Thursday, 20 October 2011

18 Unique Identifiers You Want To Avoid (or 3, if you were here in the equator)

From the Health Insurance Portability and Accountability Act (HIPAA).

The following are 18 unique identifiers that you want to avoid when publishing case reports, stories, anecdotes, anything that concern specific individuals, especially patients.

1. Names;
2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000;
3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;
4. Phone numbers;
5. Fax numbers;
6. Electronic mail addresses;
7. Social Security numbers;
8. Medical record numbers;
9. Health plan beneficiary numbers;
10. Account numbers;
11. Certificate/license numbers;
12. Vehicle identifiers and serial numbers, including license plate numbers;
13. Device identifiers and serial numbers;
14. Web Universal Resource Locators (URLs);
15. Internet Protocol (IP) address numbers;
16. Biometric identifiers, including finger and voice prints;
17. Full face photographic images and any comparable images; and
18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)
There are also additional standards and criteria to protect individual's privacy from re-identification. Any code used to replace the identifiers in datasets cannot be derived from any information related to the individual and the master codes, nor can the method to derive the codes be disclosed. For example, the unique code cannot include the last four digits (in sequence) of the social security number. Additionally, the researcher must not have actual knowledge that the research subject could be re-identified from the remaining identifiers in the PHI used in the research study. In other words, the information would still be considered identifiable is there was a way to identify the individual even though all of the 18 identifiers were removed.

A bit of a cultural perspective:

As a medical student now doing clerkship, I am well aware of the rules on patient privacy. I'm not sure if my country's medical council / boards has this kind of list that explicitly states which items are not for public consumption. Maybe we rely much on conscience? [It works, though!] After all, not a lot of these stuff are relevant to the average Indonesians. Items #4 down to #18 are certainly irrelevant. Well, item #8 is acceptable, but trust me, nobody here cares or understands what it means save for health professionals. Those who know their rights come from medium-upper class society, and this community constitutes around... uh, I dunno, less than 50% of the entire population. Possibly much less.

In other words, we can say that most of these patients are practically invisible. I daresay, if a careless / delinquent / just plain evil med student sells away a piece of patient's information, as long as the patient comes from a lower class / is uneducated / is not a public figure, the med student can easily evade lawsuit. Heck, the patient himself would be too [forgive me] "unenlightened", to understand his own rights, let alone to sue!

This is the phenomenon that exists in a developing country with one of the densest population in the world. If you are lucky enough to be born or to live somewhere where all its citizens actually exist and are busy defending their rights to death, remember that you are the minority here on dear ol' Earth. Most of us are just vapors in the wind.

Tuesday, 18 October 2011

The End

Owners of the world and empty hope
      in vanity head for the downward slope
Theirs is the crown of fool's gold
      with nothing but sulfur it withholds
Bedazzling though, to the minds so lame
      in the fiery lake it will be put to shame.

Yet the blessed, who live up unceasing
      to the name bestowed
      by the Spirit Most Hallowed
              they are obedient on His golden road
              faithful on His trail of blood.
These will share the glory of the King,
a crown, so bright, it forces the sun to sink.


by: Anna Elissa

Monday, 17 October 2011

The attending is always right.

1. I was wrong to use the term "subcutaneous layer" because I had been referring to the the other layers as "epidermis" and "dermis". He said I was supposed to say "subdermis" instead.

2. Polycyclic and herpetiform are lesions (not configurations of a lesion), just like a macule, papule, or vesicle is a lesion.

3. A wheal is a secondary lesion when it is caused by an external source, for example, an insect sting/bite.

4. Since what we think and what the textbooks think as right are actually wrong to him, so we all have to agree to him. "Because there's no absolute truth," he said.

People? Enlighten me. Before my head goes polycyclic.

Thursday, 13 October 2011

For St. Anna

Allow me to dedicate this one post to Saint Anna (Ann, Anne), mother of the Blessed Virgin and grandmother of our Lord. Last month, I asked for her help as the patroness of women, wives, and fertility. I was having irregular periods for a while; my body is apparently very sensitive towards things like disturbance in sleep cycle and stress (thanks, med school!), and it manifests as, among other things, problematic menses. I had never invoked St. Anna's name before, but I'm glad I finally did. This month I get my usual 28-day cycle, strangely without any nasty prodrome, so it came as quite a [nice] surprise. This is important for me because, who wants to be bothered with irregular periods when you're working hard to save the world? :p
Although my scientific side still wants to wait for several months to see if it's permanent, my less-Einstein truly believes that this is St. Anna gladly interceding for me. I'm sure her daughter also helps, because I've also been praying the rosary.

Thank you, St. Anna. Happy to have you as my patroness.

is getting what we don't deserve.


is not getting what we do deserve.

Wednesday, 12 October 2011

I Paint You

I paint you in water
A blue crystalline saucer
Unreliable though it is
You disappear at first kiss

I paint you in the sand
Where the first fish approached the land
The sea, though, is jealous
It creeps in and steals you senseless

I paint you with the branches of the tree
that carve the sky a wisp cloudy
But nature, bitter, would tear you apart
As in time the tree dies and departs

Finally, I paint you in my dream
A place where everything ought to be
In it, your image shall be breathed
And my tears shall find redeem

by: Anna Elissa

"I dream my painting
and then I paint my dream."

-Vincent Van Gogh


I'm slightly obsessed with drinking tamarillo juice lately. Indonesians call it terong Belanda, or "Dutch eggplant", probably because it was first introduced in the archipelago by the Dutch. It's very rich in vitamin A and vitamin C (antioxidants!), and low in calories. When blended and mixed with milk, it's a pink awesomeness.

Source: Wikipedia

This is how the fruits look like. You can just eat them by scooping the flesh out. I haven't tried that.

A tamarillo juice.

There's a recipe online that says about removing the seeds before blending. Not sure if that's possible, though. The seeds are attached to the flesh, much like kiwi fruits. I prefer to leave them in the drink; they add a pleasant crunchy effect. Drink the juice slowly, like you would a bubble drink, and pause here and there to bite on the seeds. Man, it's so satisfying!

The tamarillo fruit in my hand.

The boy seller was generous enough to let me take one home. Shame on me, I had never seen such a fruit before! Have you?

An example of how good God is.
And also of how worthwhile it is to go out on a limb and try something new.

{I don't like eggplants. The idea of making them into a juice was scary at first.
But this, this changes everything.}

Sunday, 9 October 2011

Col 3:23

"Whatever you do, work at it with all your heart, as working for the Lord, not for men."

Colossians 3:23

Col 3:23 is my #1 favorite verse from the Scriptures. I label all my academic notebooks with this verse. It's my comfort and my inspiration, and here's why.

Ever heard about God sanctifying the uniqueness in each and every one of us according to His purpose, instead of making us all the same (and boring)? St. Peter was a fisherman, St. Matthew was a tax collector, St. Mary was a young virgin, St. Monica was an old widow, St. Helena and Elizabeth of Hungary were queens, St. Augustine was a delinquent rascal, St. Thomas Aquinas was a brilliant philosopher, St. Benedict was a monk, and the list goes on. Each of us is given a different personality, a different role, a different calling. The essence stays the same, though: "Whatever you do, work at it with all your heart, as working for the Lord, not for men."

I feel that the above verse is the reassurance I need. I've always been the little perfectionist (although as an adult I've relaxed a bit). I couldn't put my work down before I feel satisfied with it. I like both to plan the bigger picture as well as attending to details. But the bitterness comes when other people doesn't seem to appreciate what I do, or when my work seems useless anyways. My peers can get the same or even better grades / awards / etc. with half-hearted efforts, or even by cheating. I come on time just to see nobody else does. I do the "unimportant" assignments when others do not and get away with it.

With this verse in mind, now I have a sense of purpose; I can direct my vision towards Someone who will appreciate what I do and He will make it even more fruitful. The fruits may not be directly visible, but they're there. Placing God as our Ultimate Master, higher than our worldly masters, automatically motivate us to give the best that we can, in whatever we do, with honesty and love. If we are to present our works to the King of all kings, we would definitely present only the very best, wouldn't we? The judgement from peers and human masters is no longer relevant.

Saturday, 8 October 2011

October's theme song, for the Blessed Virgin

A music video I created to the hymn "Immaculate Mary" and its Indonesian version "Di Lourdes di Gua". Dedicated to the sweetest Mother Mary. Enjoy!

Wednesday, 5 October 2011

When you forget this aspect of life

Once in a while I feel helplessly sick of medicine and the medical life. It's not the kind of feeling that makes me want to reconsider my chosen path (at least not seriously). It's more like, the feeling of loneliness, the feeling that no one understands you. You can still get by, but the flames that you thought would always be there to keep your strides spring, are gone. Which is odd, I know, because as a medical student doing clerkship, I'm surrounded by exactly the "right" people, the people who should share a lot of similar experiences and similar thoughts.

Truth is, there are times when I feel like everything is automated. People move like robots---efficient yet heartless---and they merge into the very walls of this big old hospital. Existing but not quite. In a field that deals with life, there is no life. In a field that deals with humans, there is no humanity. In a field that wants every sick person to be normal again, there is no normalcy. Thus, the loneliness. [and this emo thought]

And so in a day like these, it's a relief to be able to read about real people in medicine. That's why I subscribe to so many blogs by med students and doctors. They are essentially telling the same thing: Hey, we're in this together. We're gonna be fine. YOU are gonna be fine!

Also, the great thing about these bloggers is that, they are all so infectious in their zeal, their humor, their perspective. This is what I seldom get. Too many people whine and complain and cry over trivial stuff. Granted, some people may thrive on stressful atmosphere, but not me. I like eustress. But not distress. I get frustrated easily when surrounded by whiny stressed out folks (especially those who think that they need to broadcast their distress so that everyone will know about it, and consequently become distressed too).

Have you tried taking a break from yourself? Trust me, a few hours of that is worth it. It has helped me reduce unnecessary preoccupations, helping me to not take myself too seriously. Once in a while, just pause and step back and see the bigger picture. Get things into perspective, learn what it's really all about.

For all medical bloggers out there, keep blogging! You have no idea that even while blogging you can save someone from committing suicide, do you? (not that I have contemplated suicide myself)

Tuesday, 4 October 2011

Serenity Prayer

God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.

Living one day at a time;
Enjoying one moment at a time;
Accepting hardships as the pathway to peace;
Taking, as He did, this sinful world
as it is, not as I would have it;
Trusting that He will make all things right
if I surrender to His Will;
That I may be reasonably happy in this life
and supremely happy with Him
Forever in the next.


Sunday, 2 October 2011

"Sorry, your angel wasn't too angelic, was she?"

From Twitter:

Baby: "God, if you send me to the earth now, tell me my angel's name."
God: "You'll simply call her, Mom."

Sweet. But wouldn't be so sweet if the scenario continues like this:
Baby: "God, why did my angel kill me before I was even born?"