Tuesday, July 12, 2005

Grand Rounds #42

Welcome to Grand Rounds, a weekly roundup of our best medical blogging. Aggravated DocSurg hosts next week.

Top story: A London EMT blogs about terrorist bombings, at Random Acts of Reality.
"...Once the shock had settled, I started to feel immense pride that the LAS, the other emergency services, the hospitals, and all the other support groups and organisations were all doing such an excellent job. To my eyes it seemed that the Major Incident planning was going smoothly, turning chaos into order."
Newsweek then reports on his blogging, in “History’s New First Draft.” Our thoughts and prayers are with the victims and their families. More at Medpundit, Intueri, and Infoisfree.

Other medblogging highlights:

July on the wards. New interns, new residents. How's it going? Dr. Chaplin finds that it’s the toughest job he’ll ever love:
Student: "Did you make it home okay post-call?"
Me: "Sure! I only fell asleep once I pulled into the driveway."
Dr. Michele Au begins her Anesthesia residency, and finds that it's like flying an airplane.
It's the takeoffs and landings that are the really scary parts (corresponding of course to inducing the patient and waking them up at the end), but the difference is that at this point, the time in flight is scary for me too...
What happens when a resident asks for help? At Intueri, Maria finds out:
The flush burned my face. I shouldn’t have asked for help. I should just suck it up and write all the notes. But am I SUPPOSED to carry the whole service? Am I supposed to write notes on everyone? What is the fellow supposed to do? How did this happen? Why do I feel bad for asking for help?
(Note: it's not always like that! -Ed.)

How to pay for these residents? Medrants worries about drug company funding of residency positions. He notes the dilemmas:
Currently, we rely heavily on federal funding through Medicare. This reliance does “handcuff” medicine in its own way. We have fixed numbers of “slots”, which do not necessarily match changing needs and opportunities...
Blogging about your patients? Clinical Cases and Images Blog discusses federal privacy rules, so we can all sleep better at night. (Note to housestaff: yes, you will sleep again.) Some patients are disappointed that they’re not in her blog, notes Jassy Timberlake.

Dr. Charles reflects on a teen’s labor and delivery.
Sodden black curls burst forth, a new face with light freckles,
next chin, then neck, then shoulders. Teenage mother
gave a final big push...
In "Storm Warning," the Cheerful Oncologist's allegory, medical disaster looms like an approaching hurricane. Get ready for a shock! And are we prepared for large-scale disasters? MSSPNexus Blog writes about Disaster Preparedness in Healthcare.

“Video robots” help a urologist make rounds at Johns Hopkins. Medviews is incredulous:
A lumbering robot, C3PO like, wheels itself into a patient room, and the video doc asks how the patient is doing….
A robotic meeting diminishes the sense of a patient’s worth to the physician. He or she is just not important enough to get the big kahunah’s personal time.
Some docs would leave video robots in the dust. The Cheerful Oncologist instructs us in the art of "Lightning Rounds:"
You’ve all come across doctors who blow through their weekend rounds like a Cigarette boat on the lake at sunrise. This unfortunate focus on brevity tends to leave behind patients and families who have no idea what is going on, not to mention progress notes that bear an uncanny resemblance to line twenty-six of the Rosetta Stone...
The envelope, please. Creative Blogging Award goes to Orac, for his inspired attack on certain fallacies about autism: "The Hitler Zombie Smells Thimerosol."
Deep within a dark crypt, far beneath the ground, it slept. The air was thick and musty, and the crypt utterly silent, so silent that its heartbeat would easily have been heard, if it actually had a beating heart...
Ask the medbloggers. How do I survive a deposition? Dr. Tony has tips. Is there a feed for audio files offered by NEJM? There is now; Kidneynotes has created one. What is an HSA? Insureblog tells us, in Parts 1, 2, and 3.
Why can’t I get insurance? HealthyConcerns wants to hear from you.

Why know baby’s gender sooner? This doula has thoughts. What is a Health Buddy? Tim Gee has the scoop. (Think "video-robot-doctor-lite." The photo shows a handheld device that asks, “How do you feel today?” One more step toward the demise of my career…) And how was your first Trauma Call? This med student tells all.

Diabetes Mine. Amy Tenderich's blog offers more than tips for controlling blood sugar. She gives us insights into the lives of diabetics. Here, she posts on the trail of debris that follows her, when she tests her glucose.

Medical Waste: Red State Moron recalls a time when precautions were few. Wasted Meds: Where do discarded meds go? Look to the Great Outdoors. Interested Participant wonders what should be done about it.

Making the diagnosis: Kevin, MD comments on cognitive errors that can lead to missed diagnoses. See the comment thread for a debate about which tests are "reasonable and necessary." And Jeff Jennings points to a blog that's devoted exclusively to difficult diagnoses: Pulmonary Roundtable, for baffling pulmonary and critical care cases.

"It's not evil, it's research."...Or, so they might have thought. Dr. Maurice Bernstein, of Bioethics Discussion Blog, points to a chronology of experiments on humans, starting with the 6th century BC. Yes, it omits many good, ethical experiments. But Dr. Maurice urges us to read it anyway.
I think that human research whether medical, psychiatric or social science or others involving human subjects is not some activity where the ethics should ever be forgotten. Just as we remember those scientists who made the wonderful medical discoveries which has saved lives and discomfort, we should also keep a list of bad and sad experiments and understand why the system of reseach should be fixed so that the ethical failings of these and others of similar ilk are never again repeated. ...Maurice.
Alcohol and street drugs. Dr. Emer, at Parallel Universes, discusses the surge in meth production in the Philippines. GruntDoc helps police take a drunken driver off the road:
"I am sitting next to a car stopped in oncoming traffic at (location). The driver looks like he's either asleep or dead". (I was pretty sure he was alive, but not taking chances)...
Generics go global. It's tough all the way down the pharma food chain, says David Williams at Health Business Blog. Price competition for generic drugs is intense, as Indian companies enter the market. Can China be far behind? Still, consumers' prices haven't dropped.

Scamming scammers. The Krafty Librarian, on fake medical research:
My question for the blog readers...
What happens to the bad research?
Is this the darkest Grand Rounds ever? (And why wouldn't it be, this week?) Here, try this post: "Only Love Makes Sense," from About a Nurse. A simple, sensitive post about how love heals. In fact, just talking about love is healing for May's aphasic patient. Illness, pain, loss, memory, longing, intimacy, and caring...it's all here. (No video-robot-nursing for May!)

And here's some good news: Corpus Callosum sends word that SARS research may benefit those who suffer from other causes of respiratory failure. Dr. Andy is cautiously optimistic about a potential treatment for ulcerative colitis.

I see deep caring and commitment in all of these posts. Thanks to all who submitted their work. Prior Grand Rounds here, and submission criteria here. Contact Nick at Blogborygmi, and tell him that you want to host Grand Rounds.
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