Grand Rounds, Volume 3, Number 11

Welcome, all, to this week's Grand Rounds. Thanks to everyone who worked with me to get the party started - what a great group of bloggers! As of tonight, I've had 37 submissions. Alas, I can't fit them all in with comment, but I will at least link each somewhere in the post.

In the Trenches

I love the stories from the front lines of practice.

Protect the Airway tells a compelling story about saving a cancer patient from an overdose of pain meds, and rising above judgment to give her the care she needed in while treating her like a human being.

Kenneth J. Trofatter describes the role of prenatal aneuploidy screening and patient counseling in making a tragic birth outcome a little less difficult - moved me to tears!

Sid Schwab of Surgeonsblog muses on the real-life tensions between surgeons and medical types; the real thorn in his side is internists referring to what they do as "cognitive work," which seems to imply by contrast that surgery is non-cognitive.

On a cheerier note, GruntDoc demonstrates what young wannabe docs can do to make an impression on him - a little sucking up never hurt anyone.

Kim at EmergiBlog offers docs for a little consideration, please - clean up your own sharps, for starters - and let her do her job, and do it safely. Furthermore:

I can appreciate the fact that you find the nursing notes indispensible. I’ve worked with doctors who could not have cared less if I had written haiku all over the front of them, so your appreciation of my documentation is admirable.

Your willingness to take my notes from me at any time, regardless of how critical my patient is or how imperative it is for me to chart-as-I-go is NOT admirable.

Scalpel or Sword recounts the unorthodox career path of an ER doc - don't judge him because of his training!

Research
Hsien-Hsien Lei at Genetics and Health reminds us that, hello, the genome is complex, people, so don't be shocked by phenomena such as copy-number variants.

The genome is already interesting and complex enough without the need to overdramatize it.

That means not just the media, but you, too, scientists.

Yes! Steven Palter, docinthemachine,
tells us how you to live to 100: just make sure your mom is under 25 when she gives birth to you. Oh... wait a sec... Anyway, IF that association holds up (I'd love to see the epidemiology study - can someone find me a copy?), and IF you have access to a time machine, the secret is in the telomeres.

Dr. Anonymous briefs on this week's new research findings on chemo-brain - now there's evidence of a neurologic basis for the phenomenon; with luck, the findings could spur further research to understand and address the problem.

Policy, Public Health, and Insurance

Bloggers interviewing bloggers - what a great idea. Nothing like a good one-on-one dialogue to add show-biz sparkle to a blog. I don't know about you, but I'm picturing Jon Stuart or Ellen DeGeneres behind a big desk, with, oh, Maureen Dowd or maybe Sting in the hot seat. Even if the interview actually occurs via email. A mutual admiration society, you say? Sure, why not?

To that end, rdoctor interviews Hank Stern of InsureBlog, where Hank offers some opinions on health insurance and the health care crisis. Then Hank offers his own post: further thoughts on the recent survey of Americans regarding who should pay more for health insurance.

Colorado Health Insurance Insider bemoans the waste of money from "routine" childbirth procedures like episiotomy (no longer recommended as a routine procedure, by the way) and unindicated cesarean sections. (I'd add that the docs blithely disregarding prior discussions with moms in these cases is pretty egregious as well.)

Dr. R.W. Donnell, in Notes from Dr. RW, urges readers to beware of "woo" - scientifically unsupported alternative medicine - particularly when it's combined with allopathic offerings. Dr. RW, and others, I'd like your thoughts. Not to plug alternative medicine - ANY modalities used on patients should be tested if possible in randomized studies - but how can patients be sure that "standard" procedures and treatments are evidence-based? What about that full-body scan, or the drug that's been around so long no one's ever tested its safety in an RCT? Is that not, in effect, a form of woo, too?

Fixin' Healthcare offers some thoughts on the role of academic medical centers in health reform. I'd like to hear more about this!

Then in Tales from the Emergency Room and Beyond, Cous in CA makes a case for offering the human papillomavirus (HPV) vaccine to men...

while The Blog that Ate Manhattan takes HPV test manufacturers to task for undermining the doctor-patient relationship.

Health Business Blog offers some thoughts on how to make biotech drugs cheaper, since the difficulty in standardizing their manufacture makes it hard to produce viable generic alternatives.

And finally, let's have a belated moment of silence in honor of World Aids Day (Dec. 1); Dr. Deborah Serani offers a few facts and figures to ponder.


Adolescent Health

Mother Jones at Nurse Ratched's Place offers a tough-love approach to misbehaving adolescents and the parents who let them get away with it. Not in my hospital, she admonishes.

Andrea Giancoli of The Family Fork ponders bariatric surgery for teens - is it too risky for kids?

And in a bit of news sure to stir up discussion, Nancy Brown at Teen Health 411 tells of web-based networks (e.g., via Facebook) of people who'll buy Plan B for underage women, no questions asked.

The Patient Perspective

Good for Amy Tenderich of The Diabetes Mine - she's written a guidebook for diabetics on managing their care, in collaboration with Dr. Richard Jackson of the Joslin Diabetes Center in Boston. The book takes into account disparities in diabetes care, and how hard it is to keep up if you're among the 90% of patients who don't meet the ideals of blood glucose, blood pressure, and cholesterol.

Six Until Me describes an intimate moment of mutual caring, in which a man administers his partner, who is a diabetic, her insulin for the first time. Some excellent writing here.

Hands-on Advice for Practitioner and Patient

Jolie Bookspan in The Fitness Fixer presents a strength and balance exercise that involves sitting on the floor (and getting up again) without using your hands. Harder than it sounds!

Not My Second Opinion offers practical tips for patients and docs on how to deal with wounds. In the blogger's perspective,

I'm fond of scars. They impart a sense of history with pain and suffering, then regeneration and recovery. They mark a person as different and the scar-bearer is changed forever.

For parents, some myths about child safety from Dr. Enoch Choi...

and a post from Clinical Cases and Images on the limits of treating anemia in chronic kidney disease.

Mental Health

If you were dying of cancer, you'd be mad, too, says Dr. Crippen, the NHS Blog Doctor. He asks for common sense in mental health treatment, as well as hospice care, for the terminally ill, and spare him the political correctness.

Tales from the Womb recounts an encounter the writer had with a patient who goes on at great length to demonstrate to the doctor that he is Jesus Christ. This excerp is nice:

“You're telling me that you are totally drug free, right now, as we're sitting here talking?” I found this much harder to believe than the fact that he thought he was Jesus Christ.

Thank goodness, some hope in a depressing world. JonMikel, MD, at Unbounded Medicine presents a new treatment for depression. Harmless, though? I don't know... I still think I'd like to see the RCT data - what if you get hit over the head with one?

And some words from the Anxiety, Addiction and Depression Treatments, advocating for better mental health treatment for prison inmates and parolees.

Combating Hype in Health News

Two bloggers after my own heart:

Sandy Szwarc at the Junkfood Science carefully takes on media flogging of the benefit of folate supplementation in lowering homocysteine levels (another alleged benefit), for preventing heart disease. She also takes the media - and the federal government - to task for misrepresenting the risks of the so-called "obesity crisis."

Paul Auerbach at Outdoor Health regrets the hype surrounding an "attack" on a trainer by an orca (killer whale) at Sea World - they're wild animals, after all, not house pets.


Spirituality

Last two. Then can I go to bed?

In Rickety Contrivances of Doing Good, Susan Palwick - a wonderful writer - describes the role of the ER chaplain...

and Cynthia King at Cancer Treatment and Survivorship offers guidance on spiritual help that family members can offer relatives with cancer.

Whew!

And for completeness:

The Neonatal Doc
MSSP Nexus
Sumer's Radiology Site

Next week's Grand Rounds will be hosted at Anxiety, Addiction, and Depression Treatments.