Grand Rounds #53 Published

One of the reasons that I’ve been less compelled to write recently is that much of the void that existed has been filled by the many health care providers now writing so well.  "The void" that I perceived was the absence of transparency in our business.   Before weblogs – it was uncommon for real healthcare providers to reveal their thoughts & feelings about the work that we do in a public forum.  Our patients know us as either wonderful and kind .. or uncaring, thoughtless and hurried  .. but little was revealed or understood by the "general public" about who we are and what we’re thinking. 

Another obvious role of medical weblogs is to educate.  We educate ourselves and our colleagues by constantly gleaning the vast information resources – and pointing to important or compelling bits.  And of course we editorialize .. which is the true advantage here.  We’re transparent about our biases – so (as some have argued) we may even provide a better view of the "news" as we’re more honest about the lens through which we view things:  new research findings, hew medications/indications, etc.

We’ll start with a few of the old favorites .. and them move into some of the more recent additions to the world of medical weblogs. I had over 50 suggestions for inclusion this week … and have done my best to select a good sampling.  Please don’t be mad if I didn’t include you! ..

• Doctor Bob, as usual, educates.  Lest week – he brought us this entry on consumers using the Internet to choose physicians and hospitals – and reminds us that data inherently misses many of the qualities that can differentiate between good and not-so-good physicians.
• Sydney’s style is more informal – news clips  with editorial tag lines.  I think this is what makes her blog so popular.  It’s quick reading – but you can always plan on seeing something new there.  Today’s post on physician conflict of interest begins with this: "Sadly, this is not surprising …[text of news item here] … and ends with this "Even sadder, the doctors involved can’t seem to understand why this is wrong."  Great stuff.
• Another "old timer" from the medical blog world is/was Steve Hoffman .. who has been nearly as Idle as I am.  C’mon, Steve .. get back into gear!
• Gruntdoc needs to look out for earthquakes!
• Orac tells us about a tragic and unnecessary death of a child.
• Alwin has also been in the mix for a few years … and he’s still trying to figure out why he blogs:   
• "Me? I’m just as confused as I’ve always been. I’ve never been able to settle on an individual topic to focus on. No real reason to go on, no real reason to stop. After 5 years, this joint has it’s own kind of institutional inertia. “Help, help! I’m blogging and I can’t give up!” I could have been saved if I had been wearing my BlogAlert necklace…"
• .. and we can’t even get rolling without mentioning Docshazzam … who went for a "girlie ride" this week.  Her blog – which (still) has the best title – chronicled her journey through a residency in Emergency Medicine.  She writes wonderfully – and her anecdotes about life in the ER are vivid. 
• Matthew Holt’s blog is not one to read when you only have 30 seconds.  Gotta really think when you read this stuff – but I’m always impressed with his ability to see through the crap and guide the gentle reader through the maze we call our "heal care system." Today’s blurb:
• "Today the Wellpoint Borg collective has assimilated the last of the resistant for-profit Federation Blues spaceships that was challenging them in the outer Galaxy. But shouldn’t it be the Empire crushing the rebels rather than being the rebels (or am I mixing two famous sci-fi memes) "

and on to some more recent additions …

• Intueri is the most poetic.  I simply love the prose:
• The patient sat on the bed, his limbs dangling weakly from his trunk. Mustard was smeared across his chin and a soggy crumb of bread dangled from his upper lip. His mouth was hanging open.  When he spoke, his mouth never completely closed and yet somehow, his speech was thick and slurred like a milkshake that would not travel up a straw.
• Barbados Butterfly weaves a tale of the Elderly Woman atop a Trolley.
• Neils is a medical student at Tulane – and his posts about about post-hurricane Gulf Coast are informative – yet also provide some of that transparency we like so much:  I can tell from his writing that he’s a medical student .. learning this stuff .. and loving the excitement of it all.  Such a novelty this medicine bizness is … (he seems to be saying) .. so fun/scary/exciting/important.
• Red State Moron reports on limiting medical student work hours.  But back in the day:
• "Rounds started at 430 am; we usually had 60 patients on service.  Think Maine in the summer.  A lot of trauma, mostly MVC’s and burns.  We would spend the day in the OR, and finish with evening rounds and usually be out by 9 pm.  I never opened a text book.  But I learned more in that month than I thought was possible. "
• Aggravated Docsurg follows with another wonderful view into the mind of a physician .. as we follow the bouncing ball through his cortex … all of which oddly reminded me of an episode I blogged about a few years ago. Physicians who listen are likely to hear more than those who speak.  Duh.
• Power and Control shares a compelling review of research supporting the hypothesis that drug abuse is self medication for pain/anxiety.  This is one of the self-evident "truths" that most of us accept without good science to back us up.  Last week I suggested an antidepressant medication for a man who drinks heavily – smokes marijuana often, and uses cocaine to "keep stable."  But he doesn’t want to take a medication for fear it will alter his physiology.   "Man – you ARE taking medications" I meekly suggest.  He doesn’t see it that way.
• Diabetes Mine is a weblog written BY a diabetic FOR diabetics.  It’s a great resource and I often refer patients there. This week she reminds us that a 15 minute eye exam can be much more than that … and then gives an excellent overview of one of the prevalent theories on the viral causes of Type 1 diabetes. I enjoy reading medical blogs by people who are doing their best to learn as much as possible about the disease that they (or a close friend/partner/relative etc) have.  Like the medical student blogs – I can feel the WONDER and EXCITEMENT as the science is explored … yet as that happens .. the imperfection of the science – and our truly limited understanding of all of this becomes more clear.  Debunking the myths that physicians know everything.  A+
• Healthyconcerns is jonesing for a medlog fix … (which of course will soon be satisfied) .. and last week pointed us to the very cool earpopper (featured on Medgadget) that I am actually thinking of purchasing .. and has problems with increasing blood pressure over a silly little bill.
• Parallel Universes teaches us that men don’t wash their hands after they go potty.  (no mention of the classic Seinfeld episode .. which of course confirms this "medical fact.")
• The Health Business blog carries the message from a Boston Globe story that patients should plan for doctor visits.  Yeh .. um .. I agree, but the post sounds a bit like mom telling you to wear clean underpants.  This is a Blog, man .. where is your opinion/emotion?
• This from ImpactED: "Being dead really sucked. I had a cramp in my leg and the body bag smelled like a bicycle repair kit." keep reading this one .. it’s funny .. and a bit unnerving.  With friends like this .. ?
• Tim Gee is a connectologist .. writing about workflow automation. 
•  .. and from the "what took them so long" department .. Clinical Cases Blog tells us about dental students getting lectures via podcast.  Hey – I thought of that WEEKS ago! ..
• Speaking of podcasts (yes, Ken … we keep missing each other .. I’m still "in" .. ) There is a great podcast at soundpractice.net J. with Scott Armstrong of Wharton who talks about the limits of peer review, the need for transparency in the doctor/patient relationship and the limitations of experts.
• Kidney Notes shares a great view of the medical blogworld via a tagcloud 
• Sometimes we think of difficult patients and groan as we inch toward the exam room door.  It’s true (transparency again) A Difficult Patient reminds us that difficult patients are not difficult on purpose .. and it’s difficult for them too! "This blog is very personal, and it is written by a difficult patient." 
• No medical weblog roundup is complete without a pointer to two medical bloggers I’ve actually met:
• John Faughnan’s posts are rarely medical, but always thoughtful and informative.
• Enoch Choi is at the AAFP conference .. which is heavily financed by the pharmaceutical industry.  Good thing Enoch is immune to this:
• "I’m surfing thanks to Crestor, which i don’t use since the singaporean studies showed twice the incidence of liver function abnormalities, causing them to recommend 1/2 the highest dose as a max for Asians. Good drug otherwise, I’ve heard."
• Is Glenn McGee a Vulcan?   Glenn’s posts on Bioethics.net are excellent – and usually thought provoking .. but we wish he would take a stance sometimes .. as he does a great job of raising the issues .. but I often have a hard time figuring out where he stands.  Reminds me of a classic dialog:
•  Bones: SPOCK! You and your damnable Vulcan logic…

  Spock: You’re far too emotional Doctor.

  Bones: Why you damned green-blooded pointed-eared inhuman jack rabbit.
  Why don’t you just go fry in hell!

  Spock: Unlikely, Dr. McCoy, hell is …

On that note — we’ll close the anniversary edition of Grand Rounds.  Tune in next week and thanks for reading!