Grand Rounds 5:1 – In Your Own Words

I’m honored to co-guest-host this week’s Grand Rounds. Without further ado, here’s Dr. Val Jones.

Welcome to the historic, 5th year anniversary of Grand Rounds, the weekly summary of the best of the medical blogosphere. As the proud new co-leader of Grand Rounds, I am committed to expanding its reach, promoting the Grand Rounds “brand,” and making sure contributors’ voices are heard by healthcare’s movers and shakers.

This day happens to be historic for me as well, since I have just taken the leap into blogging independence. I’m excited that “Dr. Val and the Voice of Reason” lives on at the Getting Better Blog. I am committed to integrity, transparency, and medical accuracy ““ presented in a warm, and down-to-earth manner. Unfortunately, my new site is not live yet, so KevinMD and Kim from Emergiblog have graciously allowed me to crash guest blog at their sites for this edition of Grand Rounds.

I’ve chosen to present the submissions in their authors’ own words ““ the purest form of expression. I selected my favorite quote from each blog post, and organized them topically with an introductory cartoon of my own. The order in which they appear reflects the order in which they were submitted. Asterisks denote exceptional story-writing (IMHO).

Thank you for reading ““ and please consider supporting Grand Rounds by featuring its new button on your blog or website. Health bloggers have a collective voice ““ it is Grand Rounds!

The Healthcare “System”

Dr. Wes, Our Healthcare Hindenberg: “I wonder how any health care system, much like the foregone housing market, can sustain itself with our current similar mindset of universal, limitless healthcare for all”¦ Like the 12-step program for Gambler’s Anonymous, we must first acknowledge we have a problem and are addicted to shiny objects, the opulent, and the whizbang. Only then can we start to recover from our healthcare spending orgy.”

Dr. Rob, Holes In The Bottom Of The Boat: “Simply put: any system put in place must have a means of cost-containment ““ something that is missing from most plans. It is as if we are talking about getting a bigger bucket to bail the boat rather than patching the holes in the bottom of the boat that are spewing money. Any system in place that does not contain cost somehow will fail.”

Doc Childneuro, Those People: “Insurance companies have a motive to charge or exclude the smokers and the obese. It turns out they have the same motive to exclude those with Cerebral Palsy and Multiple Sclerosis. This motive applies to any family with cystic fibrosis or sickle cell disease, or an entire host of genetic disorders.”

Louise, Domestic Medical Tourism: “Large employers are increasingly interested in networks that allow their employees access to hospitals all across the country, providing a much wider range of cost and quality of health care options for their employees. Large employers have bargaining power, and some have already struck deals with foreign hospitals, which they’re able to use as leverage to bargain down the prices at domestic hospitals.”

Allen Roberts, Transfers: “And, the hard and ugly truth: transfers have allowed a lot of very dysfunctional hospitals to stay open, IMHO. A hospital cannot get Ortho coverage for the myriad reasons specific to that specialty? Well, just transfer them to a hospital that does. In this way, bad hospitals (administrators and medical staffs alike) aren’t confronted with their failures, their failures are transferred. The inadequate hospital now doesn’t have to face angry patients and their families for their inability to manage their medical staffs, they just defer their responsibility to those who are just that: responsible.”

Bob Coffield, HIPAA: Can you release medical information to family and friends?: “The Office for Civil Rights has issued new guidance for providers to follow when assessing whether or not they should provide protected health information (PHI) to the friends or family of a patient under HIPAA Privacy Rule 164.510(b).”

Kim, Wheels Are Turnin’ ““ Blog World Expo, 2009: It’s not “maybe” anymore. We’re on. Put in your vacation requests. Get a passport if you need one. Sign up for those extra shifts. Arrange for coverage while you’re gone. October 15 – 17, 2009, Las Vegas, Nevada. The medical/health blogosphere will have a full track of presentations at BlogWorldExpo09.The missing ingredient is you.


David Williams, Obama v. McCain on health care. Part 4: Premium subsidies and tax changes: “Obama’s plan would be better than McCain’s if enacted as described, because it would reduce the number of uninsured while McCain’s plan would have the opposite effect. However if McCain’s proposal led to a cap on employer deductibility as a compromise ““which seems likely”“ I’d favor it.”

Hank Stern, Mo Money: “The government doesn’t have any money of their own. Businesses do not pay taxes (or civic rent).The government derives income from taxpayers. Businesses derive income from customers. Bottom line is, we all pay.”

Being A Doctor

PalMD, So Would You Do It Again? “The financial stresses of being a young doctor (including starting a practice, having a family, caring for patients, etc.) are tremendous, and our system pushes the talent away. Still, for people who love medicine, love other people, love to wake up every morning knowing that you are making a concrete difference, the sacrifice in time and money is worth it.”

Vitum Medicinus, Join me on my first on-call shift, and find out why I slept so little: “5:21 pm ::: Fell asleep on the toilet while eating a granola bar.

5:36 pm ::: Woken up by a patient who claimed I was sleeping in his bathroom”¦”

Bongi, Sign: “He swung his hand back with the index finger extended briskly in the sign demanding the scalpel. The prof threw his hand onto the scalpel’s point. I imagined an old Japanese warrior throwing himself on his sword.”

Bruce Campbell, Uncertainty: “My vacation had ended up delaying his surgery by several days. I could not deny that.’Oh, Doctor, I was so certain that the cancer would have grown too large for surgery by the time you got back into town! I was certain that he would die!'”

Dr. Shock, Emotional Intelligence and Medical Education: “The nurse-rated patient doctor relationship (PDR) and the Emotional Intelligence (EI) score for the doctor were positively associated with patient trust at a significant level. A doctor’s self reported Emotional Intelligence did not correlate with patient-rated trust, or the patient rated quality of the Patient Doctor Relationship.”

Dr Skakhi, You’re Not A Real Saffa [South African] Doctor Until You Have: “Seen worms exiting the human body via anus, nose, mouth & laparotomy; cauterised warts the size of cauliflowers; stopped wearing a mask around TB patients (pregrad)”¦”

Joshua Schwimmer, The Medicine 2.0 Congress: “The first “Medicine 2.0” Congress happened on September 4 – 5 in Toronto, Canada. You’re justified in being confused by “” or even skeptical of “” any concept released under the version number “2.0” (or, even God help us, “3.0”). But the people who gathered under the flag of Medicine 2.0 early this month are actually doing interesting work.”

Jeffrey Leow, House 106: The Socratic Method: “Why are specialists doing this U/S and interpreting them? What was the radiologist/US technician doing?”

Dr. Carson, The Ugly Side of Being a Doctor: “I’ve resuscitated babies in a Walmart and a pizza joint. I’ve run to multiple car accidents and performed the Heimlich in restaurants. I answer questions daily for readers, friends, neighbors and strangers. I keep an otoscope charged in my kitchen. I make house calls and advise friends. I have two websites. I make no money but dream of funding humanitarian missions. Because I have time and medical knowledge, I hope to use it well.”

Diagnostic Conundrums

Allergy Notes, Allergy to Wine? Correct Diagnosis May be Wine-Induced Anaphylaxis and Sensitization to Hymenoptera Venom: “Wine contains many contaminants. Some of them come from Hymenoptera insects that fall into the wine when grapes are collected and pressed. We have found patients with allergic symptoms related to wine consumption who are sensitized to Hymenoptera venom without previous stings.”

Laika Spoetnik, Nursing Myths (1): Post-operative Temperature Measurements. “Routine temperature measurements in post-operative patients have a very low sensitivity, a low positive predictive value and meaningless likelihood ratios.”

Robin S, Fiona Apple may just have it right…: “Pituitary tumors have a large spectrum pathology. These’little buggers’ may cause large problems, also.”

Patient Education & Perspectives

Sudeep Bansal, MD, Gray’s Anatomy Vs Real Doctors: “There is a lot of inaccurate information on television. According to this survey people remember health information imparted on TV, probably more so than given to them in their doctor’s office.”

Rachel Baumgartel, Heroic Diabetes: “Jay Cutler hasn’t seen too many negative comments around Denver media – if anything, it is portraying him as the heroic diabetic (if any mention of his new condition is made at all). His health was starting to decline last season, but could that really be the only reason the Broncos declined as well?”

Clinical Cases, Google founder Sergey Brin starts a blog, shares he’s at risk for Parkinson’s disease: “Sergey shares that he has a mutation in the gene LRRK2 which carries markedly higher chance (in the range of 20-80%) of developing Parkinson’s disease”¦He says,’This leaves me in a rather unique position. I know early in my life something I am substantially predisposed to. I now have the opportunity to adjust my life to reduce those odds (e.g. there is evidence that exercise may be protective against Parkinson’s). I also have the opportunity to perform and support research into this disease long before it may affect me.'”

Amy Tenderich, Five Things I Learned About HealthDesign: “There are so many people with diabetes (and other burdensome conditions) out there struggling just to make ends meet. Fancy new technology is not helpful for people who have no access to it.”

Julia, Nomenclature: “Why isn’t there a better nomenclature for something as life-altering as fatigue? Ideas, anyone? I’ll start: Phylum:’lying-on-the-couch-like-a-giganticus-slugiae’ Class:’stinkus-maximus-no-shower-for-two-daysium.'”

**Kerri Morrone Sparling, Twenty-Nine: “Some people will say that being diagnosed as a kid is easier because you grow up with this disease [diabetes] and it becomes your “normal” without much effort. Others say that an adult diagnosis is easier because you have decades without the disease, thus maybe lowering changes of complications. From my perspective, I can’t even wrap my head around an adult diagnosis. I only know what I know.”

Laurie Edwards, The Words We Use: Language and the Patient Experience: “For patients who have struggled with diagnosis for years, finally having a name for their symptoms can be incredibly validating. It also confers membership in a community of patients with the same symptoms and struggles, which, given the isolating nature of some chronic illnesses, is important.”

Dr. R, The Sandwich Generation: “I already knew that I was in The Sandwich Generation; where I have to care for both my aging parents and my own children. But I did not know that I was in The Sandwich Profession; where a primary care physician could be sandwiched into the smallest possible space in a humongous building.”

**Barbara Kivowitz, Putting Illness in its Place: Betty & Peter’s Story of Pancreatic Cancer: “Couples dealing with illness understand too well how illness turns a relationship of equals into one of patient and caretaker. Autonomy slides into dependency; activity is regulated not by interest but by stamina, and time gets measured by intervals between medication doses.”

Health Tips

Ramona Bates, Graduated Compression Stockings: “Graduated compression stockings are useful in preventing deep venous thrombosis (DVT). Like many things, they only help if used and if used properly. A recent study showed that up to 26% of patients had the wrong size stockings.”

Jolie Bookspan, Getting The Right Yoga Medicine: “In modern life, it is common to sit too much. The answer is not more sitting, but to get up and stretch the other way. The concept is not just mystic yoga, but common sense.”

Paul Auerbach, Farewell To Outdoor Falls: “Mountaineers fall from precarious ledges, youths fall from slippery rocks near the edges of waterfalls, rock climbers fall off boulders, and hikers get dangerously close to the edge of poorly maintained trails, from which they plunge into canyons”¦”

Dean Moyer, Back Pain And Anger: “Over 60% of the people surveyed were feeling somewhere between irritable and downright hostile just prior to the bonehead move that earned them a ride to the ER.”

FreshMD, Wet Nurses: “A wet nurse is a woman hired to breastfeed another woman’s baby. Having fallen out of favour in the Western world around the end of the nineteenth century, wet nursing has recently been making a small resurgence. Women who want their child to benefit from breast milk, but want to return to work full-time and don’t want to pump, for example, outsource the nursing to the hired help.”

Nancy Brown, The Importance of Family Dinners: “If you could reduce the chances that your child would smoke, drink, use illegal drugs, misuse prescription drugs, and have friends that did those risky things – all in less than an hour a day – would you do it? Of course you would but the research suggests that less than 60% of families are doing it – and you actually only have to do it five times a week to enjoy the benefits. I am talking about family dinners – at least five times a week – how easy is that?”


Next week Grand Rounds will be hosted by Monash Medical Student. Be sure to submit your best posts to him this week! If you’d like to be sent more information about Grand Rounds, please email me at [email protected].