MedBlogs Grand Rounds 2:6

Grand Rounds, which is hosted each week by a rotating group of bloggers, is the easiest way to stay up to date with the best writing in medical blogs. Grand Rounds shares the same purpose as the annotated table of contents in printed medical journals like the NEJM and the Annals of Internal Medicine: it introduces noteworthy writing and encourages further reading.

I have the pleasure of hosting Grand Rounds this week. Here are the blogs:

Another great collection, and a day early, to boot!

Update: Added the required link. Update 2: Fixed the link. Sorry, folks.

Gates gives £28m to malaria team

My favorite Billionaire:

Microsoft billionaire Bill Gates is donating £28 million to a UK university as part of a £145m ($258.3m) gift to malaria research worldwide.

The Bill and Melinda Gates Foundation is supporting three international projects over five years.

One project at the Liverpool School of Hygiene and Tropical Medicine will look at ways to control the mosquitoes that spread malaria.

Others will look for new malaria drugs and environmentally-safe insecticides.

Mr Gates said malaria was a “forgotten epidemic”.

“Millions of children have died from malaria because they were not protected by an insecticide-treated bed net, or did not receive effective treatment,” he said.

“If we expand malaria control programs, and invest what’s needed in research and development, we can stop this tragedy.”

I’ve railed about malaria being ignored in other posts. Bully for the Gates Foundation for putting their riches toward helping others.

Where are the Physician Leaders?

I received a thoughtful email the other day, and though I only have partial answers, I wanted to share it and give my response.

I follow health care issues in the newspaper and on radio. I am as far from understanding the complexities of medicine and patient care as Pluto is from Mars. But, I often ask myself the question, where are the docs? The issues concerning health care: rising costs and the uninsured, sharpen with each day. Can the medical community organize among themselves and take a leadership role in implementing solutions for these issues? Can physicians be more than influential advocates? Can the medical community take the initiative to develop a health care system that is responsive to all, regardless of financial circumstances? By applying their culture of excellence, they can be valued by all who seek relief, not only by those who can afford it.

This is a good (series of) questions, and one I’m not terrifically well equipped to answer, as my role in medicine is in the practice and not the administration of medicine. However, I’ll give my grunts’-eye view.

Can the medical community organize themselves and take a leadership role? Well, probably not, but for several reasons. Some of that has to do with the analogy that getting more than three docs to agree on a policy is like herding cats, but also with the realization that there isn’t any one, or even series of answers to the major questions of reimbursement or access that a majority of docs agree on. Single Payor has its proponents, and they make impassioned arguments. Those opposed to a single payor system (and I’m one of them) are not willing to take the chance that the unknown devil is better then the one we have, and there’s not much middle ground there.

Can physicians be more than influential advocates? Not unless there’s a considerable shift in the focus of an awful lot of physicians who decide to embark on a career in politics. The solution to health care and costs isn’t in the hospital, or the state medical society, or with the AMA, though all are active in their respective legislative domains.

Ultimately, the ‘answers’ are political ones, they aren’t easy, and they aren’t made exclusively or even largely by docs. They’re going to be made by politicians, and ultimately by the voters (our patients).

UAB Nurses Rap!

I’m a big fan of ER Nurses, but not of rap music. Why do I mention those two interesting things in one sentence?

Because the University of Alabama (Birmingham) ED nurses have the best Emergency Nurse rap video I’ve seen! For the record, I’ve seen exactly one, but it’s terrific!

UAB ER Nurses Rap!

Update: The Performers are listed as “Craig Barton and Company”. Wow, terrific work!

Disclaimers: It’s a Windows Media file (.wmv), it’s 3MB big, and I didn’t create it. Also, I have no idea who made it (“the Internet is you Daddy”), so if it’s yours, let me know.

Hat tip to Nurse Kelley for the video!

US Public Health Officials Predict Plenty of Flu Vaccine This Year

US Public Health Officials Predict Plenty of Flu Vaccine This Year

WASHINGTON (Reuters) Oct 25 – At least 70 million doses of influenza vaccine will be available for the U.S. market this year and everybody who wants a shot should be able to get one, health officials said on Monday.

The Centers for Disease Control and Prevention opened flu vaccination to everyone on Monday, saying the priority groups, such as seniors, who need the vaccine first had been given plenty of time to get them.

“There is no reason for anyone to delay or go without their annual flu shot,” Health and Human Services Secretary Michael Leavitt told reporters in a telephone briefing.

In a statement, the CDC said that providers with adequate supplies of vaccine should broaden their vaccination efforts “to include other people, especially 50-to-64 year-olds, who are interested in getting an influenza vaccination.”

Last week the CDC reported that too few Americans are getting vaccinated against flu.

So, go get a flu shot.

It’s time to stop overhead Code calls in the Hospital

CPRTonight, after hearing about the 5th overhead call for a Code Blue in the hospital, it occurred to me what an anachronism this overhead announcement practice is, and quite a pointless one. I think it should be stopped, and here’s why.

First, I understand that a code requires a marshaling of resources: in no particular order, the House Supervisor, a Respiratory Therapist, the physician in charge of the patient, or the anesthesia / EM doc in house. With those people, and the nurses and techs available on any inpatient ward in the hospital a very effective code can be run, and the patient can be moved to the ICU if it is successful.

What do all those parties just listed have in common? They are in-house (except the PMD, but their surrogates count here, and the PMD isn’t going to hear the overhead page at home anyway) and they have pagers, at a minimum. They can all be marshaled in mere moments, and a discreet paging for a code would no doubt cut down on the number of gawkers who accumulate in the hallways outside the patients’ room. There’s no reason to disturb the entire hospital for a code call.

This goes double for the ridiculous practice of calling codes in the ICUs (or the totally absurd calling of codes in the ED I once worked in). Look, if you cannot handle a code in one of those places with the people you’ve got, you need to get out of the hospital business.

So, why the overhead pages? I can think of two reasons. The first is historic, the ‘we’ve always done it this way’ model. There is a need to alert a small cadre of people to come and help in a code, but that number is really very small, and with modern technology overhead calls are a disruptive throwback to olden times.

The second reason is just a guess, but I often wonder if this isn’t done on purpose, to let everyone in the hospital know that this is serious business, and it doesn’t get much more serious than a code. (Why do we call them Codes, anyway? Everyone in the hospital over the age of 10 has seen enough TV to know what a Code Blue is, it’s a euphemism).

So, I think we should start pushing our hospitals to join the 21st Century and stop calling codes overhead. I intend to start tomorrow.

No Fishing

Riding recently, I noticed how low the Benbrook reservoir is. How low is it?

tell it to the heron

This low. This is the boat dock, and that area of low brown grass is the inlet from the lake to the dock area.

As of today, 12 feet below normal (via the Army Corps of Engineers).

Survivor: ER!

I wrote a week or so ago that we’re remodeling a big chunk of our ED, and the controlled chaos resulting. The hospital and the docs agreed we should keep caring for the same number of patients (which is code for continuing our policy of never going on ambulance diversion, unless it’s for Trauma, and then we have to be pretty overwhelmed). So, the ‘new’ hall beds are crammed, and things are moving along, carried on the backs of the staff. An appreciated, hard-working staff who inexplicably don’t seem fazed in the least.

Then yesterday the lab decided to implement their new order entry system, so the unit secretaries are having to work harder, relearning ordering tasks while still juggling everything. This reminded me of something, and I decided we’re now on a reality TV show: Survivor: ER!

Some nefarious TV network is slowly turning up the heat to see who will crack first and last. I’ve decided the next big move has to be turning off the HVAC, followed by about 1/2 or more of the lights going out. I’m sure there’s more, but I have never watched Survivor, so my analogy flops there.

At any rate, the fun continues.

MedBlogs Grand Rounds 2:5

It’s up, at Hospital Impact.

I’d like to return this parrot…

Straight from today’s headlines:


The proposed EU ban on exotic birds comes after Britain confirmed that a parrot died in quarantine of the same H5N1 strain of bird flu that has devastated poultry stocks and killed more than 60 people in Asia….

e's pinin
Causing, of course, another Python Flashback:

… Mr. Praline: ‘E’s not pinin’! ‘E’s passed on! This parrot is no more! He has ceased to be! ‘E’s expired and gone to meet ‘is maker! ‘E’s a stiff! Bereft of life, ‘e rests in peace! If you hadn’t nailed ‘im to the perch ‘e’d be pushing up the daisies! ‘Is metabolic processes are now ‘istory! ‘E’s off the twig! ‘E’s kicked the bucket, ‘e’s shuffled off ‘is mortal coil, run down the curtain and joined the bleedin’ choir invisibile!! THIS IS AN EX-PARROT!!

The deceased parrot isn’t funny, but the skit is.

Toy plush available here.

The Agony of ‘BlackBerry Thumb’

Now I’m glad I didn’t get one:

The Agony of ‘BlackBerry Thumb’: “Orthopedists have been treating tennis elbow and repetitive stress wrist injuries for years now, but the advent of handhelds and video games with their tiny keypads is taking its toll on another body part: the thumb.”

Well, not really. I’d like to have one but have utterly no justification for it. Plus, I like my thumbs sans aches.

via Wired News.

LSU Medical, Nursing and Dental continue despite Katrina

Wow. Students, and their teachers, can be incredibly resilient:

BATON ROUGE, Louisiana (AP) — The sun is barely up, but the movie theater parking lot holds dozens of cars.

There’s no early matinee. The cars belong to Hurricane Katrina refugees from New Orleans — nursing students waiting for class to start.

So in Theater 4, nursing management will be followed by “Serenity.” After the Research in Nursing class, “Elizabethtown” is showing in Theater 6. An anatomy exam in 7 precedes “The Gospel.” And in Theater 11, Mothers and Childbearing Families (aka obstetrics) is followed by the Wallace and Gromit movie “The Curse of the Were Rabbit.”

“It’s just like an auditorium-style classroom,” says Jenelle Johnson, 24. “They use PowerPoint. But we can smell popcorn on our way out.”

While New Orleans’ universities will not reopen until spring semester, LSU’s medical school cranked up again just a month after Katrina, setting up shop in the state capital. Tulane’s med school opened a week later, in Texas.

“We were amazed at their resilience,” says Joe Keyes, senior vice president of the Association of American Medical Colleges.

The vast majority of medical students — LSU’s 2,800 and Tulane’s 2,600 — stayed with their schools. The dental school reports only one of its 316 students transferred.

That’s an exceptional statistic, and says a lot about their students. And, it’s good.

Michael Yon This Sunday on Pundit Review Radio

Your Sunday evening war reporting:

With so much happening in Iraq, from the trial of Saddam to the voting on the Constitution, we are happy to announce that Michael Yon will be back on the Pundit Review Radio this Sunday evening. Michael’s work is the most insightful and compelling of any reporter in Iraq, in our opinion. His ability to bring the good, bad and ugly, in the proper perspective, is unrivalled.

Anyone who follows his work undertsands that this is going to be something special.

When: Sunday, October 23, 9pm EST
Where: Streaming Live at Boston’s Talk Station, WRKO

PunditReview has done these before, and they’re supposed to be good.

Sounds interesting. No pun intended.

SoundPractice podcasts: me!

I’ve joined the club, and am now the subject of a podcast!

Kent Bottles, Editor-in-Chief of The Journal of Medical Practice Management interviews [me] of the GruntDoc.com medical blog. Several of the topics they discuss are medical blogging and its effect on medicine, why doctors are so slow to adopting new technology, personal experiences with EMR implementations, comparisons between military medicine and private sector medicine, mainstream criticism of medblogging and blogging’s self-correcting nature, expecting medical residents to know what type of medicine they want to practice so early in their career, keeping up with changes in emergency medicine, being a doctor in todays medical environment, the physician “generation-gap”, and tips to new medical bloggers.

I just listened to this, and have re-discovered that I am neither glib nor deep. Nor an accomplished off-the-cuff speaker. Dr. Bottles is a very good interviewer, and I appreciate being included.

If you have 23 minutes to kill and aren’t sleepy, here it is.

Ode to the Astrodome

Required reading for Texans, and anyone else interested in the history of the Astrodome: Ode to the Astrodome:

“It was the Taj Mahal of sports, the 8th Wonder of the world, called the ‘Can-Do Cathedral’ in response to those who said it could never be built. This vast structure was large enough to comfortably house an 18 story building. It was here that Ali danced, Elvis sang, Billy Graham preached, Evel Knievel jumped over cars on his motorcycle, and Elvin Hayes met Lew Alcindor in an epic college basketball contest. It has hosted polo matches, soccer and ice hockey games, bullfights, auto races, rodeos, conventions, boat shows, and even a little tennis match between a woman and a self-described male chauvinist pig. Robert Altman even made a movie here. It was an unmatched engineering marvel, though not necessarily a beautiful structure; Larry McMurtry once called it ‘the working end of the world’s largest deodorant stick.’

An excellent article.