Grand Rounds is six years old. Considering things age in hyper dog years on the internet, that is a lifetime. What Nick Genes put together has been impressive. For the past year I’ve gotten to be a part of it. Today Grand Rounds, in my opinion, continues to serve an important function as part of the social network of medical bloggers. It continues to be a reference point for the medical blogosphere. It’s important; which is why I’m here putting this together at 3 am instead of sleeping prior to my call.
To the wonderful bloggers who make Grand Rounds work each week, “I don’t know half of you half as well as I should like; and I like less than half of you half as well as you deserve.”
I imagine Grand Rounds continuing to go strong but it only does so on the efforts of those who contribute and volunteer. If you’re interested in hosting a future date of Grand Rounds please drop me a line.
I’ve picked a few from amongst the dozens of excellent posts submitted. Consider it my quirky self indulgence to go with a couple of narratives this week.
As the house officer drew up a dose of morphine, the old physician spoke, “Doctor, at which medical school did you train?”
The house officer told him.
“Ah, well then, do you know John Hunter?”
“John Hunter… The man who grafted a human tooth onto a cock’s comb, who stole the corpse of the Irish Giant, who described semen held in the mouth as having a warmth similar to spices and who proved the contagiousness of venereal disease by self-inoculation?”
I recall the thrill of reciting the Hippocratic Oath for the first time as part of a ritualistic White Coat Ceremony. It felt like the incantation somehow connected me to a long line of great men, from Hippocrates to Benjamin Rush to my childhood family doctor. It marked a distinct line between the life I had already lived and the medical profession that was to become a considerable part of my identity. But is the Hippocratic Oath an outdated, out of touch relic in the complex modern world?
From The Patients Perspective
I’ve learned a lot from the patient bloggers who contribute to Grand Rounds. As well, they’ve been the backbone of making Grand Rounds work. Kerri and Amy and Laurie and others have never shied away from helping make Grand Rounds work. This week they all come strong again with their submissions
Up until now it’s been all about me and my #$%@ chronic illness. That wasn’t so bad, for me. Far tougher is the realization that someone you love — someone who’s been the rock of your existence — may not be so invincible after all.
Luckily, my brother-in-law is a physician in Germany, and after hearing about the symptoms, suggested we might be facing a case of Lyme disease.
Phantom exercises help decrease pain in patients with traumatic amputations and phantom limb pain. Although a small study, the researchers showed that “exercising” the phantom limb results in better pain relief than just general exercise.
1. Practice What You Say
2. Never Tell On A First Date
3. Be Casual Yet Confident
Patient safety is a healthcare discipline that takes a critical look at how well intention meets outcome. It’s one of the six key dimensions of quality described in the IOM reports that first quantified how often people are harmed as a result of seeking care, then outlined improvement strategies.
Today’s list allows me to share 25 tweeps I’ve identified as valuable patient safety resources, visionaries, or exemplars.
[My physical therapist and I] talked about writing and teaching and graduate school, and we talked about rescue dogs and traffic and commuting.
And even though she was there because I have PCD and bronchiectasis and I was literally choking in phlegm before she arrived, it didn’t really come up.
It wasn’t that my illnesses were invisible (um, hello hacking cough and vigorous clapping) but they were not defining.
Until three years ago, I was also a marathon walker and a racewalking coach for an organization that trains endurance athletes who raise funds to fight blood cancers.
I never got better. I never walked another half-marathon. I never got back to my daily routines. I never felt healthy again.
From The Providers
That doctors, nurses, pharmacists and others find time to blog shows the value of online self publishing. Maybe as one of them taking time to do so I’m a little biased. Like most I tend to actually on intermittently touch on actual clinical issues and instead comment on life within the health care system.
of the things i encounter in my work, the one i find most disturbing is family murders. for some reason they happen with too much frequency in our country. it seems that some people, when life is too much for them are not happy to only put a bullet through their own head, but they feel the need to wipe out their entire family first. in my opinion it is a dastardly and cowardly act for which there is no excuse…ever.
Last month, I was intimidated to learn that all consultation notes had to be dictated, having never had to do this before. Ok, I was downright worried! Fortunately, the hospital has a service that handles the technical side, and they even gave us Residents a little brochure with the standard headings to start us off. I clung to that yellow tri-fold of paper for dear life.
At the risk of being ridiculed, I volunteer to be on the Emergency Medicine Death Panel! I relish the opportunity to establish some futility and idiocy standards. We need to declare what is clearly dead already, what will certainly be dead in a few moments, and identify elements of the system which we would all be comfortable seeing dead.
Death is an important player in EM and yet shockingly, we habitually/traditionally/culturally fail to recognize death and make ridiculous statements about it.
I have commented on this topic multiple times in the past. In short, medical blogs are not a source of “actionable” medical information. The same principle applies to Wikipedia. You must be treated by an expert – not a “crowd” – as in the “wisdom of crowds” concept used by Wikipedia.
It’s like the scientists think if they keep reporting the same evidence, eventually someone will listen. A new study in Archives found that exercise is still good for you. And it’s never too late to start.
Healthy Business, Policy, Technology & Law
It is a great time to be wonkish. That might be a poor adjective. It is an interesting time to be wonkish. The potential for change of the American health care system is there and likely, even if the change proves less dramatic than some would like. Indeed this week is policy heavy and our bloggers comment on a whole range of issues. One of them even celebrates a birthday to go along with Grand Rounds.
Baucus’s 233-page “leaflet” of a health bill captures the essence of President Obama’s reform framework, including key insurance reforms like restricting denial of coverage based on pre-existing conditions, an individual mandate on basic insurance, and the creation of insurance exchanges. In contrast to the other bills, this particular bill can be loosely summarized by a couple of numbers.
In 1997, after undergoing daily dialysis for five years, she received her first transplant. Most of the cost of the dialysis and the transplant, totaling hundreds of thousands of dollars, was absorbed by the federal Medicare program, which provides broad coverage for those with end-stage renal disease.
By late 2003, her transplanted kidney had failed, and she returned to dialysis, covered by the government at $9,300 a month, more than three times the cost of the pills. Then 15 months ago, Medicare paid for her second transplant — total charges, $125,000 — and the 36-month clock began ticking again.
“If they had just paid for the pills, I’d still have my kidney,” said Ms. Whitaker
The Health Business Blog is four years old with over 2000 posts.
I wonder who gets the better deal, the car salesmen whose profession is to sell cars all day long or myself whose profession is to manage all day long. It will be like this with the meaningful use implementations. Everyone is going to be running the race, so before you begin the race. Let’s talk about obstacles for the race pertaining to vendor management.
Are some things that we tend to regard as essential really not that important? Could they perhaps be doing more harm than good?
One of the problems facing our health care system is that there are so many people involved who are looking out for their own best interests, rather than what is best for the system as a whole and patients as individuals. The sheer force of the lobbying power that has descended on Washington this summer is evidence of that.
Hopefully as time goes by and CER becomes more common, we’ll see health care that is influenced primarily by science, data, and patient outcomes, without regard for who may or may not profit from the results of the research.
[David Goldhill] notes, quite wisely, that “insurance” is generally used to pay for unexpected expenses (tree falls on your roof, car accident) not routine expenses. Thus (his example) nobody would think it reasonable that you would use car insurance to pay for gas while we all expect health insurance to pay for every checkup.
Therefore, he reasons, no amount of mandated cost control can overcome the intrinsic distortion created by a third party paying consumers’ costs.
In my world of oncology, some groups of surgeons and radiation oncologists have teamed up to provide prostate cancer care. Prostate cancer can be often be treated by either modality. In the older procedure-based model, these two groups would have fiercely competed for the same patient. But, working together, they can actually do what’s best for the patient.
Consumer Driven Healthcare will arise as “consumers” themselves slowly chip away at the walls and take over city.
In the midst of much healthcare reform talk, not Alzheimer’s Disease reportenough attention seems focused on ensuring healthcare systems’ preparedness to deal with cognitive health issues -with Alzheimer’s Disease as the most dramatic example- which are predicted to grow given aging population trends.
With the media and political attention focused on the health insurance coverage debate, it may be hard to get anyone in the U.S. to think about other policy issues that affect health. But a group of prominent docs, including ACP president Joseph Stubbs, are giving it a try. They published a letter in BMJ and The Lancet urging politicians to take strong action on climate change.
The Clinical Corner
Patients turn with incredible frequency to the internet for health information. So much of it is questionable, to put the right information out there is a challenge. Here are some fine efforts.
Forty percent of 120 volunteers taking anti-heartburn drugs called proton pump inhibitors (PPIs) had a rebound increase in gastric acid secretion, resulting in acid levels above their starting levels.
[A] single dose of the H1N1 vaccine will offer protection for most adults within three weeks of vaccination.
How does a person prevent gout? The basic tenet is to minimize uric acid production in the body, and/or to prevent its precipitation into crystals within the body’s tissues and fluids. There are risk factors associated with suffering from gout, so doing one’s best to mitigate these is the proper approach.
The best clinical description of asthma in later antiquity is offered by the master clinician, Aretaeus of Cappadocia (1st century A.D.). The numerous mentions of “asthma” in the extensive writings of Galen (130-200 A.D.) appear to be in general agreement with the Hippocratic texts.
Some of the best things we read are difficult to classify. They’re multidisciplinary or they look at situations in such a new light that we can’t really put them in a box. The following are submissions of note that I enjoyed but didn’t think fit into the categories above.
Bullying is also being defined more broadly now as not only repeated taunts or attacks, but as spreading rumors and social exclusion. Whether it happens on the playground or on Facebook, bullying is destructive to any community or school. Bullies and their victims are more likely than their peers to experience depression, suicidal thoughts, less likely to finish high school or hold down a job. Bullying is traumatic for everyone involved and the grief and the experience and difficulty of moving forward with life is the same as people who have lived through other traumas.
I read that McKinsey, one of the leading Management Consultancy firms is expected to recommend 25% cost cuts at Vogue. They have already advised a 10% staffing cut in The NHS to achieve a saving of £20 billion by 2014.
In actual fact the NHS could have saved even more money by doing away with the likes of McKinsey.
That does it for Grand Rounds this week. Marking six years. I hope you enjoyed it. Until next week at MedLibLog take care.