MedBlogs Grand Rounds 2:17

MedBlogs Grand rounds features the best writing about medical topics in the blogosphere, brought to you weekly with rotating hosts. Though the topics are medical, the posters do not need to be for consideration.

Without further ado, a quick announcement:
Hearty Congratulations to the 2005 Winners of the Medical Weblog Awards!
(Whoever they are). The announcement will be today, over at MedGadget.



And Now, our Feature Presentation

Medical Practice

Dust in the Wind meets up with an angry former patient:

Many months ago I was involved in caring for a patient who was very badly hurt in a serious motor vehicle collision. The community I live and work in is relatively small. I have heard through many sources that this person was very angry and having many issues related to the accident. One of his most pressing concerns was that his favourite clothes were cut off.

I was the cutter.

GeekNurse wishes us to know about the Science of Correct Bear Placement. I trust there’s a medical publication in the offing.

Impacted Nurse tells the tale of tragedy, of a life cut short, and those affected by it:

And then she stepped out before him, and he braked hard, but already she had hit the car with a dull thud that was felt rather than heard, above the Mozart string quartet that he so loved, but would never be able to listen to again.
Not ever.

Doctor Disgruntled on Clausewitz, defensive medicine, and teaching residents:

One of my favorite of Clausewitz’s observations is on the subject of “friction” in the chain of command. He notes that “countless minor incidents – the kind you can never really foresee – combine to lower the general level of performance, so that one always falls short of the intended goal. Iron will-power can overcome this friction; it pulverizes every obstacle, but of course it wears down the machine as well.”

Lubb Dubb, by a cardiologist (surprise!) has thoughts on a recent JAMA paper about the OPTIC Trial for AICD discharges:

I recently consulted on an older gentleman brought in from an outside hospital who had a defibrillator that had fired >8 times in the prior two weeks. I find this totally outrageous as in my opinion these events should be equivalent to being shocked by lightning.

Doctor (formerly known as the Madhouse Madman) tells the tale of a tragic death narrowly averted, and ends with:

I’m constantly amazed at the serenenity of our “admitting diagnosis” when compared with what actually happened. Or what could have.

Dr. Charles, one of the truly gifted writers in the MedBlogosphere, Tells of the Four Packs on One Match a day lady:

“Yes, young doctor, that’s right,” she rasped. “One match at seven A.M., and I’m lit for the rest of the day. But don’t worry; I won’t smoke in your office.”

Kevin, M.D. says:

It’s ridiculous to think that doctors lower their standard of care based on whether their patients have the right to sue.

and gets an argument in the comments.

sleepdoctor points out something I hadn’t thought of: Bedwetting child? How do they sleep?

However, pediatricians frequently neglect to ask their enuretic patients about symptoms of obstructive sleep apnea, a common cause of nocturnal enuresis.

The Cheerful Oncologist, one of our other bright-star literary medbloggers, has an allegorical tale that very well describes the relationship between physician and patient. If I had a regular practice I’d frame one for every exam room.

Dr. Emer (Phillippine Blog Award Winner) comments on the recent Lancet study that showed iron supplementation for iron-deficient children actually made their malaria outcomes worse, and points out that his country of the Phillippines has both.

Robotic Surgery Blog has some interesting questions following a big surgery on a very elderly patient:

Heroic measures as patients get older. What patients are too old for what type of care. In any other country I do not believe (the patient) would have received this operation.

The use of an expensive technology- what kind of benefits really exist?
One of the criticisms of robotic surgery is that it costs more and is unnecessary. In properly trained hands, this story shows what kind of benefits can be achieved. My previous four nonagenarians all spent 9-14 days in the hospital and all needed rehab stays of about 2 weeks prior to going home.

Anxiety, Addiction and Depression Treatments attempts to answer an important question:

…what is the relationship between traumatic events and drug and alcohol addiction? Can a traumatic event, such as 9/11 be used to explain a drug problem, and therefore, the actions that might result from that addiction?

After poring over the voluminous literature that has been published on the comorbidity of drug addiction and post traumatic stress disorder, the answer appears to be… maybe.

Agggrivated DocSurg gets the award for the best post title: The Straight Poop on Anal Fissure Therapy. And then proceed to tell us how to fix them

Ever had an anal fissure? Speaking as someone who has treated many folks with them, and who developed one in medical school, I can assure you that they are a wee bit painful.

Red State Moron talks about prenatal diagnosis and termination, and ends with:

…the way in which information is conveyed regarding birth defects (chromosme anomalies included), can have a substantial influence on a patient’s decision to continue or terminate a pregnancy complicated by a fetal anomaly. Which I think is unfortunate. All the more reason to try to provide patients with as much data as possible, whenever possible, prenatally.

Intueri has a pateint who notices something in nature missing in his life:

“Does that bother you?” I asked, uncertain why it would.

“Yeah,” he sadly answered. “They can organize their lives better than I can.”

Health Information Technology

The Healthcare IT Guy is trying to organize a healthcare blogger author/reader meetup:

Your friendly neighborhood bloggers are considering a meet-up at the HIMSS ’06 conference next month in San Diego. Will over at Candid CIO came up with the idea and it met with unanimous approval of it being a great idea through several e-mail exchanges with other bloggers this weekend.

The Medical Blog Network wonder if the Wikipedia effect will carry over into medicine and publications:

Wikipedia is giving closed-source encyclopedists a run for their money. We will keep watching Medscape / WebMD progress.

on the same note,
Clinical Cases and Images Blog has a nice point/counterpoint to the ‘medblogs/wiki and peer-reviewed content’ idea:

Point: User-created content has the power to expand and correct peer-reviewed content. Then, you need Google Medicine to find what you are looking for in this enormous mash-up of blogs/wikis/journals/books/sites that we call Web 2.0.

Counterpoint: Peer-reviwed literature is not going to be replaced by individual blogs. The Web 2.0 phenomenon is very new and we still have not figured out what is the best way to use it in medicine.

The idea of “open content” is great but what if the content itself is not that great?

Actual point and counterpoint added by me.

Medical Connectivity interviewed some tech folks you’ve never heard of who are trying to bring order to the “wireless wild west” in hospitals. Until reading this, I hadn’t really thought about it, but there are so many different wireless systems in my joint it’s a wonder they work at all. Read to see what GE is teaming up to do about it.

Health Policy

NHS Blog Doctor (a new blog that’s really taking off) has a solution for the NHS’s funding woes:

The only way to solve this is to put a charge on the front end. I have said it before. I am saying it again, and I will keep on saying it. The last time I said it I got over two hundred e-mails from people, most of whom remain wedded to this nonsense of “free at the point of entry.”

The NHS is only “free at the point of entry” when it is not closed.

Health Business Blog has something to say about the economics of Pharma, while taking an editorialist to task. Here’s the teaser:

The writer assumes that companies will stop selling their drugs in low-price markets and that the US price for drugs is the “market price.” In fact, pharmaceutical companies have been able to practice price discrimination —

In a first for me, three blogs not only commented on the same topic (States requiring a certain percentage of their payroll on healthcare for their employees), but submitted their posts together, as complimentary! So, here they are:
Insureblog starts it out with:

Statements like “employers should pay for it” and “requiring companies to provide health insurance” reveal a stunning ignorance of how our system works:

Heath Policy says:

The problem with states compelling coverage is that, while they have the muscle to do so, they don’t necessarily have the resources to cope with the fallout.

HealthPolicyConcerns.com says:

We are not a pure capitalist society…we regulate how much profit ends up being made in many different ways. Companies are free to make fair profit, not unfettered profit.

Those are just snippets, and there is some thoughtful input in the comments.

Fixin’ Healthcare wonders if WalMart might just have some answers in health care:

Now, Wal-Mart is using its business model in an attempt to drive down the cost of health care plans. ….., who better than Wal-Mart and their business model to further test this approach?

Medviews has a solution to the closure of hospital-based Diabetes centers:

Let hospitals do the work that they were meant to provide- acute care. Let the outpatient folks do what they are geared up to do- provide care in an integrated fashion in a community setting

DB’s Medical Rants on the pharmaceutical industry: the good, the bad, and the ugly. He’s got some reform ideas:

1. Require the FDA to have the pharmaceutical industry fund independent studies on new drugs. …
2. Outlaw DTC advertising. …
3. Require transparent drug pricing. …

medpundit thinks companies firing people for smoking off the job is wrong:

Some companies have taking to firing people for smoking – at home. There’s an awful lot of hue and cry about our loss of freedoms at the hands of the Bush Administration, but it seems that there’s much more loss of freedom at the hands of medicine. It’s an example of medical advice taken to an extreme.

Hospital Impact wants us to think about the Hospitals of the Future:

…there is some evidence that better design actually leads to better care. Check out the Center for Health Design’s Pebble Project. While these great results can’t all be attributed to design, “evidence-based design” is an inevitable force of the future.

Interested-Participant reports some New Zealand research on the psychological effects of abortion, and has a prediction:

The abortion rights advocates will be screaming about this research. I’m sure they’ll dispute the methodology of the study and significance of the findings. It’s also probably a safe assumption that the mainstream American media will downplay the research, if it’s reported. And, that’s a big ‘if.’ Leftist news outlets likely will not want the public to know that abortions lead to long-term adverse consequences.

Science

The Biotech Weblog points out the “hedgehog protein” could hold a cure:

… if we can activate the pathway, we might be able to prevent or reverse osteoporosis and simultaneously prevent or reduce fat accumulation,” he said.

Aetiology, in a post titled “Are female night owls screwed?

As I write this at 2AM sitting under annoying fluorescent lights, am I increasing my risk of developing breast cancer? Maybe, according to a recent study showing that melatonin-depleted blood can spur the growth of mammary tumors:

Oh, and several of the Science Bloggers have moved over to a sorta-group blog, ScienceBlogs

Terra Sigillata is by a pharmacologist, and his introduction is very interesting, but here’s the crux:

Terra Sigillata is a metaphor for the fact that the Earth itself has provided medicines to various cultures for centuries.

A new blog by an experienced pharmacologist, this’ll be one to watch.

Orac had a Rodney Dangerfield moment or two, and his defense of the academic research physician is passionate and pointed.

Humor in Medicine

A Difficult Patient found an automatic trivia generator, and it’s allowed several heretofore unknown tidbits to travel out. For instance:

  • It takes 8 minutes for light to travel from the Sun’s surface to GruntDoc.
  • Physicians have often been found swimming miles from shore in the Indian Ocean.
  • Jacob Reider once lost a Dolly Parton lookalike contest.
  • It is impossible to fold Dr. Charles more than seven times!
  • Until the 1960s, medpundit was not allowed to enter Disneyland.
  • Only one person in two billion will live to be Shrinkette!
  • It takes more than 500 peanuts to make “Dr. Green”.
  • There are roughly 10,000 man-made objects the size of DP (the Difficult Patient) orbiting the Earth.

Someone has a little too much time on their hands…

Pharmagossip has the answer to the question “Could homeopathy prevent a pandemic?” You’ll have to click over for the answer.

Doc Around the Clock isn’t enjoying the password change procedure in his hospital:

After picking a new password at our hospital one would think trying to obtain security clearance at the Pentagon would be a walk in the park. Here is a recent adventure I had in trying to choose a new password and the continual pop-ups I would get when I would find my password invalid.

I feel a rant coming on this, myself.

Emergiblog has an extraordinary tale, a first-day nobody would ever forget. I won’t ruin it by abstraction. Just read it.


This was my third time to host, tying me with Geena. (That whole Gunner thing, again).

Next week’s host: Kevin, M.D.

Obligatory and heartfelt thanks to Nick at Blogborygmi for getting this whole thing started, and for his PreRounds series on the Grand Rounds Hosts (requires free registration).

I’ve enjoyed my reign as “Best Medical Weblog”, and hope the crown rests well on the next brow. The only thing I’m really going to miss is the jet.


Comments

  1. A splendid roundup. The one-post rule also meant that we had to omit another good post on why/how the majority of physicians should consider using blogs in daily practice:

    “Physician Blogging: How to Get Results Worthy of Time & Effort”

  2. Great job on this weeks GR! And you are right, I do have too much time on my hands (I’ll have a job soon . . .)! Hey, with all this time on my hands, I found this as well: http://www.titane.ca/concordia/dfar251/igod/main.html (don’t go there if you don’t have a sense of humor)

  3. Another great job! Thanks for hosting!

  4. Great job, and thanks for taking our triple submission :) BTW: My blog name is HealthyConcerns, not HealthPolicyConcerns. Thanks!

  5. Great job. Very well organized. A lot of work but a lot of good information. Thanks for including me.

  6. Hey Doc, fabulous work organizing these timely topics…and hosting for a third time, no less?!? I’m honored that you selected my introductory missive for this week’s edition. You’re obviously a physician with great wisdom and compassion – hope I live up to expectations.

  7. Excellent Grand Rounds this week. Thank you for your efforts in putting this together this week. It is really well organized and comprehensive.

  8. Thanks to all, though obviously Abel hasn’t read this site much.

  9.  
    Terrific job, Doc!

    And a Special Thank You for the way you handled our little “gang post.” ;-)

    Have a great rest of the week!
     

  10. Rosemarie@MikeMathisProds.com says:

    Hey GruntDoc! Just ran across your blogsite and I must say, you are quite an interesting guy. I’m producing a show called, “E.R. Mysteries” for Discovery and I would love to have you tell one of your E.R. stories. Did you ever have trouble diagnosing a patient right away and the presenting symptoms were baffling? It would be great if you eventually unraveled the mystery and saved that person’s life. Please write back when you get a chance! Thanks!

  11. Thanks Doc,

    I appreciate the time and effort you put into this.

    Dom

  12. Very nicely done. This is the first time have have seen Grand Rounds. I can promise I will be a regular visitor.

    One day I hope my blog will be “up there in lights.”

  13. Thanks to all of you who are in medicine and blog – I’m a medical librarian and Grand Rounds is required reading for me every week and has led me to some wonderful information and insight – and a ton of new blogs to read!

  14. Sheila M Blanchet RN says:

    I am just wondering if anyone has any opinions on the increasing use of nurse practitioners and physicians’ assistants in primary care practices. I took my kids out of a family practice group for many reasons but the biggest reason was that as soon as this group hired a bunch of PA’s suddenly the doctors were always just “too busy” to see my kids when they were sick. The best I could get was an appointment with a PA. I had to get downright nasty and put my foot down to get them in to see an actual physician. It wasn’t long after that that the doctors were also too busy to be bothered to do their routine physicals. I would be told an appointment with a physician would mean waiting between four and six months, but, hey, if I would agree to seeing a PA they could pretty much get me in that very day! It struck me as coercive and very poor medicine since it meant that for all intents and purposes my kids had doctors in name only. Their healthcare was to be entirely provided by PA’s with no physician overseeing anything. I don’t buy the idea that these people operate under the direction of a physician. No physician would even so much as poke his or her head in while we were there to see what was up and what was being done about it. Recently my own internist had his wife, who took one of those fast track MSN Nurse Practitioner programs designed for people with degrees in other areas (in her case an MBA) with absolutely no requirements for any prior clinical, medical or nursing experience at all, join his practice. Now it’s the same thing with him. After ten years of being able to see him when I’m sick, now only his wife is available for sick visits, except for heart attacks I presume. I called yesterday because I had a fever, sore throat, ear pain and a cough productive of green sputum and was told I could see her or nobody; a first in his practice. The receptionist did helpfully offer to let me see him some time next week. What is going on in primary care? I read all kinds of articles bemoaning the lack of respect for internal medicine as a profession and then doctors behave like this. I don’t see the point of doctors calling themselves primary care providers if they can’t be bothered seeing their own patients when they’re sick, or, as in the case of patients who need to be hospitalized, who abandon their patients to the care of hospitalists whose credentials and skill levels the patient’s own physician can’t possibly know. I have already switched the kids’ care to a pediatric group whose doctors see their own patients no matter what and I will be leaving my physician as soon as I can find another who won’t dump me off to a barely trained nurse practitioner when I’m sick. I should have seen the writing on the wall with the family practice group. They couldn’t wait to dump their hospitalized patients on the hospitalist group. One of the doctors cheerfully explained to me that for him it made it possible not to have to spend an hour driving all the way back and forth to the hospital to see just one patient. Now he could use that time in the office to see four or five patients, not just one. How nice, huh! The office patients are not only less complicated, but you can cram more of them into an hour’s time and increase your fees substantially to boot! Any comments?

  15. “I am just wondering if anyone has any opinions on the increasing use of nurse practitioners and physicians’ assistants in primary care practices.”

    Yes, yes, yes. This is now causing a real problem in the UK. Not in primary care, though, where you will still see a physicina, but in the hospitals, where what we call “nurse specialists” are now front ending the system. They are doing colonoscopies, cystoscopies, they are seeing patients referred from primary care with possible malignancies….. I could go on….well actaully I do go on and on and on about this on NHS BLOG DOC.

    Of course, the “nurse specialists” only see the NHS patients. Private patienets who pay, the prime minister and members of the Royal Family still see doctors.

    See particularly http://nhsblogdoc.blogspot.com/2005/12/sue-and-dave-and-hospital-at-night.html
    and read the reference under “Sue and Dave”

    …and any article under “Dumbing down”

    Hospitals in the UK are being stripped of doctors. It is a nightmare.

    John

  16. You are wonderfuland great.Since my English is not so good,only i can say that you are filantropic person and you have done the best for humanaity.Continue the same.” Verba volant scripta manent”.Your faitfully Dr.Xhavid Duraku

    (ed: Verba volant scripta manent translates as: “Nothing is built on stone; all is built on sand, but we must build as if the sand were stone”, by Jorge Louis Borges. I rather like that.)

  17. Jim in Texas says:

    Well done from a non-medical guy. You multi-task very well!!!