MedBlogs Grand Rounds 4.31 @ Revolution Health

A terrific Grand Rounds.

Grand Rounds 4.31: How … – Blogs – Revolution Health
Welcome to Grand Rounds 4.31, Dr. Val’s edition of the weekly rotating carnival of the best of the medical blogosphere. There are many approaches to summarizing submissions to Grand Rounds, and I have chosen one that has never (to my knowledge) been used before.

Don’t miss it!

Bring Out yer Dead…Blogs

Yes, it’s that time, when I’m bored and the sidebar of links needs pruning. If you haven’t blogged in three months you’re either incarcerated or you’ve quit blogging (or both).

The following blogs are now moved to the ‘dead blogs’ list:

There are still a lot of terrific blogs, and feel free to send me a link to yours if I don’t already have it (send it through the contact form, please, and not the comments).

I’m going to miss some of those a lot.

Aggravated DocSurg: We Don’t Speak the Same Lingo

Aggravated DocSurg: We Don’t Speak the Same Lingo


I finally thought of a meme

I got tagged with the six-word meme plague recently, and couldn’t think of one, unti it just occurred to me today while driving home (and it’s weird, as I wasn’t even thinking about it consciously):

When your emergency happens, I’m ready.

Yes, the contraction is cheating.  I can live with it.

Health Management Rx: Maryland Gets Million+ to Reroute “Unnecesary ER Visits”

Health Management Rx: Maryland Gets Million+ to Reroute “Unnecesary ER Visits”

Interesting: pay a group to keep people out of the ER, without actually specifying how they’re going to do it(but giving them legal cover to try).

It bears watching.

Nurse Sean (dot) com » Change of Shift: Volume Two, Number 21

Nurse Sean (dot) com » Change of Shift: Volume Two, Number 21
Welcome to Change of Shift for April 17th, 2008. I have enthusiastically dubbed it, “The European Dreams Edition.”

Go and get it!

An engineer’s guide to cats

Hat tip: Black Triangle » Blog Archive » An engineer’s guide to cats

MedBlogs Grand Rounds 4:30

Welcome to this week’s edition of Grand Rounds, a round-up of the best of the medical blogosphere. If you’re interested, here’s my Pre-Rounds interview. Thanks to founder Nick, and to everyone who send in submissions. I wasn’t able to include them all, but hope you will enjoy these selections, in no particular order.

Go, read!

Men’s Health Talks Peyronies’ Disease

In the email:

I know the ED you usually talk about is the emergency department and not the other kind but in February, I reached out to you Men's Healthto introduce (, a website that offers men who are affected by Peyronie’s disease, both, information and support. Since the launch, it has been so exciting to watch the forum grow into a place for anonymous discussion; people speak openly about their experiences with the disease as well as pose questions that can be answered by physicians.

To keep that conversation going, the site is hosting a live chat on April 16th at 7 pm (EST) with Dr. Culley Carson – an urologist who specializes in the treatment of Peyronie’s. This is a great opportunity for people to have their questions about the disease and its treatment options addressed by an expert in the field, so I would love for you to share this event with your readers.

On the homepage, you will see “Participate in the chat on April 16”; you and your readers are more than welcome to learn more about Dr. Carson or submit comments here ahead of time if you can’t make it and have questions you would like answered during the chat.

If it interests you, tune in!

Newsweek: Top 10 First Aid Mistakes Thank heavens for emergency rooms. But sometimes the first aid measures taken on the scene before a patient arrives at the hospital can make all the difference, especially if the ER is crowded. (On average you’ll wait 45 minutes before seeing a doctor, according to the Centers for Disease Control, and longer in urban centers.)

We asked two experts, Dr. Tom Scaletta, the outgoing president of the American Academy of Emergency Medicine, and Denise King, president of the Emergency Nurses Association, to identify the 10 most common first aid mistakes—and what you should do instead.

Not bad as generic advice goes; interesting that all but one end in “go to the ER”. Even the one that needs a dentist.

Quote of the day

Tonight’s comes from some EMS colleagues, while describing a patients’ eyes during a seizure:

“He’s got a conjugal gaze”.

Now, I’ve been on both sides of the conjugal gaze, and it has never involved a seizure. So far as I know.

The actual term is conjugate, by the way.

Mere Rhetoric: TSA’s Idiotic Pilot Handgun Regulations Kept Classified, End With Accidental Firing On Flying Plane

So, here’s what happened, as a follow up to the initial post:

Mere Rhetoric: TSA’s Idiotic Pilot Handgun Regulations Kept Classified, End With Accidental Firing On Flying Plane
…On March 22, pilot James Langenhahn was stowing his Heckler & Koch USP .40, issued to him by the Department of Homeland Security… while his co-pilot prepared to land the plane. As he was placing the pistol… it discharged a single shot which exited the left side of the plane, doing little damage… Some pilots say it was an accident waiting to happen.

Seems like an accident waiting to happen to me, too. Read the post for insight as to why this happened, and will probably happen again.

Nevada: Clinics Linked to Outbreak Give Up Licenses – New York Times

Nevada: Clinics Linked to Outbreak Give Up Licenses – New York Times

Horrible.  They fully deserve to be put out of business, at a minimum.

WSJ Health Blog : Report: U.S. Wastes More Than Half of Health Spending

Health Blog : Report: U.S. Wastes More Than Half of Health Spending
Health care isn’t exactly known for its efficiency, but a new analysis from PricewaterhouseCoopers puts the value of the waste sloshing around in the system at a whopping $1.2 trillion a year.

That’s right. Trillion–with a T. The findings of the firm’s Health Research Institute suggest that up to that much “wasteful spending” could be going on, more than half the $2.2 trillion spent on health care in this country.

PwC arrived at that estimate by pulling together a lot of previous research and performing its own analysis. Still, the particulars are a bit vague, with some large ranges.

A lot of the waste is attributed to some favorite bugaboos of efficiency advocates, including ineffective use of information technology ($81-$88 billion), claims processing, ($21-$210 billion) and defensive medicine ($210 billion). Medical errors cost $17 billion and badly-managed diabetes is tied to $22 billion.

Frankly, I’m surprised the ‘defensive medicine’ slice isn’t higher. Read their blog entry for the rest of the story.

From my worm’s eye view of the health system there’s absolutely no reason for me, as an individual physician, to try to decrease healthcare spending. Oh, I’ll make it a point to prescribe generics whenever possible, I’ll gently try to talk people out of xrays they don’t need but want, but that’s about it. There are very powerful forces aligned to prevent anyone or anything from denying even the most futile or insane healthcare spending.

The Ottawa Ankle Rules are but one example. Every ED sees patients with ankle sprains, and some need xrays (but up to 35% don’t, at least in Canada). When I was with the USMC, where I could tell patients ‘no, you don’t need an xray, you have a sprain’ I taught and applied the Ottawa Ankle Rules, and was reasonably proud I wasn’t sending a constant stream of sprained ankles to the xray department for normal xrays to be taken. I mentioned this effort to one of the ED physicians at the base Naval Hospital once, and his response surprised me: “Please don’t do that. When they are off duty they come down here to get an xray of their ankle”. So, applied science and physical exam, with an explanation (I had a lot of time per patient then, and very little equipment) didn’t do it, they went around the system to get an xray. Whay? Because they wanted an xray. There’s an addiction to tests and tech in US medicine (on both sides of the equations, I’ll grant), and it’s not healthy for the patients or the pocketbook.

Nobody I know in the US even tries to apply the Ottawa Ankle Rules in civilian hospitals. Refuse to do an unindicated test? Are you bananas? The patient will insist on “Talking to your boss”, will call the patient advocates’ office, etc, and the incentives are very clear: just order the test, no matter the lack of utility.

Fortuantely organized medicine has stopped sending the message that physicians need to be the gatekeepers of healthcare spending, since there is no backup for those doctors and decisions that would do just that: deny useless tests and futile care. Ask the HMO’s how their rationing care to try to prevent escalations in cost (and save money on their healthcare on the cheap model) went over with the public, the same public that was supposedly aware that for a lower cost they were going to have to have less control over the “I want it all, now” healthcare that’s the norm in this country.

The current system is a prescription for indulgence and waste on a colossal scale. The only way to reign in the explosion of spending in this country is rationing of some sort: Free markets will ration based on ability to pay; single payor will ration based on refusal to pay and a blizzard of paperwork for everything. There is no free lunch, and we’re spending money we don’t have on tests and treatments we don’t need.

We have met the enemy, and he is us*.

Update: About the PWC report; I’ve read it, and am underwhelmed. Here’s the methodology (page 3 of the report):

About the research
As part of its preparation for the 180º Health Forum, PricewaterhouseCoopers’
Health Research Institute (HRI) interviewed more than 20 health industry and
government executives who will be participating in the forum sessions. The
forum is dedicated to change in healthcare. Reviewing the waste in health
spending was viewed as an appropriate starting place for discussing how to
restructure incentives, investments and priorities. In addition to interviews,
HRI reviewed more than 35 studies about waste and inefficiency in healthcare
and commissioned a survey of 1,000 U.S. consumers to get their views on
what constitutes waste and inefficiency in the system.

So, it’s a series of opinions with very nice graphs. As documentation of conventional wisdom it’s first rate; as a scientific critique, less so.

Rasmussen Reports™: Poll on health care coverage

The entire article is short, and there’s a lot of interesting information in there, but I just wanted to highlight the following bits (all emphasis added):

Rasmussen Reports™: The most comprehensive public opinion coverage ever provided for a presidential election.
Twenty-nine percent (29%) of American adults favor a national health insurance program overseen by the Federal Government. A Rasmussen Reports national telephone survey found that 39% oppose such a government-led initiative while 31% are not sure.

The survey also found that 46% believe the quality of care would decrease under a national health insurance program while 16% believe that quality would increase. Twenty percent (20%) say the quality of care would remain about the same while 18% are not sure.

At the same time, 42% believe the cost of health care would increase while 25% would expect prices to go down.

If I’m reading this correctly (and I’m willing to concede I might not be) though 29% of those polled want a national healthcare plan at the same time only 16% believe the quality would increase.  Granted those don’t have to be the same poll respondents, but you’d think that if we’re to embark down an untried road those in favor of it would be hoping for better care quality.  Odd.

While opposing a national program overseen by the federal government, Americans support requiring companies to provide health insurance for their employees. Sixty-three percent (63%) favor such a requirement while 24% are opposed.

Nearly everyone I’ve listened to thoughtfully about healthcare financing (and the economy) say we need to divorce employment from insurance, yet 63% want to keep the current employer-based system.  I’d like to see some more information about that preference; is it fear of the unknown, or is it a lack of understanding that employer provided healthcare isn’t free to the recipient?

An earlier survey found that just 31% rate the U.S. health care system as good or excellent.

At the same time, people give much higher reviews to their own health care coverage.

This is odd to me, and the best explanation I can come up with is that virtually all the news about healthcare is negative, so even though those polled said their individual care was good or excellent, they think they must be lucky, because all the news says US healthcare is going badly, so it must be bad overall.

There’s not a big groundswell for socialized medicine.  Yet.