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Grand Rounds Volume 3 Number 1 Happy Anniversary

Grand Rounds 3.1 Happy Anniversary

Welcome to the second anniversary of the weekly roundup of the best blog writing among health and medical writers. We’ve come a long way since Nick Genes started this weekly review as a forum of physicians writing for each other, and now have a more active participation from an incredibly diverse number of voices. Nick was kind enough to interview me for Medscape’s weekly introduction of the hosts, and I’m amazed that he has the time and energy to keep this up while in residency.

As this is an anniversary, I wanted to host a party here at Tech Medicine, and invite you to partake in the delicious treats you find at different celebrations we all love. In a few instances I’ve made the treats more del.icio.us by linking to a couple writers that talk up the same topic to give a fuller richness to the conversations‘ multiple points of view. The more we writers refer to each other’s posts and the original article we’re talking about, the more that others can find our conversations when they search on that topic. Come join the party and add to the buzz!

Here’s an overview of the party and feel free to click thru to that section (lots of entries this week!):

Party preparation:
Guest list: all are invited, even if some haven‘t come.
Appetizers: what’s a party without great food? Plenty of food & nutrition bloggers think so.
Entertainers: enthusiastic goofballs sharing and inspiring wonder

Party Proceedings:
Get the party started: the party comes to life when these folks show up
Conversation starters: hot topics among medbloggers this week
Rememberances: parties bring anniversaries to mind, and there’s nothing like giving honor to the good old days
Who’s hot and bothered and rallying for a cause: give these folks wide berth! They feel strongly about stuff and aren’t afraid to tell ya.

After the party:
Whoa... what a night! Here's what hits you in the morning.
Party gadflies: the buzz continues with the paparazzi
Continuing the party, in person: what good is a party without a reunion, in real life!

Guest list:

As Grand Rounds has had a policy of welcoming all who have an interest in sharing about their experience, all health carnivals and blog networks are invited to join in, even if they don‘t usually come, except for those in medlogs.
Health & Medical Carnivals such as Pediatric Grand Rounds and Nursing: Change of shift, or these networks of health bloggers:
The Medical Blog Network
Medscape MedStudents
Medscape Nurses
Med Student Blogring


You know, for me, a party’s only as good as the folks that get together. Of course since you all are exactly my cup of tea, the other thing that makes a party for me is the grub (and the wine but that‘s a for a different carnival):

Spinach and E. Coli tops Digg Health currently, but the articles there link to the same old, same old MSM press, rather than original opinions (del.icio.us):
The CDC's the most current, whereas NYT and CNN can't keep up.
Dr. Paul Auerbach of Healthline‘s Outdoor Health encourages us to avoid “Spinach Woes” by boiling thoroughly and washing dishes as well. I've always wondered how pre-washed veggies keep fresh. Always on point, Medpundit keeps up with the developments. Dr. Charles gives the lowdown on the culprit, E. Coli. Machine harvesting may have a lot to do with the contamination. Img courtesy of KidneyNotes.

Everyone worries about the cholesterol in our vittles and Healthline’s Health Observances pumps up National Educational Cholesterol Month as I at Tech Medicine cover a recent NEJM article about how a specific branded drug possibly helps more than the benefit from the absolute amount of cholesterol lowering.

Cynthia Sass of Healthline‘s Diet Dish in "Eating Your Feelings" discusses the food/feelings connection, how emotional eating is practically learned at birth, along with strategies you can use to help defray emotional eating.

Enjoy too many of these vittles and you may be concerned about diabetes and Amy Tenderich’s critical of but intrigued with the possibility of preventing Type 2 Diabetes suggested by the Avandia DREAM study (sponsored by manufacturer GlaxoSmithKline). Kelly Close provided her the dirt. And many are commenting on this since the NYTimes covered the story.

My friends know that I’m a total wine nut, but this ad for non-alcoholic beer strikes me as SOOO wrong

And speaking of dietary vices, if you saw me this past week at Epic’s User Group Meeting in Madison, you’d know I lived off of the “Worst Seven Foods for Health and Longevity” rather than the purported best (even though I agree they‘re delicious)

There’s Free Pizza with Vaginal Exam Practice for Vitum Medicinus, a first-year medical student, who thinks that being in medical school might take a bit of getting used to, and passes on this extracurricular activity.


What’s a party without great entertainment? Here’s our lineup:

Wow, there’s a crowd around Dr. Wes as he shares his favorite parlor trick -- no need for hired magicians!

Who’s that wide-eyed guy gesticulating wildly in the corner? I overheard he’s sharing the wonder of seeing for the first time how to briefly kill someone and bring them back with adenosine.

Quick, guess the heart murmur: "thump, swoosh, thump" or "Bang Bang Bang" or "Ka boom!" heard by William Rubin’s student

Why are those musicians averting their gaze when focused deeply into their performance? Dr. Emer say’s it’s about “HOW TO THINK BETTER” - 'looking away' has its rewards (I know this is tru for me when I argue with my wife...)

What’s a party without some game going on the tube? Bard-Parker loves his football, but reflected on the danger as the Buccaneers quarterback had his spleen emergently removed after getting sacked a few times. GruntDoc fleshes this out with pictures & video of how the Bucc Qb got fixed.

A party’s not a party without some tunes, and for our listening pleasure, KidneyNotes has a list of the newsy & medical podcasts he listens to on his iPod on the way to work.

Let’s Get this party started:

Amy Tenderich breaks the start-of-party nervous quiet with a cry of consternation plus expletive yelling there’s “Trouble in Reimbursement City” when third-party payers won't be covering continuous glucose monitoring any time soon.

Fellow acute care doc Shadowfax similarly cries out about a near-explosive experience in his ER, when a woman came “packing,” not just concealing drugs "on her person" which was the initial concern. This image caused a lot of consternation across the medblogosphere.

I fully support a physician’s choice to practice according to their conscience, and am sympathetic to this particular point of view, but I still felt badly for this gal’s experience unsuccessfully finding emergency contraception.

Another unsuccessful attempt: what happens when the patient's body doesn't cooperate: what's more uncomfortable, when a practitioner begins to lose confidence in his/her skills, or when a patient does?

Every medblogger was saddened by the loss of Steve Irwin (he did have 300 million tune in to his funeral), and my buddy Ves shows why he was so unlucky, with examples of the 2 lucky enough to survive such an injury, and follow-on commentary on the injury from my ER pal Paul.

Conversation starters:

Medical providers who are reading recognize this as a frequent question at a party, “hey doc, can you look at this rash?” Well, Dr. Paul Auerbach of Healthline‘s Outdoor Health reveals how he recently responded to a pal’s similar request in “A Diagnostic Dilemma

When my friends get together for a party the hottest topic is always our kids, and Andrea Giancoli of Healthline’s From the Family Fork chats about improving preschoolers’ health in “Preschoolers Get a "Healthy Start"“ from Dr. Christine L. Williams’ Health Start program that was tested and started in upstate New York.

If it’s not about our kids, it’s about getting pregnant, and a bunch of obstetricians are chatting in the corner:
Dr. Carl Herbert of Healthline’s The ART of Conception covers the ethics of infertility treatments when reviewing the U.S. President's Council on Bioethics report.
Dr. Ken Troffater of Healthline’s Fruit of the Womb shares “A Stitch in Time” which describes his experience assisting a pregnant patient with twins and early dilation of her cervix at 22 weeks, requiring emergency “cerclage” which helped the patient immensely.

Electronic medical records is a frequent topic among medbloggers, and all the more so this week with a NYT op-ed by recently dearly departed U.S. chief of Health IT, David Brailer who supports portability of records by funding the programming of connections between different institutions.
John Sharp of eHealth cries 'hear, hear' (pro)

An earlier NYT article supporting EMR keeps getting press among medbloggers who are all pro-EMR: 1, 2, 3, 4, 5, 6, 7 points of view.

Bill Crounse usually blogs on EMR but this week brings up how mini-clinics in retail locations like Wal-mart can improve patient convenience, but my question is does it improve the quality of care without sending records to the primary care provider, and being able to look up records from the PCP?


Some of the stories told at the party are really memorable, some stories from the trenches while they’re currently slogging thru it, and some stories from the vivid past to enlighten us of what’s occurred.

The way some remember is by continuing to help out, providing mobile medical care by RV, one year after the flooding of Katrina and Rita: Dr. Cheri LeBlanc. She was the key physician helping us work with Pastor's Resource Council Compassion when I went to NOLA to provide Katrina relief last fall. Others recall the Katrina crisis at Charity Hospital.

Dr. Charles beautifully remembers a patient whom he had the privilege of being the last to care for and reflects on others who touched her.

Stories of the old days in his community hospital as a surgeon railing against the machine, parts 1, 2, 3, 4.

Continuing on the surgical meme, Barb of Barbados Butterfly has posted a series of stories about her hard times during her first term as a surgical registrar in Australia. In 'Darker Days' Barb describes her fears, tears and self-doubts in the midst of bloody death, medico-legal dramas, heavy drinking, industrial disputes, M&M (Morbidity and Mortality) conferences and fatigue-driven naps on the side of
the highway. Parts 1, 2,

Many are recalling 9/11:
From Healthline's Cancer Treatment and Survivorship by Dr. Cyndy King, there's a connection between 9/11 survivors and cancer patients: survivorship.

Honoring our heroes is one way to manage with what terrible news we have to communicate, and Jarrad honors his oncology mentors beautifully.

Relating our own war stories is another way to honor the past, and Tinquebelle returns to blogging after a many year hiatus, relating the personal risks of and stress during delivering HIV-infected drug addled mothers and her empathy for them.

Who’s hot and bothered and rallying for a cause:

Other than the entertainers and yarn-weavers at a party, you have some who passionately pump up pressing punditry - these folks evangelize their point of view.

With all of the usual Pro-National Health Insurance blogging from Matthew Holt's THCB and Graham Walker it was interesting to hear from someone who is Anti-Single payer because of the increased wait times.

Decreasing Medicare reimbursement is leading MDs to drop Medicare from their practice, do cosmetic procedures, or leave medicine altogether, Bob Vineyard reports.

Neonatal Doc rallies a anti-eugenics cry against the abortion of disabled embryos.

The most compelling writing among blogs is the stories revealing what goes on behind the scenes. This post about the GHF concerns frustrations about patients who are frequent visitors to the ER, and how to deal with them for good (I’m specifically disgusted with this activity, as I‘ve seen it happen mostly from other hospitals in big cities “transferring“ patients to the city my residency program was in.)

One way ERs don't want to deal with them for good is this way: dying in their waiting rooms noted by A Hearty Life. (del.icio.us) Many were equally up in arms about this terrible outcome, as the Death in the Illinois ER Ruled a Homicide: in Waukegan, 49-year-old Beatrice Vance died of MI waiting in ER: Notes from Dr. RW, Medpundit, GruntDoc, Kevin, M.D., Medical Connectivity Consulting, Kevin, M.D., NHS Blog Doctor, and ProfessorBainbridge.

There’s nothing like talking money to egg on docs, and radiologists avoid malpractice litigation by not reviewing mammograms since there’s been a 50% increase in cost of average indemnification for all breast cancer malpractice litigation of $438,000 in 2002 from 1995.

Amy Tenderich’s concerned that there’s tons more workers in “Healthcare is Hot” but patients aren’t getting better care.

Susan Palwick, a volunteer ER chaplain has strong views on helping suicidal patients.

Matthew Holt calls attention to the fact that someone’s gotta be making it hand over fist with the rising costs since that represents income to someone. Elisa Camahort chimes in about healthcare company profits in the last couple of years rising with flat revenues. When's the congressional hearing?

Rallying about $4 Wal-mart generic prescriptions:
Con: If Wal-Mart's list becomes everybody's list, that means Wal-Mart is setting national health care policy. Put another way, someone at Wal-Mart will be deciding if your blood pressure will be treated with atenolol or metoprolol. Or if, after a root canal, your dentist will send you home with Lortab or Darvocet. In that light, it may matter just a little.
Pro: Fard sees this simply as brand-building but possibly challenging the PBMs if successful.

Dr. Anonymous considers the FDA a bureaucracy without merit and next week's Grand Rounds host thinks clinical trials are sometimes without merit as well.

Some shoutin' goin' on in the corner supporting rehabilitation of sex offenders.

And a whisper in another corner about possible asymptomatic bird flu, which I have not read anything about and would doubt based on the severity of illness of those affected to this date.

Local medblogger Kim notes that nurses who provide all of the care and don't delegate are better nurses for it -- they know what's going on with their patients.

After the party:

Have you ever woke up the morning after and felt a tinsy bit of regret? Here are some folks who’ve shared that regret, and others find a way to redemption.

Fat doctor, whose I’ve loved for her personal accounts of treament for stroke, struck out last night, stone drunk, then hung over. Nice to know medbloggers are human, and thank goodness for anonymity (i hope it stays that way).

A little sore when you got up? Dr. Jolie Bookspan, Healthline’s Fitness Fixer discusses “Fixing the Commonest Source of Mystery Lower Back Pain

Here's a step-by-step path back to Babe-dom full health.

Regrets about missing hints by the signs of patients although they refuse to share symptoms.

Regrets about through medical training having “had the experience but missed the meaning… [professors] who trained me would fit better with ‘had too much experience but deliberately (dis)miss the meaning‘

If you follow that cup of hangover-chasing coffee with 4 more, you could possibly reduce your risk for Alzheimer’s (if you were a rat that is).

There’s nothing like cuddling up with that morning coffee, watching medical TV dramas, and HIStalk's best news he's heard: Season 1 of St. Elsewhere will finally be available on DVD on Thanksgiving weekend. Not only is it the best medical drama in history, it may be the best TV series ever. I've never seen a TV show that could make you laugh and cry at the same time. ER and its ilk are a pale comparison. "Paging Dr. Howard, Dr. Fine ..."

Topher considers the consequences of that dreaded call from the cute gal you hooked up with the night before -- “I’ve got Chlamydia” and the awful complications it can mean for you.

Party gadflies:

What’s a party without the gadflies that gossip about what’s going on? The great thing about this party is that everyone is invited, including the media, and they’ve been turning out in full force, on TV, in the papers like USA Today, and the New York Times.

Everyone’s worried that some camerapic is going to betray a revealing pose at the party, and here’s an audiocast reviewing PDA phones for use in mobile healthcare.

We're even watched by Search Engines & meme monitoring services:

While on the topic of Search Engines, how could I not mention the buzz about Healia this week (even though this is a Healthline blog, hurrah for editorial independence!):
John Sharp of eHealth (pro)
Carol Kirschner Driving in traffic (pro)
Her doc (pro)
David Williams (con) who provides a detailed example how Google performs better, with a response from Healia in the comments.

Continuing the party, in person:

If you’d like to get together as health & medical bloggers in the real world, there are a few places we’ll be meeting:

CDHCC Dec 11-13 Consumer Directed Health Care Conference at Consumer Health World Located in Washington DC, where I’ll be speaking on Health Blogging.

HealthCamp (in planning) an unconference like BarCamp.

As announced in previous editions of Grand Rounds, The Medical Blog Network and Envision Solutions, LLC are running the first global survey of healthcare bloggers. The final survey results will be presented during Healthcare Blogging Summit 2006 in Washington, DC. Please take a few minutes to learn about and take this important survey. The poll closes this Friday, September 29.

Whoa. What a party. I'm looking forward to the buzz we make, and hope it leads to more conversations about hot topics. Here's to blogging! Cheers!

Thanks to the folks listed below in "links to this post" for the link back, as well as these that google didn't notice:
Dr. Helen, Sunlight Follows Me, Alwin Hawkins, Dr. Emer, The Tundra PA, Kim of Emergiblog, Clinical Cases, HealthyConcerns, PharmaGossip , Alas! Dissect Medicine and Kevin, M.D..

Remember to send your entries for next week's host to Blog carnival at: http://blogcarnival.com/bc/cprof_21.html

If you prefer, send the submission letter to drkavokin at yahoo dot com (remove spaces, place @ and .)
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Dr. Schwimmer's blog explores the intersection of medicine, new technologies, and the Internet.