What ever happened to Panda Bear and GutShot?

[ElChamaco]

Anyone know? Panda posted a while as "melanoleuca" and then disappeared completely...

These two guys were like the good and bad angels on your shoulder, although GutShot was a lot less vehement.

I disappear from SDN for a couple of years and the older timers just vanish? Who are all you new kids btw?

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[Narmerguy]

I don't know about panda bear but I was almost positive I've seen Gutshot post in the past month.

Edit: I was actually wrong.

http://forums.studentdoctor.net/showpost.php?p=8316490&postcount=6

That was his most recent post, June 2009.

 

[DrYoda]

Panda always said he was leaving SDN after residency. I didn't really believe him, but I guess he was serious (unless he started another account and didn't identify himself).

No idea about gut shot, haven't seen him in a long time.

 

[Catalystik]

Panda Bear had his account username changed to random numbers, but his posts and legacy live on. Melanoleuca was an active poster until a year ago, but Gut Shot hasn't been around for almost a year and a half.

 

[ElChamaco]

They left us without any parting words or explanation after nearly a decade in service?

 

[45408]

Panda is an attending ER doc in Louisiana, and he got a divorce unfortunately. He's making mad cash though apparently.

 

[loveoforganic]

In NO? Might have visited his ED during interview.

 

[Sid Farkus]

Panda is an attending ER doc in Louisiana, and he got a divorce unfortunately. He's making mad cash though apparently.

Very sad to hear... I ate, slept, and breathed his archives last winter and have referenced the advice from Mrs. Panda Bear a few times when talking to/consoling my g/f about school and residency.

 

[Forthegood]

GutShot was a hero of mine. I used to get on just to see what he had said.

I saw that last post from him too and noticed he has been MIA for a while. Then again, who hasn't? He'll be back I'm sure, even if it takes 1000 PMs!

 

[45408]

In NO? Might have visited his ED during interview.

pretty sure he's in a non-academic setting, so I doubt it.

 

[MichaelC]

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Sexy.

 

[Stuart Smalley]

Sexy.

What is that and why do you keep posting it?

 

[ModerateMouse]

What were these 2 users known for?

 

[quiltlady]

I am not surprised Panda got a divorce. He spent far more time on this forum than he did with his family. He told his wife he had quit SDN, but lied to her. She and I had discussions on the matter.

 

[Forthegood]

What were these 2 users known for?

Hope and reason

 

[MichaelC]

What is that and why do you keep posting it?

A spammer was here earlier and I was flirting with them. The mods seem to have deleted their posts, though.

 

[Narmerguy]

Hope and reason

Don't mislead them.

 

[Dianyla]

What were these 2 users known for?

Dead African Babies.

 

[JKinSC]

Dead African Babies.

That's still, I think, my favorite post he ever made! No one was better at describing the "Goat Rodeo" for what it really is. Last I saw, he posted a few times on MDOD, but I haven't seen him back there in several months.

Matter of fact, I think this was his last post there:
http://docsontheweb.blogspot.com/2010/05/few-things.html

 

[ModerateMouse]

Dead African Babies.

I read the post -- it's decent.

And then I began reading the rest of his blog. It reads pretty well -- I can't quite put my finger on it, but his writing often reminds me of those cheap paperback thrillers that people buy to keep them entertained during long airplane trips...

Maybe that's it? Just when a sentence is about to be finished, he tacks on another clause, and then another, until you are wondering what started the eloquently worded sentence, and why you are still reading?

He is pretty opinionated in the blog.

EDIT: I read more of his entries, and he comes off as an uncaring prick. It is possible that I am just a naive person, unschooled in the practice of medicine, but to me it seems that a doctor should try to cure his patient and not just ignore a potential illness.

He advises ER physicians to avoid ordering X-rays unless they are absolutely needed.

The reason? There might be lung cancer, which I don't care about since the patient did not present with any respiratory symptoms.

Is it just me, or is a doctor's purpose to try to watch out for his patient's health instead of attempting to cover his ass?

Which brings me to one of my biggest pet peeves, that is, the ordering of imaging studies and lab work in triage. Sure, sometimes this practice speeds up disposition but not every patient, for example, with abdominal pain needs an Acute Abdominal Series; a set of four xrays at my hospital. With a few exceptions, the Acute Abdominal Series should be reserved for, well, patients with an Acute or "Surgical" abdomen which I assure you most of my patients do not have. Vague abdominal pain certainly does not qualify and the Acute Abdominal Series is completely useless in either ruling in or ruling out anything useful in the majority of patients for which it is automatically ordered.

If I suspect something is going on I'll get a CT scan.


Not only is the routine ordering of unnecessary imaging wasteful but once we get the study we are now on the hook for every finding on it, even those that are incidental. If I miss a small pulmonary nodule on an unnecessary chest film that later turns out to have been lung cancer I own it and the ensuing lawsuit. Better not to know…especially if the guy came in for a sore throat and no other respiratory complaints and with a completely normal lung exam.

But, who knows. Maybe I will feel that way pretty soon.

 

[Dianyla]

But, who knows. Maybe I will feel that way pretty soon.

While I agree that he might be insensitive, there is a method to his madness. Read the House of God, and get back to me.

 

[Astarael]

EDIT: I read more of his entries, and he comes off as an uncaring prick. It is possible that I am just a naive person, unschooled in the practice of medicine, but to me it seems that a doctor should try to cure his patient and not just ignore a potential illness.

He advises ER physicians to avoid ordering X-rays unless they are absolutely needed.

The reason? There might be lung cancer, which I don't care about since the patient did not present with any respiratory symptoms.

Is it just me, or is a doctor's purpose to try to watch out for his patient's health instead of attempting to cover his ass?




But, who knows. Maybe I will feel that way pretty soon.

Read the post he made while trying to see it from his point and it might make a little more sense. Doctors don't diagnose solely based off imaging. They have a suspicion of pathology based off history and physical, and then if imaging is warranted, they get it (and it may or may not confirm their diagnosis). But imaging a person who has no clinical need for it isn't necessarily helpful for the patient, since the radiologist and the ER doc might not be looking for incidental findings (that small pulmonary nodule he mentioned in his post). If they don't find it, it might be totally understandable to us, since the patient had a presenting complaint that had nothing to do with lung cancer. But if you ordered the first film to have something questionable on it, you are liable for the findings on that film (whether you notice them or not).

On top of this is the argument that being exposed to unnecessary radiation isn't great for you either. As you said, a doctor's purpose is to watch out for his patients. That means not exposing them to radiation if they don't need it. It may be relatively safe for most patients, but I'm sure there are people out there who got that last, cancer inducing DNA mutation from an xray.

And I second Dianyla's recommendation to read the House of God.

 

[45408]

EDIT: I read more of his entries, and he comes off as an uncaring prick. It is possible that I am just a naive person, unschooled in the practice of medicine, but to me it seems that a doctor should try to cure his patient and not just ignore a potential illness.

He advises ER physicians to avoid ordering X-rays unless they are absolutely needed.

The reason? There might be lung cancer, which I don't care about since the patient did not present with any respiratory symptoms.

Is it just me, or is a doctor's purpose to try to watch out for his patient's health instead of attempting to cover his ass?

No, if a patient has lung cancer, I want to know about it. However, if a patient has an incidentaloma - http://en.wikipedia.org/wiki/Incidentaloma - then it's a huge pain in the ass for everyone, and I do NOT want to know about it.

My father-in-law has a meningioma that was discovered incidentally (the ringing in his ears had stopped, but the MRI had been ordered), making it an incidentaloma. No problem, right? Except now he has to pay a lot more for life insurance because he might have "brain cancer," and he had a bunch of follow-up MRIs and neurosurgeon visits for no reason at all.

Many, many, many patients have abnormal lab findings at some point in time, but if you just wait it out briefly and re-check, they will normalize. HOMEOSTASIS.

In short, don't order lab tests looking for something you don't need to find. Leg pain? Don't get a chest x-ray. They'll be getting follow-up films for their "solitary pulmonary nodule" for ages. Read about false-positives for things found on mammograms. There are more benign findings than malignant ones.

 

[Narmerguy]

Read the post he made while trying to see it from his point and it might make a little more sense. Doctors don't diagnose solely based off imaging. They have a suspicion of pathology based off history and physical, and then if imaging is warranted, they get it (and it may or may not confirm their diagnosis). But imaging a person who has no clinical need for it isn't necessarily helpful for the patient, since the radiologist and the ER doc might not be looking for incidental findings (that small pulmonary nodule he mentioned in his post). If they don't find it, it might be totally understandable to us, since the patient had a presenting complaint that had nothing to do with lung cancer. But if you ordered the first film to have something questionable on it, you are liable for the findings on that film (whether you notice them or not).

On top of this is the argument that being exposed to unnecessary radiation isn't great for you either. As you said, a doctor's purpose is to watch out for his patients. That means not exposing them to radiation if they don't need it. It may be relatively safe for most patients, but I'm sure there are people out there who got that last, cancer inducing DNA mutation from an xray.

And I second Dianyla's recommendation to read the House of God.

Well, let's call it for what it is. Panda's opinions and posts are highly jaded and, to his own admission, the ramblings of a man who hates most aspects of the medical profession. I wouldn't look to his opinions and ideologies as a demonstration of how we should approach our practices.

House of God is fine if only balanced with proper writings from authors with different biases than Dr. Shem.

 

[Dianyla]

House of God is fine if only balanced with proper writings from authors with different biases than Dr. Shem.

I'm in complete agreement. I just don't think we should necessarily vilify the Jade Panda for not running a whole battery of diagnostic tests on every patient.

 

[traitorman]

Unless you guys work in an ED and don't just shadow/volunteer there, a lot of Panda's viewpoints are spot on. With the way a lot of patients (both knowingly and unknowingly) take advantage of the ED, I can see why he may seem jaded.

An ED is for emergencies and for every additional patient that comes through the ED for primary care complaints, medical care has to be rationed even more. The time spent on critically ill patients become shortened and you run the risk of missing something important. Imagine working your ass off for 8 hours straight of a 12 hour shift on a busy Monday evening - when the most you've had to eat is a couple of crackers, and a small cup of juice. Your reading xrays, EKGs, getting radiology results from the radiologists, consulting multiple doctors for different patients while remembering the H&P and pertinent lab/diagnostic findings for each and every patient. Then you have multiple patients/family members insulting you because you're taking too long or not ordering the tests they DEMAND you order, etc... it can become stressful for everybody.

Because time is so limited, you cannot, for example, order that CXR on that elderly male who came in for an ankle sprain just because he wants to check his lungs. He needs to go to his primary care doctor with those kinds of concerns.


and at the rate CT scans have to be ordered because doctors are forced to cover their asses, radiation exposure could become the new "asbestos"

 

[Perrotfish]

He advises ER physicians to avoid ordering X-rays unless they are absolutely needed.

The reason? There might be lung cancer, which I don't care about since the patient did not present with any respiratory symptoms.

Is it just me, or is a doctor's purpose to try to watch out for his patient's health instead of attempting to cover his ass?
.

I think his point was that you'd need to be a radiologist, in the top 1% of your profession, have more time with the scan than an ER doc has with a patient, and be having a VERY good day to actually notice that the little spot on the CT that shouldn't be there when you don't have any clinical suspicion that something could be there. However since you took the CT you are now legally on the line for it and the patient in his grief can now supplement his life insurance with everything you've ever earned. So avoid unnecessary testing.

Imagine working your ass off for 8 hours straight of a 12 hour shift on a busy Monday evening - when the most you've had to eat is a couple of crackers, and a small cup of juice.

I hear this a lot, and I would really like to meet all of these starving ER physicians. Almost every ER doc I've ever met was shaped like a basketball.

 

[gujuDoc]

Panda Bear to my understanding wanted to leave after he finished residency.

He did his medical school at LSU and went up to Duke for a year for a family med residency program which he HATED with a burning passion. Reapplied to residency programs for EM and went to a small community program in Lansing, Mich.

Upon finishing there he decided to move back to his roots in Louisiana. He has kept his blog on here on SDN's website somewhere where there are medical blogs but he decided it was time to retire his posting on here.

I don't blame him.

He is now practicing as an attending in Louisiana as an EM physician living with his wife, 4 children, and dogs.

 

[gujuDoc]

Dead African Babies.

Sooooooooooooo true his making fun of personal statements was the best ever.

 

[CougarMD]

Posting threads solely to discuss other members is not what the pre-allo forum, or SDN in general, is for. Accordingly, this thread is being closed.