Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

Chloe Turns 1!

Happy Birthday!

Today, our beloved Cavalier King Charles puppy, Chloe, officially turns 1 year old!  I may be a bit biased, but she has become my favorite doggie of all time!  Here is a photo from earlier today of her basking in the early morning sun on our balcony.  Have a special day today, Chloe!

I Deleted Facebook after Twelve Years

Yesterday, I deleted my Facebook account.  The decision was made after nearly a year of back and forth thinking.  I surprised myself, questioning, “Should I delete my account or not?  What will other people think?  What will I miss?”  In the minutes after deleting my account, I felt emptiness and — dare I say — a little anxious.  Those feelings quickly faded.

In the grand scheme of things, it’s kind of crazy to know that Facebook was a “free” service I had been using since ~2006.  Opening an account just before I entered undergraduate school, it was fun to stay in contact with people my own age.  Even through undergrad and med school, it helped me stay in contact with family.  Doing some high-level math, my total time investment equates to TWELVE years of loyalty to Facebook, the social network.

Valued at $500 billion dollars as recently as July 2017, the wealthy corporation, whose mission is to “Give people the power to build community and bring the world closer together” has amassed TWELVE years’ worth of my data.  The problem is this data, either in part or whole, has been patently been exploited for financial profit.  In my opinion, it is unlikely that Facebook will stop using targeted advertisements, which requires lots of user data.

Impetus to Delete My Facebook Account

Unknown extent of the (ab)use of my account’s data.

There are numerous well-written articles (see list) describing the now-famous data breach by Cambridge Analytica (CA), wherein Facebook data of 50 million users was stockpiled in an effort to develop profiling models of U.S. voters in an attempt to manipulate human behavior.  Data included user identities, “likes” activity information, and friend networks.

The NY Times reports that “Cambridge paid to acquire the personal information through an outside researcher who, Facebook says, claimed to be collecting it for academic purposes.”  The vehicle to acquire this data was a survey that some people voluntarily completed.  The same NY Times article also reports that “Only about 270,000 users — those who participated in the survey — had consented to having their data harvested.” A list of predicted traits were eventually developed by a researcher associated with CA, including:  neuroticism, openness, IQ, political views, job information, whether one allows self-disclosure, and many others.  Per the NY Times article (website link in this paragraph), CA still has copies of Facebook user data.

TIME magazine shed light on the fact that Android cellphone users had call and text messaging log information transmitted to Facebook over several years.  Some screenshots show call type, contact’s name, and duration of the call.  These people entrusted Facebook Messenger, granting access to their phonebook contacts, so they could use the app.  However, it seems to be less clear to the end-user exactly the level of detail uploaded to Facebook’s system.  Interestingly, Facebook users who did not use the Messenger mobile app do not seem to have been notified their contact information was transmitted to Facebook.

Although I am simplifying matters here, I want to stress the seriousness of these events.  Users’ data was unknowingly used for financial and political profit.

Deactivation vs. Deletion

Knowing that we have the option to “deactivate” or “delete” our account is important.  If deleting your account, consider downloading a copy of your Facebook data (in “settings”) and also downloading any tagged photos uploaded by other friends that you want to save (must be done individually).

According to Facebook’s official website, here are the differences:

  • Deactivation
    • Profile/timeline are temporarily taken down, no longer visible to public.
    • Messages and “some other information” are still visible to “others.”  Language is vague here and needs more detail.
    • Simply log in and pick up where you left off.  All data is intact.
  • Deletion
    • Once processed (takes ~14 days per Facebook), you lose all access to your old account.  Request may be canceled by logging back in.
    • Could take up to 90 days (three months) to delete information in backup servers/systems.
    • “Some information” still is visible to others.  Vague language again here, needs more specificity by Facebook.
    • Facebook still retains log records and “some material,” but assures the person’s name is “disassociated” from this material.

Screenshot Source: Facebook.com, date 3/30/2018.

Moving Forward

The benefit of using Facebook does not outweigh the harm, or specifically, the use of my account for profit using techniques I do not agree with.  Similar to when I deleted my Instagram and Snapchat accounts, I feel a renewed sense of focus and presence in the here-and-now.  I sincerely hope we as a society are able to find a way to communicate with friends and family that does not exploit our information for profit.

Moving forward, I plan on using “old school” modalities including text messaging, phone calls, and email.  For now, I plan on keeping my Twitter account because it allows me to easily follow authentic medical doctors, medical journals, and other healthcare professionals.  My hope is that tech companies make a concerted effort to adhere to privacy rules and avoid transfer of user data in unsavory ways.  Transparency using plain language is key.

More Reading

The information on this post has been gleaned from the following well-written news articles.  I suggest anyone who is interested in this topic to read more.

Photo credit:  https://unsplash.com/@stickermule

My Last Month of Wards as a Resident: Reminiscing

With only one week remaining in my final month of Wards (adult inpatient medicine), I’m finding the moment bittersweet.  Undoubtedly, there’s a sense of nostalgia.  I remember my first day of Wards, not knowing the answer when an RN asked me, “Can the patient in room [632] eat breakfast?”  I remember hours spent answering the onslaught of pages from the floor pager when on-call.  I remember the metamorphosis when my title changed from “intern” to “senior,” and all of the new expectations that came with the new position.

Internal Medicine residency is rigorous, but it’s something I am so incredibly thankful for.  Wards is considered one of the more rigorous rotations, since it includes working six days/week and 24+ hour calls.  The remarkable amount of information I have learned throughout 12 months of Wards, over the past two and a half years of residency, has molded me into the young physician I am today.

Time Management:  According to Each Year of Residency

Since beginning residency, “efficiency” has signified different things.  Intern year, solid time management equaled seeing all of my patients and writing all of my notes before the unwritten deadline (e.g. when our attending liked signing them).  Slowly but surely, I ultimately learned to formulate my own medical treatment plan independent of my senior.

Second year marked another keystone moment in my training when suddenly I had to manage a list of 20 patients, two interns, and a medical student.  Time management at this stage meant staying on top of admission orders, completing admission med reconciliations, updating medication/treatment orders, and answering “upper level” management questions that were filtered via the interns.

Now in my third year, I am working on fine-tuning my practice of medicine and deeper learning.  It’s expected that I know how to treat common illnesses, but third year residents also need to expand on our relatively small knowledge base so as to better care for patients.  Increasing efficiency when admitting patients, prioritizing sick patients, and identifying who may soon become very sick is consequential.  Finally, learning how to coordinate with the RN and even radiology technicians can have a management-altering impact!

What I Hope to Take With Me

  • Remember the lessons learned from both positive and negative patient outcomes – be mindful of improvements to patient care.
  • Each attending has something amazing to contribute – take a few positive elements from each one and formulate my own ideal way to practice medicine.
  • Always approach each new intern/resident with respect.  Also understand that I may teach them something valuable, even if it seems mundane to me.  Conversely, I need to keep an open mind and realize that a junior may know something I don’t!
  • Prioritizing and time management is imperative!  It can help enhance medical care, and even save lives.

Learning During Residency – How to spot an effective teacher/mentor

I love Internal Medicine residency training.  I am blessed to be at a fantastic program.  For the past several years, my medical practice – and career – has been molded by attending physicians.  I often sought out the “best” teachers/mentors to help.  Here’s my guide to pinpointing an invaluable teacher-mentor during inpatient and outpatient clinical rotations.  This applies to anyone training in clinical medicine – from nurses to medical students, residents, and beyond.

1.)  Approachability

Friendly and easy to talk to should be keystone elements in a mentor.  Renowned mentor leaders in academic medicine should and – most importantly – can be approachable.  A lot of brilliant people in academic medicine are fantastic physicians, but intimidate students and residents.  Some people argue that to be respected, one must behave in an authoritarian way.  Anecdotally, this is unequivocally false.  Residents prefer to work with attendings who treat them with respect and encourage learning.  This translates into better patient care.  We physicians are here to treat patients.

The average resident does not need to be coddled, but does need a mentor who is easily accessible and responsive.  Approachable means the student or resident can discuss face-to-face/call/text any clinical scenarios and pose questions at will.  This greatly augments real-world learning for the student and resident.  Honestly, it is the #1 most underrated attribute in an attending physician.

2.)  Knowledge

Self-explanatory.  The student or resident physician expects that their mentor be an expert in their field.  Adult wards attending doctors need to impart clinical expertise on their team.  This includes the art of medicine.  There are innumerable instances where a clinical guideline (that any resident can read in a textbook) doesn’t exist or is published on “expert opinion.”  A true mentor will provide timely medical decision making advice to help the student and resident learn.  Finally, when a procedure is indicated, the true mentor will give the resident hands-on experience under a watchful eye.

3.)  Networking

To a certain extent, once you’ve begun residency, your career path will be influenced more so based on who your mentor knows.  Yes, you are expected to be a competent doctor and know how to treat patients.  However, an excellent mentor will help guide his/her student/resident/fellow in a number of ways.  This includes suggesting relevant conferences and events to attend.  One of my mentors helped me attend the ACG/WCOG conference here in Orlando.  Intimidating at first, it turned out to be a really nice experience.  Networking provides a way to help others in medicine become familiar with you, exchange ideas, and advance your career.  I have a tendency towards the introverted side when it comes to professional networking, but am rapidly learning that meeting other like-minded professionals is extraordinarily fulfilling.

4.)  Research Guidance

Although my primary focus as a physician is to care for patients, attention to publishing journal articles is also crucial.  I wouldn’t be in the position I am now without it.  Publishing in print/online journals shows peers you seek relevance in academia and want to expand mankind’s knowledge.  A quality mentor will proactively assist with editing and submitting manuscripts — or find a colleague who will get things done.


  1. Approachability
  2. Knowledge
  3. Networking
  4. Research guidance

The four key items listed above need not be in a single mentor.  One of the most important things I have learned since starting residency is that combining two or three mentors can get one started on the best path to the career of choice.  The rest is up to you.

Keep the faith, and seek out the people who embody the ideals you desire in yourself.

Endoscopy Simulator

Thought I’d share a photo of my residency program’s GI endoscopy simulator!  Earlier today, I had fun testing out some of the EGD and Colonoscopy scenarios on this machine.  Once a month, our program allows for “Simulation (sim) Lab.”  Essentially, it’s an hour-long block wherein residents practice code blue 90’s, rapid responses, central line insertions, and even practice with the simulator.

Interestingly, not only does this simulator attempt to recreate life-like images while you manipulate the endoscope, but it also includes a fully-functional biopsy/intervention channel.  This allows the user to position biopsy forceps, epinephrine injection needles, and more.  Really cool technology!

GI endoscopy simulator

Simulator is ready-to-go for the next clinical scenario!

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