so the lawyers will expect you to know that.

History and clinical examination are as always the cornerstone of diagnosis - nothing new here, just that they are all too commonly ignored. "B-symptoms" (fever, night sweats, weight loss), enlarged lymph nodes >2 weeks duration (be careful with unilaterally enlarged tonsil in children!) and if bone marrow is involved expect hematological symptoms (anemia, infections, bleeding...).

Use your ultrasound! As bedside ultrasound is becoming available in every emergency department there is no excuse of not making a quick look. If you know FAST you know how to localize the liver, spleen, aorta and surrounding area. Of course you are not expected to find deep enlarged lymph nodes but the above mentioned monster tumor would have been hard to miss.

LD/LDH is a cheap labtest worth considering, neither sensitive or specific but abnormal value should raise your eyebrows.


Any tips or thoughts from the readers?

The cryptic abdominal pain

I really love the thrill of evaluating the patient with abdominal pain of unknown origin. True abdominal pain is a symptom, not just a complaint and an underlying pathology should be sought. Emergency physicians have a critical role in diagnosing what can and should be treated and sending home everything else. They are the gatekeepers and must know uncommon diseases presenting as common symptoms.

I recently had an interesting case of abdominal pain which had valuable take home lessons for the EP, I would like to present it for you to share my learning points.


A 50y/o male who was treated three years ago for non-Hodgkin lymphoma and was cured. He now comes to the ED with two day history of sudden onset, aching pain in left lower quadrant. It was worse when he was lying on his left side. No fever/chills, nausea, diarrhea or other symptoms. Despite pain been able to eat and is not generally sick or affected by his pain.

Patient is worried that this might be his lymphoma coming back since at that time he had a similar diffuse central, upper abdominal pain going on for 5 weeks until he finally had his diagnosis.

On examination the patient has normal vital signs and is afebrile. Abdomen is non-distended, soft on palpation with localized pain about 5x5cm in left lower fossa. No muscle guarding. No palpable tumors. Lab tests all normal (WBC, CRP, hemoglobin, electrolytes, LFTs).

A clever surgeon temporarily working in the ED has a theory and asks for a CT abdomen which reveals this diagnostic image:
Hint: look in LIF!





The radiologist says no pathological lymph nodes in abdomen/pelvis, normal colon with and without contrast but notices "stranding of fat near colon descendens and nearby an enclosed capsule containing fat". Bull's eye for the surgeon: epicloic appendagitis it is indeed.

Patient is sent home on NSAIDs to expect full recovery within 1-2 weeks.


Now this is certainly a rare condition but definitely worth knowing as we are working with abdominal pain all the time in the ED. The patient was indeed very sensitive in exactly that 5x5 area but unaffected otherwise. It was tempting to send him back home but it just didn't make sense, there had to be something explaining his pain. So in the future it will be on my ddx list of unexplained abdominal pain.


Then there was another take home lesson from this particular patient. It turns out he had a long and worrisome period of pain for 5 weeks until he screamed at the doctors to make a CT. And he was right... His epigastric/thoracal pain was at first diagnosed as 'gastritis' (the all too commonly used trashcan for unspecific symptoms!) and treated unsuccessfully with PPIs and later Tramadol. When the patient couldn't sleep any more and caught fever even he comes back and gets a CT which shows a 17x15x12cm big retroperitoneal monster tumor!


So what are the take home lessons?

First of all, we need to suspect lymphoma to find lymphoma. The lymphomas are after all a relatively common disease (about 5% incidence), highly curable but presenting in many different ways. All medical textbooks describe unexplained abdominal/chest pain as one of the presenting symptoms so the lawyers will expect you to know that.

History and clinical examination are as always the cornerstone of diagnosis - nothing new here, just that they are all too commonly ignored. "B-symptoms" (fever, night sweats, weight loss), enlarged lymph nodes >2 weeks duration (be careful with unilaterally enlarged tonsil in children!) and if bone marrow is involved expect hematological symptoms (anemia, infections, bleeding...).

Use your ultrasound! As bedside ultrasound is becoming available in every emergency department there is no excuse of not making a quick look. If you know FAST you know how to localize the liver, spleen, aorta and surrounding area. Of course you are not expected to find deep enlarged lymph nodes but the above mentioned monster tumor would have been hard to miss.

LD/LDH is a cheap labtest worth considering, neither sensitive or specific but abnormal value should raise your eyebrows.


Any tips or thoughts from the readers?

Choosing the best technology platform

The Commodore Amiga story is one I like to tell to examplify that even the best technology will sometimes succumb to market (money) power. The Amiga was introduced in 1985 and was at the time a technological breakthrough as it could easily display colorful, animated graphics and play high quality sound while PCs (and even Apple) at that time were black & white and had one single speaker that could only beep. It's operating system was cleverly designed and handled windows and multitasking (like playing music and writing text simultaneously) with a breeze while PCs at that time were playing hangman with you on a green DOS screen. The Amiga was geniously designed by brilliant engineers, incorporating clever and advanced technology so that it was way ahead of it's competitors and thus jaw-dropped everyone who saw it in action, below is one of the first demos showing of Amiga's capabilities




Despite technological advances, the Amiga was elbowed out of the market mostly because the public's attention was where the money was and vice versa, so IBM, Microsoft, Apple and the big giants won with their inferior products.

For me, like many, this was a sentimental battle. Not only did I love my Amiga but I felt the world could gain so much with it's advanced technology. The revolution came finally but only many years later as the PCs finally caught up and the IT boom set off and changed the world as we know it forever. Still today I wonder what had been if the Amiga had had the impact it was designed to have?

Today I feel pretty much in the same way about some technologies being in the shadow of others enjoying the spotlight without really having done so much to deserve it. Now you may say I am arrogant but let me remind you I've been using computers almost since infancy and I've tried many different technologies so that what I use today is the result of many years of trial and error. I have made dramatical u-turns when I feel there is another technology which fulfills my needs better -  like when I switched to Linux after having been a Windows fan for more than 10 years.

For this reason I get irritated when the world seems to believe there is only one gadget existing like Apples' i-products. Physicians are head over heels about iPhones and now iPads but what most of them haven't done is to actually compare them to the alternatives. I have done this and for many reasons (open source software, USB connection, high configurability just to name a few) I prefer Android to iPhone.

The Linux vs Windows one is a no-brainer, Windows is a totally overvalued piece of software that exists today only because of the power of money (you could start with asking yourself why it is so hard to buy a computer without Windows pre-installed). Read my above mentioned blog-post to find out why.

Then there is the Google Apps vs MS Office debate. I was an Office fan too and I found Google Docs to be a lousy product in it's beginnings. But it has advanced a lot and today it is one of the most important IT tools I have and has dramatically changed the way I work and stay organized both as a physician and family man with three children.



The message? Be critical, open-minded and picky about your technologies. Don't just buy a product because the word of the street thinks it is the best. There is no thing such as 'one size fits them all' when it comes to software and gadgets - decide what to purchase based on what your needs are and what you are going to do with it. There are plenty of blogs and IT magazines out there to do some home-learning!

Choosing the best technology platform

The Commodore Amiga story is one I like to tell to examplify that even the best technology will sometimes succumb to market (money) power. The Amiga was introduced in 1985 and was at the time a technological breakthrough as it could easily display colorful, animated graphics and play high quality sound while PCs (and even Apple) at that time were black & white and had one single speaker that could only beep. It's operating system was cleverly designed and handled windows and multitasking (like playing music and writing text simultaneously) with a breeze while PCs at that time were playing hangman with you on a green DOS screen. The Amiga was geniously designed by brilliant engineers, incorporating clever and advanced technology so that it was way ahead of it's competitors and thus jaw-dropped everyone who saw it in action, below is one of the first demos showing of Amiga's capabilities




Despite technological advances, the Amiga was elbowed out of the market mostly because the public's attention was where the money was and vice versa, so IBM, Microsoft, Apple and the big giants won with their inferior products.

For me, like many, this was a sentimental battle. Not only did I love my Amiga but I felt the world could gain so much with it's advanced technology. The revolution came finally but only many years later as the PCs finally caught up and the IT boom set off and changed the world as we know it forever. Still today I wonder what had been if the Amiga had had the impact it was designed to have?

Today I feel pretty much in the same way about some technologies being in the shadow of others enjoying the spotlight without really having done so much to deserve it. Now you may say I am arrogant but let me remind you I've been using computers almost since infancy and I've tried many different technologies so that what I use today is the result of many years of trial and error. I have made dramatical u-turns when I feel there is another technology which fulfills my needs better -  like when I switched to Linux after having been a Windows fan for more than 10 years.

For this reason I get irritated when the world seems to believe there is only one gadget existing like Apples' i-products. Physicians are head over heels about iPhones and now iPads but what most of them haven't done is to actually compare them to the alternatives. I have done this and for many reasons (open source software, USB connection, high configurability just to name a few) I prefer Android to iPhone.

The Linux vs Windows one is a no-brainer, Windows is a totally overvalued piece of software that exists today only because of the power of money (you could start with asking yourself why it is so hard to buy a computer without Windows pre-installed). Read my above mentioned blog-post to find out why.

Then there is the Google Apps vs MS Office debate. I was an Office fan too and I found Google Docs to be a lousy product in it's beginnings. But it has advanced a lot and today it is one of the most important IT tools I have and has dramatically changed the way I work and stay organized both as a physician and family man with three children.



The message? Be critical, open-minded and picky about your technologies. Don't just buy a product because the word of the street thinks it is the best. There is no thing such as 'one size fits them all' when it comes to software and gadgets - decide what to purchase based on what your needs are and what you are going to do with it. There are plenty of blogs and IT magazines out there to do some home-learning!

Lazarus’ sign

Lazarus' sign is one of these signs that you just have to know because it is just so perversely stunning. Basically it is a corticospinal reflex in the brain dead where the patient (or it's body) will flex both arms as if he was grasping after some object or even trying to 'give a hug', scaring the hell out of family members or inexperienced personnel. BTW, Lazarus's sign is *not* the same as decorticate or decerebrate reflex.

Today I heard a story from a college who was doing the apnea test to confirm a patients' brain death and while bending over to auscultate the heart, the patient performed the Lazarus' reflex and seemingly hugged the doctor while showing no other signs of life. Nice!


Lazarus’ sign

Lazarus' sign is one of these signs that you just have to know because it is just so perversely stunning. Basically it is a corticospinal reflex in the brain dead where the patient (or it's body) will flex both arms as if he was grasping after some object or even trying to 'give a hug', scaring the hell out of family members or inexperienced personnel. BTW, Lazarus's sign is *not* the same as decorticate or decerebrate reflex.

Today I heard a story from a college who was doing the apnea test to confirm a patients' brain death and while bending over to auscultate the heart, the patient performed the Lazarus' reflex and seemingly hugged the doctor while showing no other signs of life. Nice!


Backing up your data the modern way, power to the cloud

Caring for your most precious belongings
should not be taken  lightly!
Everyone not living in a cave has sometime lost important data and consequentially had their days of remorse and pulled hairs. Classically, a laptop with years of work is stolen or a hard drive with invaluable personal photo albums crashes unexpectedly. As in the flight industry, human errors are your biggest threat - more than once I have accidentally deleted precious files.

Our data is our life-collection of work and memories and as the days of pen and paper are being replaced by electronic data it is becoming the one most important property to hold account of. As 9/11 showed us, corporations survived huge losses of business documents but there is nothing to replace your years of email correspondence or personal photo albums. Not only is it an emotional loss but it will set you back by months as you try to pick up pace again after losing all your office data. Just the thought of losing my calendar data gives me the chill - loosing track of planned meetings and events for the next week would render me butt-naked!

Backup is no more
The traditional way of backing up data is to copy to other medias such as CDs, DVDs or external hard drives. This is how it all started before the Internet came and cloud-technologies and we were happy just to have a second copy of our data in case of disaster. There are many drawbacks with this old approach such as:

  • No media is safe when put up against time: DVDs and even high quality hard drives have an industry accepted failure rate of 1% meaning that your data will in time corrode.
  • Modern data includes huge media files; high quality photos and videos and we are adding up more files every day. A DVD counts 4,5gbs - barely enough to hold 1.000 high quality photos. USB memory sticks are the modern DVDs and might be safer storage medias but they will also fail on you eventually.
  • External hard drives are growing bigger every year but you want to store them far away from your desktop to ensure maximal security or they could easily take collateral damage if your desktop is hit. It might be a virus, hacker intrusion, water damage, fire... you have to place it far away, preferably at a friends house.
  • As you are every day creating more data you will have to manually grab that hard drive, connect it and backup the new files, a process easily forgotten or just ignored in the long run.
  • Eventually you will edit some old photo or document previously created and suddenly you have obsolete files on your backup hard drive. Unless you have a list of which files are updated since last backup you will have to backup your whole data collection. Or you could use software that does incremental backups but still, you will have to connect your backup drive to make it work. And know the inside and out of your software to be certain no mistakes are done.
The data-cloud is changing it all
There are plenty of problems with traditional backups but one emerging technology has the potential to relief your headache for once and for all... the data cloud. It's about moving your data from your local hard drive to online servers, virtually locked in databases which only you have access to. With the cloud, your data is available wherever you go.

Dropbox is by now know by everyone and is one of the first examples of cloud-computing and replaced many USB memory sticks, symbolizing the old approach of moving data around, between different computers. Dropbox is now loosing ground again and the reason is the lack of an interface to work with the files it stores. The amazing developments of web-technologies (such as HTML5) is moving the power from local to online software, thus the term "web-applications". Google Docs exemplifies this trend; not only can you store whatever document on it's servers but you can also work with the data (e.g. work with 'word' documents or 'powerpoint' presentations) online and even shared with closed or open group of friends and colleges. Combine these features and you have "collaborative editing" where one or many can simultaneously work with the same document in real-time without worrying about multiple versions being emailed back and forth.

I have previously written about the "online office" concept which is based on this development exactly and is the sole reason for my boosted productivity despite much more information to take care of.

So... not only do you need an online host for your data (there are now too many out there to keep count of and new services being born every day) but also you need front-ends to work with your data. One service for your office documents, one for your photos, another for music, yet another for videos... Now that's a lot of accounts and passwords to keep track of and add to that, you will have to have 100% trust in each and every service since they're literally taking care of your electronic life. We need simple solutions, preferably one key to all keyholes. And now the good news: this is indeed possible and that is exactly I am going to teach you in the rest of this post.

If you insist the old way
Only five years ago I would have told you a completely different story since there was no cloud then. I used to have a huge hard drive storing my most precious memories and had a clever software solution to synchronize my backup sets. In the end though, I was totally lost  as some weeks my photo collection would grow by gigabytes and I accepted the fact that relocating my backup-drive between various physical locations  even once a month was an impossible task to do. I tried USB sticks to make it a little easier but it was the same, I gave up. I installed an online Linux server in a safe location in my house and setup automatic and synchronized file transfers but felt highly vulnerable to catastrophes such as theft, fire or water leaks. I had just started considering using a friends' online server and synchronizing backups over FTP connection when Dropbox arrived, the rest you know.

Today, all my important documents are in the cloud and my hard drive is empty besides some downloaded podcasts and vodcasts which are easily replaceable. Going online is a point of no return after which you will sleep free of all worries about loosing your data.

Going online
Now this might be the point were some might be skeptic so I would like to remind you that there are many alternatives out there but through years of experimenting I have found the Google applications to fit my preferences the best, please check my special Google post if you have doubts.

Besides a few special applications (Pixlr and Crocodoc, that's all!) I am using the Google services for all my data. They're free, I trust Google and I am very satisfied with working their applications. The true power lies in having only one account (password) to take care of.

Introducing Google Docs
To most people, Google Docs (GD) is a simple, online document editor with sharing and collaboration functions. The Google Apps have a common 1 gigabyte pool for your data and you can easily add more storage like $5 for 20gb/year (which is cheap, compared to other services).

Uploading my vodcasts to Google Docs
What many do not know is that GD actually allows you to upload whatever document type you wish, be it a 500mb video file, your mp3 collection or zip/rar archive to name a few examples. It literally stores whatever you throw at it (you can even upload a zip file and GD will allow you to browse it just as any folder). If you have Chrome you can even drag your files or folders to Google Docs and it takes care of the rest.

As your heap of files grow by thousands it becomes essential to organize them and GD's tagging features makes this a breeze. You can of course search your collection both from top-level or inside a tag ('folders' are known as 'collections' in GD), this way you can never loose a file in your online data-heap.

My ABG document, shared with colleges.
All can view, some edit too.
Sharing is GD's pride; every file (or collection) can be shared with one or many of your friends or even as a link to the whole Internet if you like. This way I upload my home-videos to a special folder (collection) and then send the link to my family who can either view them from there or download to their own computer (GD allows you to disable downloading if you only want files to be streamed).

Editable documents can not only be viewed but edited and while you share a document you can specify what restrictions each user has. The ABG document is private to the Internet but could also be shared openly so that anyone having the link can view or edit if I decide so.

Now this is technology we are used to these days but what makes GD unique is that the organizing and sharing functions apply to all files (and collections).


For most purposes, uploading through the web-browser is just fine but it doesn't quite meet my wish for synchronizing cloud based files with those stored locally on my hard drive (the Dropbox way). Google's highly anticipated Gdrive, rumored to be out early 2012, will change all this and provide the final functionality needed for a fully equipped online hard-drive.

Despite most software now being available through the Google Apps suite there are still some missing, requiring you to have your files on your computer for locally installed software. Adobe Photoshop and Microsoft Access files are some examples. Except for image/photo editors, online multimedia editors are still in their infancy and need local software. Downloading and uploading files back after edit is cumbersome, expect GDrive to fill this gap.

What GDrive will bring is is currently unknown but for basic backup purposes, Google Docs serves it's purpose quite well. If you wish for extended features and even editing you should consider alternative services and I will now finish this post with specific details on where to store the three multimedia types we commonly work with so that they are not only backed up but also easily viewed and manipulated.

Photos/images
What makes photos unique is that you want to organize them by years, themes and even people. Picasa used to be a standalone service but was bought by Google and as such is part of their application suite. Picasa is both a great local software for working with your photos but also an online front-end, the web-Picasa. Picasa can easily upload your photos to your online storage and smartly processes the uploaded images and always keeps a copy of the original photo file - the essential feature making it a backup tool.

Picasa uses the common, above mentioned, 1GB storage pool but it doesn't count images up to 800x800 pixels or videos <15 minutes in length. If you sign up for Google+ the photo limit goes up to 2048x2048 pixels. This has important implications; if your camera is set to store high quality photos, you will most likely have bigger sized photos and thus meet quota limitations.

My family album now counts about 250 gigabytes after 15 years of photographing digitally and most of the images are bigger than 2048x2048. Despite Google space being cheaper than most competitors I am not sure I am willing to pay $100 annually for the 400gb storage pool required for this massive amount of data even though it is probably the most secure way of keeping my digital memories away from unforeseen catastrophes, even though prices will most likely go down in the future. At least until having the synchronizing feature of GDrive, as a temporary solution, I will stick to old fashioned external hard drive backups here. In the meantime, I keep the newest (not HD backed up) files secure on my Dropbox account.

Finally, I find the web-based Picasa still a little clumsy (as opposed to the local software which is a 5 star product). It has all the features needed but it's user interface really needs to be modernized (it's been the same for years now), it's browsing and folder/collection features are ages behind Google Docs' approach. Until worked on, I am not ready to give all my digital memories to the online Picasa.

For other photos such as my collection of medical photos or saved images I use for my presentations, Picasa is my best friend - every single photo stored online for easy access and share functions.

Now all this is fine but what about advanced photo/image editing? Picasa is very very basic and you will not be able to do any photoshop effects with it. For this, you will either have to manipulate your files locally or you could try out before mentioned Pixlr. This is a gap in my backup plan - the files can only be stored on Google Docs for backup purposes; you will have to download and upload them to work with. Or you could sign up with Pixlr (for free) and use their online service. This should not be a problem unless you are editing your photos every day - in that case I suggest Dropbox and hope for GDrive to come anytime soon.

Videos and films
My video files are made up of home-videos and downloaded teaching modules such as vodcasts. The latter are for viewing purposes only and I like to be able to share them with colleges, perfect for storing in Google Docs.

Home videos are different. They are precious and must not be lost, ever. Also, I would like to be able to work with them locally, making special clips for family or friends. Now many would think that Youtube is an excellent backup service for these but that is a fallacy; Youtube does not keep the original files and you cannot get back your files in their original formats (as with Picasa). Youtube is a sharing service, videos are played as streams. Even more, you are not guaranteed that your uploaded videos will stay forever. Youtube is strict about copyrights and can anytime erase your video if it has any violations (copyright background music might be enough to trigger the deleting machine) and if violated several times might risk your whole account.

This is very important:Youtube is NOT a backup service!! So what to do?

As said above, Picasa accepts video files as well as photos - voila! Even better - you have free unlimited storage for videos <15mins which should suite most of your home videos. Actually, as Picasa works with photos and short-videos in exactly the same way, I treat my home-videos the same. So again, waiting for GDrive and Picasa update but that's where I'm heading!
Finally, Youtube is not all bad. Actually, it is a great service for putting my edited clips online to share with the world. Youtube has some basic editing functions, enough for most of my needs for home-videos.

Music and audio files
All my podcasts and music in one place
First of all, your mp3 (music) collection can easily be stored within Google Music which allows you to store 20.000 music files for free. Not only have I uploaded my music collection but also do I put my downloaded podcasts to Google Music so that I can listen to them from my mobile when I'm out jogging. After putting some work into tagging the podcast files, my collection is now easily browsed by authors, topics, production year etc.
Google Music provides a small software to install on your computer which then takes care of seamlessly uploading your collection.

Currently a podcast subscription feature is very much needed on Google Music (iTunes style), in the meantime I subscribe to them with RSS Reader, download files locally, tag and upload via GM's uploader tool. A little more work but I worth it as my podcast collection is now so easily accessed wherever I go.

Finally - what about passwords?
Passwords are also precious. Even more precious as they are the keys to all our data. Keeping account of all passwords today is a true first world problem, especially now that we need to make them very complicated to defeat hackers and viruses threatening our online presence.

I have some of my less important passwords kept in a well hidden file in Google Docs - making them easily reachable wherever I am logged in or just from my Android phone. For those more important ones there is an excellent app for keeping them in an omnipresent but safe way. Check out my previous post about passwords and the importance of protecting your online data - now that you are uploading your electronic data to the cloud, you absolutely must know how to protect yourself from intrusion!

More on this topic

[Mens Health] Your life, in the clouds
Everyonë's going for the clouds!

Backing up your data the modern way, power to the cloud

Caring for your most precious belongings
should not be taken  lightly!
Everyone not living in a cave has sometime lost important data and consequentially had their days of remorse and pulled hairs. Classically, a laptop with years of work is stolen or a hard drive with invaluable personal photo albums crashes unexpectedly. As in the flight industry, human errors are your biggest threat - more than once I have accidentally deleted precious files.

Our data is our life-collection of work and memories and as the days of pen and paper are being replaced by electronic data it is becoming the one most important property to hold account of. As 9/11 showed us, corporations survived huge losses of business documents but there is nothing to replace your years of email correspondence or personal photo albums. Not only is it an emotional loss but it will set you back by months as you try to pick up pace again after losing all your office data. Just the thought of losing my calendar data gives me the chill - loosing track of planned meetings and events for the next week would render me butt-naked!

Backup is no more
The traditional way of backing up data is to copy to other medias such as CDs, DVDs or external hard drives. This is how it all started before the Internet came and cloud-technologies and we were happy just to have a second copy of our data in case of disaster. There are many drawbacks with this old approach such as:

  • No media is safe when put up against time: DVDs and even high quality hard drives have an industry accepted failure rate of 1% meaning that your data will in time corrode.
  • Modern data includes huge media files; high quality photos and videos and we are adding up more files every day. A DVD counts 4,5gbs - barely enough to hold 1.000 high quality photos. USB memory sticks are the modern DVDs and might be safer storage medias but they will also fail on you eventually.
  • External hard drives are growing bigger every year but you want to store them far away from your desktop to ensure maximal security or they could easily take collateral damage if your desktop is hit. It might be a virus, hacker intrusion, water damage, fire... you have to place it far away, preferably at a friends house.
  • As you are every day creating more data you will have to manually grab that hard drive, connect it and backup the new files, a process easily forgotten or just ignored in the long run.
  • Eventually you will edit some old photo or document previously created and suddenly you have obsolete files on your backup hard drive. Unless you have a list of which files are updated since last backup you will have to backup your whole data collection. Or you could use software that does incremental backups but still, you will have to connect your backup drive to make it work. And know the inside and out of your software to be certain no mistakes are done.
The data-cloud is changing it all
There are plenty of problems with traditional backups but one emerging technology has the potential to relief your headache for once and for all... the data cloud. It's about moving your data from your local hard drive to online servers, virtually locked in databases which only you have access to. With the cloud, your data is available wherever you go.

Dropbox is by now know by everyone and is one of the first examples of cloud-computing and replaced many USB memory sticks, symbolizing the old approach of moving data around, between different computers. Dropbox is now loosing ground again and the reason is the lack of an interface to work with the files it stores. The amazing developments of web-technologies (such as HTML5) is moving the power from local to online software, thus the term "web-applications". Google Docs exemplifies this trend; not only can you store whatever document on it's servers but you can also work with the data (e.g. work with 'word' documents or 'powerpoint' presentations) online and even shared with closed or open group of friends and colleges. Combine these features and you have "collaborative editing" where one or many can simultaneously work with the same document in real-time without worrying about multiple versions being emailed back and forth.

I have previously written about the "online office" concept which is based on this development exactly and is the sole reason for my boosted productivity despite much more information to take care of.

So... not only do you need an online host for your data (there are now too many out there to keep count of and new services being born every day) but also you need front-ends to work with your data. One service for your office documents, one for your photos, another for music, yet another for videos... Now that's a lot of accounts and passwords to keep track of and add to that, you will have to have 100% trust in each and every service since they're literally taking care of your electronic life. We need simple solutions, preferably one key to all keyholes. And now the good news: this is indeed possible and that is exactly I am going to teach you in the rest of this post.

If you insist the old way
Only five years ago I would have told you a completely different story since there was no cloud then. I used to have a huge hard drive storing my most precious memories and had a clever software solution to synchronize my backup sets. In the end though, I was totally lost  as some weeks my photo collection would grow by gigabytes and I accepted the fact that relocating my backup-drive between various physical locations  even once a month was an impossible task to do. I tried USB sticks to make it a little easier but it was the same, I gave up. I installed an online Linux server in a safe location in my house and setup automatic and synchronized file transfers but felt highly vulnerable to catastrophes such as theft, fire or water leaks. I had just started considering using a friends' online server and synchronizing backups over FTP connection when Dropbox arrived, the rest you know.

Today, all my important documents are in the cloud and my hard drive is empty besides some downloaded podcasts and vodcasts which are easily replaceable. Going online is a point of no return after which you will sleep free of all worries about loosing your data.

Going online
Now this might be the point were some might be skeptic so I would like to remind you that there are many alternatives out there but through years of experimenting I have found the Google applications to fit my preferences the best, please check my special Google post if you have doubts.

Besides a few special applications (Pixlr and Crocodoc, that's all!) I am using the Google services for all my data. They're free, I trust Google and I am very satisfied with working their applications. The true power lies in having only one account (password) to take care of.

Introducing Google Docs
To most people, Google Docs (GD) is a simple, online document editor with sharing and collaboration functions. The Google Apps have a common 1 gigabyte pool for your data and you can easily add more storage like $5 for 20gb/year (which is cheap, compared to other services).

Uploading my vodcasts to Google Docs
What many do not know is that GD actually allows you to upload whatever document type you wish, be it a 500mb video file, your mp3 collection or zip/rar archive to name a few examples. It literally stores whatever you throw at it (you can even upload a zip file and GD will allow you to browse it just as any folder). If you have Chrome you can even drag your files or folders to Google Docs and it takes care of the rest.

As your heap of files grow by thousands it becomes essential to organize them and GD's tagging features makes this a breeze. You can of course search your collection both from top-level or inside a tag ('folders' are known as 'collections' in GD), this way you can never loose a file in your online data-heap.

My ABG document, shared with colleges.
All can view, some edit too.
Sharing is GD's pride; every file (or collection) can be shared with one or many of your friends or even as a link to the whole Internet if you like. This way I upload my home-videos to a special folder (collection) and then send the link to my family who can either view them from there or download to their own computer (GD allows you to disable downloading if you only want files to be streamed).

Editable documents can not only be viewed but edited and while you share a document you can specify what restrictions each user has. The ABG document is private to the Internet but could also be shared openly so that anyone having the link can view or edit if I decide so.

Now this is technology we are used to these days but what makes GD unique is that the organizing and sharing functions apply to all files (and collections).


For most purposes, uploading through the web-browser is just fine but it doesn't quite meet my wish for synchronizing cloud based files with those stored locally on my hard drive (the Dropbox way). Google's highly anticipated Gdrive, rumored to be out early 2012, will change all this and provide the final functionality needed for a fully equipped online hard-drive.

Despite most software now being available through the Google Apps suite there are still some missing, requiring you to have your files on your computer for locally installed software. Adobe Photoshop and Microsoft Access files are some examples. Except for image/photo editors, online multimedia editors are still in their infancy and need local software. Downloading and uploading files back after edit is cumbersome, expect GDrive to fill this gap.

What GDrive will bring is is currently unknown but for basic backup purposes, Google Docs serves it's purpose quite well. If you wish for extended features and even editing you should consider alternative services and I will now finish this post with specific details on where to store the three multimedia types we commonly work with so that they are not only backed up but also easily viewed and manipulated.

Photos/images
What makes photos unique is that you want to organize them by years, themes and even people. Picasa used to be a standalone service but was bought by Google and as such is part of their application suite. Picasa is both a great local software for working with your photos but also an online front-end, the web-Picasa. Picasa can easily upload your photos to your online storage and smartly processes the uploaded images and always keeps a copy of the original photo file - the essential feature making it a backup tool.

Picasa uses the common, above mentioned, 1GB storage pool but it doesn't count images up to 800x800 pixels or videos <15 minutes in length. If you sign up for Google+ the photo limit goes up to 2048x2048 pixels. This has important implications; if your camera is set to store high quality photos, you will most likely have bigger sized photos and thus meet quota limitations.

My family album now counts about 250 gigabytes after 15 years of photographing digitally and most of the images are bigger than 2048x2048. Despite Google space being cheaper than most competitors I am not sure I am willing to pay $100 annually for the 400gb storage pool required for this massive amount of data even though it is probably the most secure way of keeping my digital memories away from unforeseen catastrophes, even though prices will most likely go down in the future. At least until having the synchronizing feature of GDrive, as a temporary solution, I will stick to old fashioned external hard drive backups here. In the meantime, I keep the newest (not HD backed up) files secure on my Dropbox account.

Finally, I find the web-based Picasa still a little clumsy (as opposed to the local software which is a 5 star product). It has all the features needed but it's user interface really needs to be modernized (it's been the same for years now), it's browsing and folder/collection features are ages behind Google Docs' approach. Until worked on, I am not ready to give all my digital memories to the online Picasa.

For other photos such as my collection of medical photos or saved images I use for my presentations, Picasa is my best friend - every single photo stored online for easy access and share functions.

Now all this is fine but what about advanced photo/image editing? Picasa is very very basic and you will not be able to do any photoshop effects with it. For this, you will either have to manipulate your files locally or you could try out before mentioned Pixlr. This is a gap in my backup plan - the files can only be stored on Google Docs for backup purposes; you will have to download and upload them to work with. Or you could sign up with Pixlr (for free) and use their online service. This should not be a problem unless you are editing your photos every day - in that case I suggest Dropbox and hope for GDrive to come anytime soon.

Videos and films
My video files are made up of home-videos and downloaded teaching modules such as vodcasts. The latter are for viewing purposes only and I like to be able to share them with colleges, perfect for storing in Google Docs.

Home videos are different. They are precious and must not be lost, ever. Also, I would like to be able to work with them locally, making special clips for family or friends. Now many would think that Youtube is an excellent backup service for these but that is a fallacy; Youtube does not keep the original files and you cannot get back your files in their original formats (as with Picasa). Youtube is a sharing service, videos are played as streams. Even more, you are not guaranteed that your uploaded videos will stay forever. Youtube is strict about copyrights and can anytime erase your video if it has any violations (copyright background music might be enough to trigger the deleting machine) and if violated several times might risk your whole account.

This is very important:Youtube is NOT a backup service!! So what to do?

As said above, Picasa accepts video files as well as photos - voila! Even better - you have free unlimited storage for videos <15mins which should suite most of your home videos. Actually, as Picasa works with photos and short-videos in exactly the same way, I treat my home-videos the same. So again, waiting for GDrive and Picasa update but that's where I'm heading!
Finally, Youtube is not all bad. Actually, it is a great service for putting my edited clips online to share with the world. Youtube has some basic editing functions, enough for most of my needs for home-videos.

Music and audio files
All my podcasts and music in one place
First of all, your mp3 (music) collection can easily be stored within Google Music which allows you to store 20.000 music files for free. Not only have I uploaded my music collection but also do I put my downloaded podcasts to Google Music so that I can listen to them from my mobile when I'm out jogging. After putting some work into tagging the podcast files, my collection is now easily browsed by authors, topics, production year etc.
Google Music provides a small software to install on your computer which then takes care of seamlessly uploading your collection.

Currently a podcast subscription feature is very much needed on Google Music (iTunes style), in the meantime I subscribe to them with RSS Reader, download files locally, tag and upload via GM's uploader tool. A little more work but I worth it as my podcast collection is now so easily accessed wherever I go.

Finally - what about passwords?
Passwords are also precious. Even more precious as they are the keys to all our data. Keeping account of all passwords today is a true first world problem, especially now that we need to make them very complicated to defeat hackers and viruses threatening our online presence.

I have some of my less important passwords kept in a well hidden file in Google Docs - making them easily reachable wherever I am logged in or just from my Android phone. For those more important ones there is an excellent app for keeping them in an omnipresent but safe way. Check out my previous post about passwords and the importance of protecting your online data - now that you are uploading your electronic data to the cloud, you absolutely must know how to protect yourself from intrusion!

More on this topic

[Mens Health] Your life, in the clouds
Everyonë's going for the clouds!

Windows vs Linux story

You have been warned, although mostly emergency medicine related, my blog is also about IT. To the heart of my IT experience is converting from Windows to Linux, the best decision I have ever made.

I like collecting stories about why this is good. I've just read an interesting article from PC World where IT geek Tony in 30 days tries out one of the Linux flagships: Ubuntu. I will not go into his incomprehensible approach of installing inside Windows and expecting to get a Linux clone which completely defeats the purpose of his experiment... But reading through the comments has revealed to me some very good Windows to Linux conversion success stories and learning points which I'd like to collect here.

Take home point: "... but the point should be clear. Microsoft effectively owns your Windows computer, while you own your Linux computer."




ricegf Mon Jun 06 06:55:52 PDT 2011
"@blamblam: What are some concrete examples of things that you cannot do with a Windows computer that you can do with a Linux machine

Excellent question. Though I'm not the original poster, I'm a libre software advocate based on hard-won experience, so I appreciate the opportunity to point out some practical implications for free vs proprietary software. I'll do so with first-hand anecdotes, and leave you to draw general conclusions.

I helped Mike (a friend), whose hard drive had crashed, to install a new one. When we reloaded Windows, the software refused to accept the 40 character authentication code (a pain not inflicted on Linux folk), deeming it invalid. We spent 30 minutes on the phone with 3 different people at Microsoft while they decided if we would be permitted to use the software he'd bought or would be required to purchase a new copy, since his machine might be considered "new" because of the replaced hard drive - the End User License Agreement (EULA) didn't define "new", leaving its interpretation at their discretion. In the end we were "permitted" to use the product for which he'd paid (via a new 40-character code), but this was the wake up call that caused me to begin my Linux transition.

I've received two physical letters from the Business Software Alliance (BSA) asserting their right to enter my home and "audit" our personal computers at their convenience to see if any of my applications are improperly licensed. They claim their members' EULAs grant them this right (the specific EULAs are not identified). I would certainly deny them access to my Linux computers, however, since they run no EULA-impaired software at all (the Gnu GPL is not a EULA).

I helped my daughter build a desktop, and purchased a retail copy of Windows XP so she could run certain games. After it was overrun by malware, we reloaded from CD - but the authentication code was rejected as "pirated". Unable to convince Microsoft that we'd purchased an original CD, unable to obtain a refund for an "opened product", and unwilling to continue buying new copies for the same hardware, we acquired a copy via different means to get the machine operating again (though it won't accept any non-security updates).

I have more stories, but the point should be clear. Microsoft effectively owns your Windows computer, while you own your Linux computer.

From another perspective, I'm able to upgrade any of my computers to the latest or any older version of Ubuntu, Fedora, Mint et. al. at any time, to share any of these systems and all of my apps freely with friends, and to run as many copies as I like in my virtual machine system (Windows most common EULA limits use to 3 copies total on the same hardware). I can run and publish benchmarks and comparisons (which was prohibited by Microsoft's EULA last time I checked). I also have confidence that the software isn't siphoning off information without my knowledge: I haven't checked personally, but independent people that I trust have - and have found that some proprietary software (not Windows) does indeed send personal info back to corporate headquarters without the user's knowledge or consent (instances occasionally pop up in the trade press, in case you follow it).

From a practical perspective, I've found Linux software to be generally better than Windows for my needs. New versions of Microsoft Office, for example, often require reformatting of complex documents while OpenOffice.org (which uses an ISO-standard file format) does not. Of course, we can (and do) use the same software on the Windows computers in the house, which illustrates another advantage of libre software - it typically has been ported to all systems! You can even find mainstream libre software on quite obscure systems such as Haiku and Plan 9, while many proprietary Windows apps won't even run on a Mac.

Speaking of apps, installation and maintenance (which is centralized through an "app store") is certainly far better under Ubuntu than any competitor I've tried (except perhaps the late unlamented Lindows) - Microsoft plans to address this at last with an app store for Windows 8. The Linux system is also far more useful out of the box (which you concede), and obviously is far less expensive to set up from a licensing perspective.

The biggest practical barriers to a Linux transition are for Photoshop users, those dependent on certain Windows-only vertical market apps, and for those with a large investment in DRMd media (Linux generally doesn't support DRM, since given source code DRM is trivial to defeat - though no DRM system has survived very long in the wild even on Windows).

Overall, my personal experience with proprietary software has been quite negative, because power corrupts and the BSA members seek near-absolute power over their customer's computing devices as the above anecdotes illustrate. My experience with libre software has been uniformly and overwhelmingly positive, and I'm far more productive - and certainly more free - than I was on Windows.

I speak only for me, your mileage may vary, but I hope this gives you some food for thought.



JoeAnotems5445 Wed Jun 29 05:53:34 PDT 2011
"The author missed the most important thing. With Ubuntu or Linux Mint, you don't use AV and you don't get infected. Microsoft gets infected with viruses, botnets and has many other security issues. Microsoft Windows cannot operate without AV, ever. Microsoft never had secure source code, and with millions of lines, it's unlikely they will go back and fix it. Linux has open source (freely available to anyone) source code and security is designed into every line. It's been that way since version 1 in 1991. Android is Linux.

I've used Linux for over 8 years without any AV and with absolutely no infections. Linux Mint is based on Ubuntu but has many extra codecs for playing Microsoft media and playing and recording DVD's - right after the install.

I've never seen the problems with arrogance from Linux users on the help posts the author mentions. If he is a Microsoft user, he is probably not familiar with the terminal commands that are commonly used when someone is trying to help. These commands have to be typed in exactly as described or they will not work. It can be frustrating and overpowering to a new user.

Also, Microsoft enjoys a large market share that has been developed over the years, even through some monopolistic practices.

Linux was never meant to be a copy cat of Windows. The authors' approach is to treat it like a Windows wanna-be. Remember, almost all Microsoft programs use a proprietary function called Active-X or Direct-X. Over the years, this has been responsible for a tremendous amount of security issues. Linux does not use Active-X. Neither does Firefox or Google Chrome. That's why they are becoming so popular, people are getting increased security using them with Windows instead of Internet Explorer.

Linux Mint is the #2 Linux OS in popularity. It's absolutely fantastic. I'm using the 64-bit version on a dual core HP with 2GB of ram. I have an ATI 2GB graphics card with a custom ATI driver meant for Linux. I use FireFox4 and Google Chrome 64-bit, both with Ad-Block Plus. I installed Google Earth, Google Picasa, TrueCrypt, FileZilla, K2B CD-DVD burner, Scribus publishing, Google DNS, Youtube-dl among others. Also, Mint comes with LibreOffice office suite that parallels Word, Excel, Access, and PowerPoint. It also comes with Gimp, which is a multi-layer photo editing program similar to Photoshop.

There are over 33,000 free applications that can be installed from a repository with a couple of clicks using the Software Manager. All you have to do is Google for the Linux equivalent of the Microsoft program you want, and you can usually find it. For example if you Google Microsoft Publisher, you get Scribus and Lynx, which can be installed for free.

For me, Linux installs in about 8 minutes with no product keys, WGA or DRM to contend with. I can't even imagine my family or I going back to any MS product. If you are a Windows user dealing with one or two computers, AV and infections seem to be manageable. If you're responsible for 20 or 30 computers, Linux requires virtually no maintenance and gives you your life back."



@AndreCostaubn:
"Windows is a lot harder to install than Ubuntu. People usually don't care because it's preloaded on new computers (as well as bloatware).

I have to remove all the viruses/trojans from my Mom's windows computer everytime I go visit my family. I installed Ubuntu on her laptop so that she stops complaining about it being slow. She was doing fine after that.

Windows doesn't just work, or else I'd be still using it."

Windows vs Linux story

You have been warned, although mostly emergency medicine related, my blog is also about IT. To the heart of my IT experience is converting from Windows to Linux, the best decision I have ever made.

I like collecting stories about why this is good. I've just read an interesting article from PC World where IT geek Tony in 30 days tries out one of the Linux flagships: Ubuntu. I will not go into his incomprehensible approach of installing inside Windows and expecting to get a Linux clone which completely defeats the purpose of his experiment... But reading through the comments has revealed to me some very good Windows to Linux conversion success stories and learning points which I'd like to collect here.

Take home point: "... but the point should be clear. Microsoft effectively owns your Windows computer, while you own your Linux computer."




ricegf Mon Jun 06 06:55:52 PDT 2011
"@blamblam: What are some concrete examples of things that you cannot do with a Windows computer that you can do with a Linux machine

Excellent question. Though I'm not the original poster, I'm a libre software advocate based on hard-won experience, so I appreciate the opportunity to point out some practical implications for free vs proprietary software. I'll do so with first-hand anecdotes, and leave you to draw general conclusions.

I helped Mike (a friend), whose hard drive had crashed, to install a new one. When we reloaded Windows, the software refused to accept the 40 character authentication code (a pain not inflicted on Linux folk), deeming it invalid. We spent 30 minutes on the phone with 3 different people at Microsoft while they decided if we would be permitted to use the software he'd bought or would be required to purchase a new copy, since his machine might be considered "new" because of the replaced hard drive - the End User License Agreement (EULA) didn't define "new", leaving its interpretation at their discretion. In the end we were "permitted" to use the product for which he'd paid (via a new 40-character code), but this was the wake up call that caused me to begin my Linux transition.

I've received two physical letters from the Business Software Alliance (BSA) asserting their right to enter my home and "audit" our personal computers at their convenience to see if any of my applications are improperly licensed. They claim their members' EULAs grant them this right (the specific EULAs are not identified). I would certainly deny them access to my Linux computers, however, since they run no EULA-impaired software at all (the Gnu GPL is not a EULA).

I helped my daughter build a desktop, and purchased a retail copy of Windows XP so she could run certain games. After it was overrun by malware, we reloaded from CD - but the authentication code was rejected as "pirated". Unable to convince Microsoft that we'd purchased an original CD, unable to obtain a refund for an "opened product", and unwilling to continue buying new copies for the same hardware, we acquired a copy via different means to get the machine operating again (though it won't accept any non-security updates).

I have more stories, but the point should be clear. Microsoft effectively owns your Windows computer, while you own your Linux computer.

From another perspective, I'm able to upgrade any of my computers to the latest or any older version of Ubuntu, Fedora, Mint et. al. at any time, to share any of these systems and all of my apps freely with friends, and to run as many copies as I like in my virtual machine system (Windows most common EULA limits use to 3 copies total on the same hardware). I can run and publish benchmarks and comparisons (which was prohibited by Microsoft's EULA last time I checked). I also have confidence that the software isn't siphoning off information without my knowledge: I haven't checked personally, but independent people that I trust have - and have found that some proprietary software (not Windows) does indeed send personal info back to corporate headquarters without the user's knowledge or consent (instances occasionally pop up in the trade press, in case you follow it).

From a practical perspective, I've found Linux software to be generally better than Windows for my needs. New versions of Microsoft Office, for example, often require reformatting of complex documents while OpenOffice.org (which uses an ISO-standard file format) does not. Of course, we can (and do) use the same software on the Windows computers in the house, which illustrates another advantage of libre software - it typically has been ported to all systems! You can even find mainstream libre software on quite obscure systems such as Haiku and Plan 9, while many proprietary Windows apps won't even run on a Mac.

Speaking of apps, installation and maintenance (which is centralized through an "app store") is certainly far better under Ubuntu than any competitor I've tried (except perhaps the late unlamented Lindows) - Microsoft plans to address this at last with an app store for Windows 8. The Linux system is also far more useful out of the box (which you concede), and obviously is far less expensive to set up from a licensing perspective.

The biggest practical barriers to a Linux transition are for Photoshop users, those dependent on certain Windows-only vertical market apps, and for those with a large investment in DRMd media (Linux generally doesn't support DRM, since given source code DRM is trivial to defeat - though no DRM system has survived very long in the wild even on Windows).

Overall, my personal experience with proprietary software has been quite negative, because power corrupts and the BSA members seek near-absolute power over their customer's computing devices as the above anecdotes illustrate. My experience with libre software has been uniformly and overwhelmingly positive, and I'm far more productive - and certainly more free - than I was on Windows.

I speak only for me, your mileage may vary, but I hope this gives you some food for thought.



JoeAnotems5445 Wed Jun 29 05:53:34 PDT 2011
"The author missed the most important thing. With Ubuntu or Linux Mint, you don't use AV and you don't get infected. Microsoft gets infected with viruses, botnets and has many other security issues. Microsoft Windows cannot operate without AV, ever. Microsoft never had secure source code, and with millions of lines, it's unlikely they will go back and fix it. Linux has open source (freely available to anyone) source code and security is designed into every line. It's been that way since version 1 in 1991. Android is Linux.

I've used Linux for over 8 years without any AV and with absolutely no infections. Linux Mint is based on Ubuntu but has many extra codecs for playing Microsoft media and playing and recording DVD's - right after the install.

I've never seen the problems with arrogance from Linux users on the help posts the author mentions. If he is a Microsoft user, he is probably not familiar with the terminal commands that are commonly used when someone is trying to help. These commands have to be typed in exactly as described or they will not work. It can be frustrating and overpowering to a new user.

Also, Microsoft enjoys a large market share that has been developed over the years, even through some monopolistic practices.

Linux was never meant to be a copy cat of Windows. The authors' approach is to treat it like a Windows wanna-be. Remember, almost all Microsoft programs use a proprietary function called Active-X or Direct-X. Over the years, this has been responsible for a tremendous amount of security issues. Linux does not use Active-X. Neither does Firefox or Google Chrome. That's why they are becoming so popular, people are getting increased security using them with Windows instead of Internet Explorer.

Linux Mint is the #2 Linux OS in popularity. It's absolutely fantastic. I'm using the 64-bit version on a dual core HP with 2GB of ram. I have an ATI 2GB graphics card with a custom ATI driver meant for Linux. I use FireFox4 and Google Chrome 64-bit, both with Ad-Block Plus. I installed Google Earth, Google Picasa, TrueCrypt, FileZilla, K2B CD-DVD burner, Scribus publishing, Google DNS, Youtube-dl among others. Also, Mint comes with LibreOffice office suite that parallels Word, Excel, Access, and PowerPoint. It also comes with Gimp, which is a multi-layer photo editing program similar to Photoshop.

There are over 33,000 free applications that can be installed from a repository with a couple of clicks using the Software Manager. All you have to do is Google for the Linux equivalent of the Microsoft program you want, and you can usually find it. For example if you Google Microsoft Publisher, you get Scribus and Lynx, which can be installed for free.

For me, Linux installs in about 8 minutes with no product keys, WGA or DRM to contend with. I can't even imagine my family or I going back to any MS product. If you are a Windows user dealing with one or two computers, AV and infections seem to be manageable. If you're responsible for 20 or 30 computers, Linux requires virtually no maintenance and gives you your life back."



@AndreCostaubn:
"Windows is a lot harder to install than Ubuntu. People usually don't care because it's preloaded on new computers (as well as bloatware).

I have to remove all the viruses/trojans from my Mom's windows computer everytime I go visit my family. I installed Ubuntu on her laptop so that she stops complaining about it being slow. She was doing fine after that.

Windows doesn't just work, or else I'd be still using it."

Gotta love these keyboard shortcuts – speed through Google search

I love fance keyboard shortcuts. They help me keep my hands on the keyboard and just focus on writing. This is one just incredibly powerful every Googler should know of;

When you've entered a search term on Google search, instead of moving the mouse pointer back to the input field and type more to refine your search, you can just start typing and voila!

There's even more I didn't know of; pressing enter and then tab  selects the first result and you can move up and down through the results with up & down arrows.


Oh my oh my!

Gotta love these keyboard shortcuts – speed through Google search

I love fance keyboard shortcuts. They help me keep my hands on the keyboard and just focus on writing. This is one just incredibly powerful every Googler should know of;

When you've entered a search term on Google search, instead of moving the mouse pointer back to the input field and type more to refine your search, you can just start typing and voila!

There's even more I didn't know of; pressing enter and then tab  selects the first result and you can move up and down through the results with up & down arrows.


Oh my oh my!

The modern, online office for boosted productivity

Productivity is the holy grail
Wether you are a physician striving to be better in your specialty, giving better care to your patients or just trying to meet the demands of modern life - productivity is the one quality you are trying to increase. Or else you would still be using pen and a paper instead of your PC.

Computers are wonderful machines, capable of tasks we could only dream of even 15 years ago. The picture on the right is of an IBM hard drive being transported from an airplane, it's capacity is FIVE MEGABYTES (5mb). Now that's less than the memory of your digital watch. A common SD memory chip today isn't sold less than 2 gigabytes! Facts like these makes us understand the potential of our computers and why I am constantly preaching that you should give your self time to learn to master it so that you make use of this power!

Creative perhaps, not productive at all! [source]
The office is the common workplace, the place where we think, produce, communicate and organize our professional and daily life. The old office may have been creative (at least when you look at these old photos!) but certainly not productive. How productive your office is today really depends on you and in this post I want to tell you about the "online office" concept.

Papers are thing of the past and will only slow you down, it is time to put all your documents to a virtual electronic data-stack to open up the powerful tools to work them and open up for the modern, mobile office. The modern office should be available anywhere, it's data well organized and searchable, invulnerable to data loss and finally it should have a rich set of tools, easy to use.

Nirvana for the minimalist
For me, the key to making all this work is minimalism. The less I have to take care of, the more I can make out of what I have. The poorer I feel the richer I am! My laptop is running a slim, yet powerful and highly configurable Linux operating system so that I have full control of my computer and minimal distractions from system messages, popup windows or other annoyances such as user interface decorations. Most applications I use are web-applications, freeing me from the hazzle of software updates or crashes. Finally, I use as few online services as possible to reduce the amount of login accounts to keep track of.

Available anywhere
Your productivity should not be limited to a physical location. When you have dead time at work, sitting on the bus or out jogging you want to learn by listening to podcasts, answer emails, write stuff or browse through previously read journal articles. The other day I had a complex patient with sudden vertigo, most likely of central origin, and I recalled having recently read an extensive article about HINTS. It took me only a few seconds to find it in Crocodoc and saved lots of time since I could tailor the work-up  to the suggestions of the article. Every now and then I use dead time at work for writing blogposts and my "Presentation" collection of 150 or so photos in Picasa is then available at my fingertips to decorate the posts. If I need to make any adjustments (crop, resize...) I have Pixlr, a free, online Photoshop mimic where this can be easily done through the web-browser. My office is truly omnipresent!

At work I rarely use the same computer and sometimes even several different ones in the same day as I wander around the hospital. The minimalistic approach makes it easy for me to launch my office from whatever computer I am sitting at since all I need is to login on a decent browser (or run Chrome as a portable app from USB if the dreaded Internet Explorer is the only one available). If there's no computer available I always have my Android, providing a mini-portal to my online office.

It's data well organized and easily searchable
Without documents there is no office, at most you can pick your nose and call your colleges to tell about it. Equally bad is an office with stack of unorganized documents and notes. You have to be able to find your documents in an instant whether you browse through them or search. With your data on your hard drive you might have folders within folders to accomplish that task but it is very easy to get lost as the folders grow fatter and count more.

Tagging (also called labeling) is the modern way of organizing data and essential skill for the online office. A document can have one or many tags, unlike the old fashioned folder arrangement it doesn't have to belong to any one tag. You can rename or even erase a tag and the belonging documents will not disappear, just not belong to this tag any more. By carefully tagging your documents they are much easier to access when browsing through them. Everyone knows the old problem of saving some document and then never finding it again, tagging will prevent this from happening again. So if you're still confused about what tagging is, check out this article explaining the concept.

As we will soon find out, tagging and searching is the one of the key features of my selection of the online office tools.

It's data invulnerable to loss and security breaches
Backing up your data is crucial, yet most people wake up it's importance when it's too late. You can read these people's stories and you will literally feel their pain.

Backups will be a problem of the past as you move your years of documents, notes, photoalbums, bookmarks,  etc to the data-cloud. Even if your house burns down at least your electronic data is still available. Surely the odds are low but the potential damage is trivial.

Just backing up the "my documents" folder is not enough. What about your email? Or your calendar and contact list? Besides, the traditional backup medias are not as safe as you thought, external hard drives do fail and even CDs and DVDs are overestimated (some DVDs for example will in only 2 years!). And what if your laptop is stolen - surely you have your data backed up but don't you feel a little uncomfortable knowing that all is now in the hands of some mischievous person?

The key here is using the data cloud and the best way to use the cloud is to use web-applications. The data cloud is a term that describes a huge network of online servers (data farms) storing your data instead. You should not have a single document on your hard-drive unless for a very good reason. A thought that might be pervasive at first but when you realize the comfort of not having to worry about if your data you will never look back again.

Check out my post "Backing up your data the modern way, power to the cloud".

OK, I got your idea - now what?
Install a decent browser
Using web-applications, your browser is the alpha and omega of your office, it is like the hud and steering wheel of your car. It has to be fast, secure and rich of features. I have tried all the major browsers and I always come back to Chrome, in my opinion the best there is currently. Read my post about it and the extensions which can make your office life so much easier.

Extend your office
As I've previously said, your office does not have to be bound to your personal room at home or work. Portable apps and smartphones are the keys to extending your office.

Chrome can be installed on it as a "portable app" so that you can open your office even on computers that don't allow installing additional software. You could even install it on your own USB stick for additional convenience (also see my above mentioned Chrome post for additional info on this).

If you decide to use the Google Apps you really should consider also using Android since it is from the same software maker. Surely there are some apps on the iPhone but with Android you can be sure they are always the best you can get (Gilette style).


Picking the tools in the toolbox
So I've explained the concept: all your documents online and use web-applications. So where to start from, what should I do? Well from now on I can only tell you how I have done it and thus I ask you to read my post abot Google Apps, the core component of my online office. You might have expected a lot of websites and online services to register to but the beauty of Google Apps is that they have most of the tools you will need and registration is free. The most important tools that Google Apps have are:

  • Gmail for secure and online email and contacts
  • Google Calendar for organizing your daily life and tasks
  • Google Reader to follow your blogs and articles
  • Google Docs for working with text documents, spreadsheets, presentations and even more
  • Google Music for your music, podcasts and audio books
  • Picasa for managing your photo albums
  • Blogger for my blogs
  • Google Sites for your managing your webpages
  • Google Groups for easy team communication
  • Google+ for your social networking experience

To introduce all of these if out of the scope of this blogpost, I just want to introduce you to the Google suite as it is the one most important ingredient of my online, mobile office, a true Swiss-army knife. I will be writing more about each and everyone very soon and emphasize how they work for me as an emergency physician.
In addition to the Google Apps, there are a few additional services (also free) I use to complement what GA doesn't have:

  • Crocodoc for my PDF collection (since GDocs misses highlighting feature for PDFs)
  • Pixlr for a free, online "Photoshop mimic"
  • Grooveshark for my discovering music
Though not strictly an office tool, I'd still like to mention Quora as it helps me a lot finding answers to my questions, a common office task. It's a professional Q & A community, sometimes giving me better answers than traditional search engines.

Learn some IT skills
The computer being so powerful, not only do you wan't to have the best components but also you want to know how to use your computer for maximum performance. Check out my posts on IT-skills: taming your computer!


More on this topic

Solutions for copying your cloud data between the different services: CloudHQ, Socialfolders, Otixo

The modern, online office for boosted productivity

Productivity is the holy grail
Wether you are a physician striving to be better in your specialty, giving better care to your patients or just trying to meet the demands of modern life - productivity is the one quality you are trying to increase. Or else you would still be using pen and a paper instead of your PC.

Computers are wonderful machines, capable of tasks we could only dream of even 15 years ago. The picture on the right is of an IBM hard drive being transported from an airplane, it's capacity is FIVE MEGABYTES (5mb). Now that's less than the memory of your digital watch. A common SD memory chip today isn't sold less than 2 gigabytes! Facts like these makes us understand the potential of our computers and why I am constantly preaching that you should give your self time to learn to master it so that you make use of this power!

Creative perhaps, not productive at all! [source]
The office is the common workplace, the place where we think, produce, communicate and organize our professional and daily life. The old office may have been creative (at least when you look at these old photos!) but certainly not productive. How productive your office is today really depends on you and in this post I want to tell you about the "online office" concept.

Papers are thing of the past and will only slow you down, it is time to put all your documents to a virtual electronic data-stack to open up the powerful tools to work them and open up for the modern, mobile office. The modern office should be available anywhere, it's data well organized and searchable, invulnerable to data loss and finally it should have a rich set of tools, easy to use.

Nirvana for the minimalist
For me, the key to making all this work is minimalism. The less I have to take care of, the more I can make out of what I have. The poorer I feel the richer I am! My laptop is running a slim, yet powerful and highly configurable Linux operating system so that I have full control of my computer and minimal distractions from system messages, popup windows or other annoyances such as user interface decorations. Most applications I use are web-applications, freeing me from the hazzle of software updates or crashes. Finally, I use as few online services as possible to reduce the amount of login accounts to keep track of.

Available anywhere
Your productivity should not be limited to a physical location. When you have dead time at work, sitting on the bus or out jogging you want to learn by listening to podcasts, answer emails, write stuff or browse through previously read journal articles. The other day I had a complex patient with sudden vertigo, most likely of central origin, and I recalled having recently read an extensive article about HINTS. It took me only a few seconds to find it in Crocodoc and saved lots of time since I could tailor the work-up  to the suggestions of the article. Every now and then I use dead time at work for writing blogposts and my "Presentation" collection of 150 or so photos in Picasa is then available at my fingertips to decorate the posts. If I need to make any adjustments (crop, resize...) I have Pixlr, a free, online Photoshop mimic where this can be easily done through the web-browser. My office is truly omnipresent!

At work I rarely use the same computer and sometimes even several different ones in the same day as I wander around the hospital. The minimalistic approach makes it easy for me to launch my office from whatever computer I am sitting at since all I need is to login on a decent browser (or run Chrome as a portable app from USB if the dreaded Internet Explorer is the only one available). If there's no computer available I always have my Android, providing a mini-portal to my online office.

It's data well organized and easily searchable
Without documents there is no office, at most you can pick your nose and call your colleges to tell about it. Equally bad is an office with stack of unorganized documents and notes. You have to be able to find your documents in an instant whether you browse through them or search. With your data on your hard drive you might have folders within folders to accomplish that task but it is very easy to get lost as the folders grow fatter and count more.

Tagging (also called labeling) is the modern way of organizing data and essential skill for the online office. A document can have one or many tags, unlike the old fashioned folder arrangement it doesn't have to belong to any one tag. You can rename or even erase a tag and the belonging documents will not disappear, just not belong to this tag any more. By carefully tagging your documents they are much easier to access when browsing through them. Everyone knows the old problem of saving some document and then never finding it again, tagging will prevent this from happening again. So if you're still confused about what tagging is, check out this article explaining the concept.

As we will soon find out, tagging and searching is the one of the key features of my selection of the online office tools.

It's data invulnerable to loss and security breaches
Backing up your data is crucial, yet most people wake up it's importance when it's too late. You can read these people's stories and you will literally feel their pain.

Backups will be a problem of the past as you move your years of documents, notes, photoalbums, bookmarks,  etc to the data-cloud. Even if your house burns down at least your electronic data is still available. Surely the odds are low but the potential damage is trivial.

Just backing up the "my documents" folder is not enough. What about your email? Or your calendar and contact list? Besides, the traditional backup medias are not as safe as you thought, external hard drives do fail and even CDs and DVDs are overestimated (some DVDs for example will in only 2 years!). And what if your laptop is stolen - surely you have your data backed up but don't you feel a little uncomfortable knowing that all is now in the hands of some mischievous person?

The key here is using the data cloud and the best way to use the cloud is to use web-applications. The data cloud is a term that describes a huge network of online servers (data farms) storing your data instead. You should not have a single document on your hard-drive unless for a very good reason. A thought that might be pervasive at first but when you realize the comfort of not having to worry about if your data you will never look back again.

Check out my post "Backing up your data the modern way, power to the cloud".

OK, I got your idea - now what?
Install a decent browser
Using web-applications, your browser is the alpha and omega of your office, it is like the hud and steering wheel of your car. It has to be fast, secure and rich of features. I have tried all the major browsers and I always come back to Chrome, in my opinion the best there is currently. Read my post about it and the extensions which can make your office life so much easier.

Extend your office
As I've previously said, your office does not have to be bound to your personal room at home or work. Portable apps and smartphones are the keys to extending your office.

Chrome can be installed on it as a "portable app" so that you can open your office even on computers that don't allow installing additional software. You could even install it on your own USB stick for additional convenience (also see my above mentioned Chrome post for additional info on this).

If you decide to use the Google Apps you really should consider also using Android since it is from the same software maker. Surely there are some apps on the iPhone but with Android you can be sure they are always the best you can get (Gilette style).


Picking the tools in the toolbox
So I've explained the concept: all your documents online and use web-applications. So where to start from, what should I do? Well from now on I can only tell you how I have done it and thus I ask you to read my post abot Google Apps, the core component of my online office. You might have expected a lot of websites and online services to register to but the beauty of Google Apps is that they have most of the tools you will need and registration is free. The most important tools that Google Apps have are:

  • Gmail for secure and online email and contacts
  • Google Calendar for organizing your daily life and tasks
  • Google Reader to follow your blogs and articles
  • Google Docs for working with text documents, spreadsheets, presentations and even more
  • Google Music for your music, podcasts and audio books
  • Picasa for managing your photo albums
  • Blogger for my blogs
  • Google Sites for your managing your webpages
  • Google Groups for easy team communication
  • Google+ for your social networking experience

To introduce all of these if out of the scope of this blogpost, I just want to introduce you to the Google suite as it is the one most important ingredient of my online, mobile office, a true Swiss-army knife. I will be writing more about each and everyone very soon and emphasize how they work for me as an emergency physician.
In addition to the Google Apps, there are a few additional services (also free) I use to complement what GA doesn't have:

  • Crocodoc for my PDF collection (since GDocs misses highlighting feature for PDFs)
  • Pixlr for a free, online "Photoshop mimic"
  • Grooveshark for my discovering music
Though not strictly an office tool, I'd still like to mention Quora as it helps me a lot finding answers to my questions, a common office task. It's a professional Q & A community, sometimes giving me better answers than traditional search engines.

Learn some IT skills
The computer being so powerful, not only do you wan't to have the best components but also you want to know how to use your computer for maximum performance. Check out my posts on IT-skills: taming your computer!


More on this topic

Solutions for copying your cloud data between the different services: CloudHQ, Socialfolders, Otixo

Why I Google

The Google applications are a core component of my online life and thus are mentioned a lot in my blogposts. Here I will explain why exactly so that you don't think that I am bought by Google!

You might also be interested in my rant about choosing the right technology platforms.

Most of you have used Google search and very likely Gmail but not everyone is aware that those two are just a small part of the bigger Google application suite, a plethora of powerful online tools for productivity and creativity. If Google Apps is new to you, I highly recommend this short introduction to this toolset which can seriously boost your productivity.

Alternatives
It is but fair to tell you that there are alternatives to Google Apps, indeed there are thousands of them but none that I know of that has the broad spectrum of application types as Google has. For Google Docs I could mention Zoho and Office 365, commonly compared to Google Docs. Remember The Milk is a nice todo-list application. To read about the others you could check this article.

Why Google apps?
Google Apps is a prime example of web-applications - they run from the browser and use the data-cloud, providing you with easy access to your data wherever you are and a fully automated backup. They are therefor the core component of my online, mobile office - as long as I have a decent web-browser running my office is up and running, ready to untap my productivity. I have previously written a post about web-applications and the data cloud and why you should seriously consider converting to these, here I will rationalize why Google Apps are my first choice.

Single login to all apps, all data in one place
Sitting in the cockpit of a 747 is very much how I feel when I have logged into Google - I have all controls within the reach of my fingertips. With a single login account I have about 30 different applications before me and only one password to take care of. Even with only a few different web-apps, it would be a hazzle to login to every single one and major treshold to start working and getting things done.

Not only are the apps interconnected but so is their data. On the surface you will not notice it but under the hood all your data within the Google apps is pooled in a single database, just showing up differently within the different applications. This means that each and every application can access your different data pools, for example Blogger and Google Docs can easily grab photos from your Picasa account, your Gmail contacts are accessed with Google+ and vice versa. Seeing is believing - from Google's dashboard you can see how your data is stacked within the different apps.

All eggs in one basket?!
Now some will feel violated by privacy issues - the fact that a private company stores so much of your personal data and there are tons of articles and discussions wiggling this issue back and forwards. This is of course a double sided coin; there are indeed companies that will use your data to personalize your ads and some might even abuse your data but if you trust your company there is so much to gain. Consider for a moment how big Google is and that their existence relies on public opinion - they simply cannot afford violating your data in evil ways, one false move and they could go down the drain over a night. Besides, whether you like it or not, in Google's huge data-cloud, you are just an ID number and your data is handled by robots who don't give a damn about what you do or don't do, like or don't like, for them you're just a bunch of binary 1s and 0s! Some think that Google's employees have fun reading emails in the Gmail database, wake up - that's just as silly as claiming that doctors sit and read patient journals for fun.

The times are different!
If you still feel insecure, I think you should consider leaving the Internet altogether and start using paper and pen again. This is the era of Web 2.0 tools where storing personal data online is the prerequisite for them to work. That is not unique for Google, it's just the way it is today. Google is well aware of these issues and provides you with an easy way to take out all your data if you should want to close down your account - Google takeout (also an excellent tool if you want to have an extra backup of your data on a local hard drive).

If you want a 3rd party solution there is Backupify. No need to worry!

Actually it makes me sleep better in the night to know that a corporation with pockets full of money and enormous muscle power is keeping my data safe. Should Google go bankrupt or be hijacked, your personal data is the least problem of all since that scenario would be a major event touching not only individuals but corporations, countries and even the whole world. You can be sure someone with greater interests will already be working on this before you even have had time to say "ouch"!

Google is also offline
Since the start of the Internet, downtimes have occured in all major services and Google is no exception but it is so rare and short that in effect you would barely have time to have a cup of coffee while it is being fixed.
A more likely scenario is that you are without Internet connection e.g. while flying or sitting on the train. This is yet another reason to choose Google Apps as they are very well aware of the possibility and have been eager to implement offline options to most of their applications. Their current technique is based on HTML5, an universal standard not likely to disappear over one night and since HTML5 support is growing even on smartphones, you will not have a problem with this on your Android or iPhone. Google Docs for example allows you to mark which documents should be available offline and they will be downloaded and synced automatically without you having to do anything but just enjoy.

Simplicity is power
Ever since Google's search page appeared, simplicity has been Google's style. Wether it's Google Docs, Picasa or Blogger - everything is easy to setup and work with, yet providing the most important features needed. Thus the Google Apps are easy to learn and use, you can start working in minutes.

Constantly updated
Google is eager to provide you with the best tools and state of art technology. I have used Google Apps for almost five years now and the features have grown enormously. Almost every month something new is being added and I feel that Google is listening to their users, adding the features most requested. As web-browsers become better every year we can expect even better features in the future. On the Google OS blog you can follow all additions as they are being implemented.

Android integretation
It should not come to a surprise that the Android operating system has great support for the Google applications, they are after all the brains behind this great OS. With the Google Docs app for instance, it's easy to search, read and even edit your documents and recently offline support was added - this literally means that your online office is available whenever and wherever you go. A technology most would have though to be impossible only several years ago.

Totally free
Last but not least - the Google Apps are totally free, for up to 1gb of storage. Despite having every single document of mine and 10 years of emails there, I've still only used 25% of my quota. In time, I will upload my 50gb or so of photoalbums to Google's services for an online backup and I have no problems with paying $20/year for their 80gb additional storage, if you ask me - the price is ridiculously low, it's just a fraction of the price of a hard drive.



A success story for me
A few years ago I uploaded every single document from my hard drive to Google Docs. My laptop now has no hard-drive installed (runs much faster off a 4gb SD memory card with Linux installed), backup and working with different versions of the same document are a things of the past. With Google's Chrome installed on a USB chip I can start my office up from any computer in the hospital in just seconds and the IT department won't have anything to say about it since I'm not opening any security threats to their in-house network. With my Android I can easily access all my online data and I use it every day for better patient care and to steepen my learning curve in emergency medicine. I am a happy Googler.

Please check out my post about the online, mobile office if you wan't to know the details!


Finally - the disclosure
And now you should understand that my choice of Google for almost everything in my online life is not just a sentimental one, it is truly the one tool that helps me the most for my productivity and creativity. I have nothing to disclose; I have no affiliation in any way with Google or related services and my choice to use their tools tools is utterly my own and solely based on years of "trial and error" with various solutions. There was even an era in my life where I had almost grown roots into the flagships of Microsoft, Windows and Office - but I woke up one day and found out there were better ways to achieve my goals.

More on this topic

I've been Googled
A blogger describes how Google grew on him from being a search engine only to his complete online Swiss army knife and why Google's applications are growing fast in the small/medium sized business world.
Google Privacy: 5 Things the Tech Giant Does With Your Data
Mashable e-magazine explains in a user-friendly way what the Google privacy issues are really about. As it turns out, a lot of fuzz out of nothing...

Why I Google

The Google applications are a core component of my online life and thus are mentioned a lot in my blogposts. Here I will explain why exactly so that you don't think that I am bought by Google!

You might also be interested in my rant about choosing the right technology platforms.

Most of you have used Google search and very likely Gmail but not everyone is aware that those two are just a small part of the bigger Google application suite, a plethora of powerful online tools for productivity and creativity. If Google Apps is new to you, I highly recommend this short introduction to this toolset which can seriously boost your productivity.

Alternatives
It is but fair to tell you that there are alternatives to Google Apps, indeed there are thousands of them but none that I know of that has the broad spectrum of application types as Google has. For Google Docs I could mention Zoho and Office 365, commonly compared to Google Docs. Remember The Milk is a nice todo-list application. To read about the others you could check this article.

Why Google apps?
Google Apps is a prime example of web-applications - they run from the browser and use the data-cloud, providing you with easy access to your data wherever you are and a fully automated backup. They are therefor the core component of my online, mobile office - as long as I have a decent web-browser running my office is up and running, ready to untap my productivity. I have previously written a post about web-applications and the data cloud and why you should seriously consider converting to these, here I will rationalize why Google Apps are my first choice.

Single login to all apps, all data in one place
Sitting in the cockpit of a 747 is very much how I feel when I have logged into Google - I have all controls within the reach of my fingertips. With a single login account I have about 30 different applications before me and only one password to take care of. Even with only a few different web-apps, it would be a hazzle to login to every single one and major treshold to start working and getting things done.

Not only are the apps interconnected but so is their data. On the surface you will not notice it but under the hood all your data within the Google apps is pooled in a single database, just showing up differently within the different applications. This means that each and every application can access your different data pools, for example Blogger and Google Docs can easily grab photos from your Picasa account, your Gmail contacts are accessed with Google+ and vice versa. Seeing is believing - from Google's dashboard you can see how your data is stacked within the different apps.

All eggs in one basket?!
Now some will feel violated by privacy issues - the fact that a private company stores so much of your personal data and there are tons of articles and discussions wiggling this issue back and forwards. This is of course a double sided coin; there are indeed companies that will use your data to personalize your ads and some might even abuse your data but if you trust your company there is so much to gain. Consider for a moment how big Google is and that their existence relies on public opinion - they simply cannot afford violating your data in evil ways, one false move and they could go down the drain over a night. Besides, whether you like it or not, in Google's huge data-cloud, you are just an ID number and your data is handled by robots who don't give a damn about what you do or don't do, like or don't like, for them you're just a bunch of binary 1s and 0s! Some think that Google's employees have fun reading emails in the Gmail database, wake up - that's just as silly as claiming that doctors sit and read patient journals for fun.

The times are different!
If you still feel insecure, I think you should consider leaving the Internet altogether and start using paper and pen again. This is the era of Web 2.0 tools where storing personal data online is the prerequisite for them to work. That is not unique for Google, it's just the way it is today. Google is well aware of these issues and provides you with an easy way to take out all your data if you should want to close down your account - Google takeout (also an excellent tool if you want to have an extra backup of your data on a local hard drive).

If you want a 3rd party solution there is Backupify. No need to worry!

Actually it makes me sleep better in the night to know that a corporation with pockets full of money and enormous muscle power is keeping my data safe. Should Google go bankrupt or be hijacked, your personal data is the least problem of all since that scenario would be a major event touching not only individuals but corporations, countries and even the whole world. You can be sure someone with greater interests will already be working on this before you even have had time to say "ouch"!

Google is also offline
Since the start of the Internet, downtimes have occured in all major services and Google is no exception but it is so rare and short that in effect you would barely have time to have a cup of coffee while it is being fixed.
A more likely scenario is that you are without Internet connection e.g. while flying or sitting on the train. This is yet another reason to choose Google Apps as they are very well aware of the possibility and have been eager to implement offline options to most of their applications. Their current technique is based on HTML5, an universal standard not likely to disappear over one night and since HTML5 support is growing even on smartphones, you will not have a problem with this on your Android or iPhone. Google Docs for example allows you to mark which documents should be available offline and they will be downloaded and synced automatically without you having to do anything but just enjoy.

Simplicity is power
Ever since Google's search page appeared, simplicity has been Google's style. Wether it's Google Docs, Picasa or Blogger - everything is easy to setup and work with, yet providing the most important features needed. Thus the Google Apps are easy to learn and use, you can start working in minutes.

Constantly updated
Google is eager to provide you with the best tools and state of art technology. I have used Google Apps for almost five years now and the features have grown enormously. Almost every month something new is being added and I feel that Google is listening to their users, adding the features most requested. As web-browsers become better every year we can expect even better features in the future. On the Google OS blog you can follow all additions as they are being implemented.

Android integretation
It should not come to a surprise that the Android operating system has great support for the Google applications, they are after all the brains behind this great OS. With the Google Docs app for instance, it's easy to search, read and even edit your documents and recently offline support was added - this literally means that your online office is available whenever and wherever you go. A technology most would have though to be impossible only several years ago.

Totally free
Last but not least - the Google Apps are totally free, for up to 1gb of storage. Despite having every single document of mine and 10 years of emails there, I've still only used 25% of my quota. In time, I will upload my 50gb or so of photoalbums to Google's services for an online backup and I have no problems with paying $20/year for their 80gb additional storage, if you ask me - the price is ridiculously low, it's just a fraction of the price of a hard drive.



A success story for me
A few years ago I uploaded every single document from my hard drive to Google Docs. My laptop now has no hard-drive installed (runs much faster off a 4gb SD memory card with Linux installed), backup and working with different versions of the same document are a things of the past. With Google's Chrome installed on a USB chip I can start my office up from any computer in the hospital in just seconds and the IT department won't have anything to say about it since I'm not opening any security threats to their in-house network. With my Android I can easily access all my online data and I use it every day for better patient care and to steepen my learning curve in emergency medicine. I am a happy Googler.

Please check out my post about the online, mobile office if you wan't to know the details!


Finally - the disclosure
And now you should understand that my choice of Google for almost everything in my online life is not just a sentimental one, it is truly the one tool that helps me the most for my productivity and creativity. I have nothing to disclose; I have no affiliation in any way with Google or related services and my choice to use their tools tools is utterly my own and solely based on years of "trial and error" with various solutions. There was even an era in my life where I had almost grown roots into the flagships of Microsoft, Windows and Office - but I woke up one day and found out there were better ways to achieve my goals.

More on this topic

I've been Googled
A blogger describes how Google grew on him from being a search engine only to his complete online Swiss army knife and why Google's applications are growing fast in the small/medium sized business world.
Google Privacy: 5 Things the Tech Giant Does With Your Data
Mashable e-magazine explains in a user-friendly way what the Google privacy issues are really about. As it turns out, a lot of fuzz out of nothing...