MedBlogs Grand Rounds XXIX

Welcome to the twenty-ninth edition of MedBlogs grand rounds, and the first hosted by a retread remedial Host Emeritus.  Thirty three bloggers submitted thirty five posts, and the diversity of topics and range of experience is amazing.  (Another blogger was added, involuntarily, so that makes 34 MedBloggers represented).

The Categories, in Utterly No Order:
Editor’s Choice, if only because it take a lot of guts to write about your up-close and personal experience with a vesuvius of poo, from Mediblogopathy:

I watch it cover the commode from left to right and spray the wall, the windows, the vertical blinds, the IV pole, the bedside table, and the nightstand. I felt more than saw splatters hitting my pants and shoes.

And you thought YOUR job was bad…

Science
Sumer’s Radiology Site wants to alert us to research demonstrating a common term in medical practice probably isn’t very useful, by posting an entire abstract:

CONCLUSION: Infiltrate is a nonspecific and imprecise term when it is used as a radiograph descriptor, and use of this term does not usually enhance patient care.

Noted.  I’ll use the word "blotch" from now on.   On a different and much more gruesome note, GrrlScientist has some questions about all those birds being killed in the name of avian flu:

How are so many birds killed in such a short period of time? Who kills them? What happens to the birds? bodies after they are dead?

  That IS the happy part.  You’ve been warned.

Training
First you have to get into training, and BardParker has data, and analysis, too!

One thing I thinks this makes abundantly clear, the solution to the primary care problem does not lie in providing more residency training slots, as they can’t fill the ones they have even after reducing the numbers.

In training, Anonymous Clerk puts his philosophy training to the test, and comes up short vs. Kant:

Philosophy 101: Kant believed we must always act "So that we could will the maxim of our action to be a universal law." … I am not there for their benefit, they are there for my benefit. I use them as learning tools. In order to become a doctor, I have no choice but to treat these patients not as ends in themselves, but as means to the particular end of furthering my medical knowledge and increasing my clinical experience.

Dr. Chaplin discusses his choice of specialties, i.e., why a man goes into OB-GYN:

The first thing "wrong" is that a man, by virtue of being a man, cannot be expected to understand women’s health issues.

  It’s a two-parter (so far), so make sure and read the next installment.

Practice and Experience
I’m So Sleepy gets the blood stirring:

This is an anesthesiologist’s nightmare. We have all sorts of tricks and techniques to control the airway. But sometimes we fail.

Geena had a patient come to say thanks:

I love when patients come back to visit. Sometimes we never know what’s become of them unless one of us remembers to ask one of the docs.

Dr. Charles has entrepreneurs for lunch, and it made him wonder about another future:

Someday I may tire of the committee meetings, the prohibitive overheads, and the HMO-dictators who second guess and block my better judgments. I?ll set up my own practice and see only fee-for-service health plans in which a modicum of physician autonomy is preserved. I?ll see poor folks for free several days a month.

  A wonderful vision. 
The Cheerful Oncologist (who has a new home, bookmark it) actually eats in the cafeteria!  The Well Timed Period has something to say about abstinence:

If you are using the abstinence* birth control method and you engage in sexual activity, it doesn’t mean you are no longer using the method. It means you are using the method either incorrectly, or inconsistently; the very definition of typical use.

Tales of an Md/PhD relates that docs need to be careful of the expectations they give:

After her accident, she was told by her doctors that she’d be "back to her normal self" after 6 months or so of a rehab program. But of course, most TBI patients never really return to the same person they were before the accident.

  Last but not least, KevinMD has more on the Tedy Bruschi case (he’s a linebacker with the New England Patriots).

Money and Medicine
Aggravated DocSurg asks a great question:

…what if we find that good quality care is more expensive, rather than a means to control costs?

Galen‘s group is thinking about Medicare cuts, Hospice Blog feels a good case can be made for their cost effectiveness, and BardParker is back again with the story of medical bargain hunters, which he doubts will go both ways.  (Me, too).

Law, and Reform
Dr. Tony is writing about the President’s medmal reform initiative, Red State Moron (best blog name, ever) comments on banning video from childbirth:

Really, I don’t care "how it’s going to play on TV".  It is not TV.  …  Can’t see?  I’m in the way of the camera?  Too bad.  There’s a complication?  Commotion?  Panic?  Yeah, that happens.  Sometimes it is not pretty, either.

and Political Calculations has discovered something missing in King County: Brains! 

…their local Medical Examiner’s office has been selling the brains of the recently deceased for profit without either their consent or the consent of their families.

Yikes!

Medical Records and Privacy
Frm Dr. Bob at The Doctor Is In comes his experience with the EMR:

The answer ? like most things in medicine ? is far more complicated than it looks.

  And he knows whereof he speaks.  Interested Participant is also looking at medical records, but of the compromised variety:

Police are investigating a burglary of two computers from the San Jose Medical Group which reportedly contained the names, addresses, Social Security numbers, and billing codes for as many as 185,000 patients.

He points out these are HIPAA violations.

The Doctor as a Reporter
Saint Nate:

Ever wonder what it’s like to be medical journalist? Here’s what a typical day covering a conference is like: 7:40 a.m. Wake up. Realize the alarm clock didn’t work. Start the day with a good, deep scotch burp. Eventually roll out of bed when you realize how close you are to falling back asleep.

  Wow, just like a real journalist!

Medicines, Safety and Politics
Dr. Andy is rightfully bent about Elidel, a cancer risk, and alleged inadequate notification of study participants:

…Imagine it turns out the medicine might cause cancer, and that the FDA is particularly concerned about long term use and use in young children. What would you expect the study investigators to do? Cancel the study …? Inform the parents of patients …? Or do nothing?

Incredibly, the answer to the question is do nothing.

  On another hand is the Bextra withdrawl from Health Business Blog:

Something?s gone terribly wrong here. The pharmaceutical companies made a big mistake … And after the FDA was caught asleep at the switch, it may have overreacted to the latest data.

JournalClub, returned from hiatus, discusses the NEJM’s latest article on lipid lowerers:

Although this may well be justified, the data presented here do not quite make the case but are spun with great skill.

Galen writes, convincingly, of the differences between free-market choice and controlled-market duty regarding contraceptive prescriptions (and other things).  Lastly, some good news via medGadget: the Polio vaccine, one of mankinds’ greatest triumphs, turned 50 today!

Things which Defy Categorization, but will be Categorized Here
TV and Movies
Dr. Emer watches more Sesame Street than I, and noticed that the Cookie Monster has sworn off cookies!  He has photos to prove it, but they’re frightening.  Bioethics Dude took in a movie about Che Guevara and learned a lesson about the difference between empathy and sympathy.

Letter to the Commenter
Never tick off Orac is my latest credo.

Behold: I see you’ve found my humble blog. Your sarcastic little comment about how you’ve supposedly discovered a "blog dedicated to the celebration of conformity" amused me, but unfortunately that is an incorrect characterization. In fact, Respectful Insolence is a blog dedicated mainly to science, evidence-based medicine, and skepticism (none of which alties like yourself appear to understand or embrace)–plus whatever else the inimitable Orac feels like blogging about at any given time.

Hospital Disasters
StreetDoc links to an unusual occurrence: bees in the ED! 

Unwelcome visitors swarmed the emergency room at St. Mary?s Hospital Thursday evening. Hundreds of bees – putting the building into internal disaster mode for hours. Just in time for a party celebrating the hospital?s new ER, hundreds of bees arrived.

  Not to be outdone, Houston’s medical center had their disaster made into a TV movie!

The flood portrayed in the movie was actually the third major flood for the medical center. I was working at The Methodist Hospital when the Texas Medical Center (TMC) flooded for the first time – 1981 I think. What an experience…

via Connectlogist Tim Gee.  (I thought that’s what you got by dialing 0 on the phone, but I was mistaken).

Drug Testing
Nick of blogborygmi, who started this whole MedBlogs Grand Rounds mess (thanks, Nick!) has to endure the indignities and physicial discomforts of a urine drug test.  Again!  Heh.

And Lastly,
The Effect of the Daylight Savings Time Change on ER Docs by richard[Winters]MD:

Time jumped forward today one hour and I am so jet-lagged.

Yeah right. I’m a shift working emergency physician.
As if I have any circadian rhythm.

  Amen, brother.

Hosted next week by GrrlScientist.

MedBlogs is growing, and you are all to be commended on excellent posts!

If I missed your entry, Mea Culpa, and put it in the comments.