Welcome to Grand Rounds! I am privileged to be your host for this week’s edition of the best posts of the medical blogosphere. As in the previous two times I’ve hosted, I will integrate music into this edition, but unlike before, I will focus on one piece of music: Tod und Verklärung (Death and Transfiguration) by the German composer Richard Strauss. I said when asking for contributions that adherence to a theme was not necessary; moreover no single theme could really encompass the excellent variety the medblogosphere has to offer. Since this musical selection is quite long–over 20 minutes at least–I have decided to present only excerpts so as to tell the basic story as we go along, placing musical interludes in the list of posts. Hopefully I still keep to the spirit of the piece while not detracting too much from the excellent contributions.
Welcome to the November 27, 2008 edition of Change of Shift. Many, many thanks to Kim from Emergiblog for letting me host this edition. Look around and if you like what you see, feel free to come on back!
Happy Thanksgiving to all of our US readers. As you're working on your unit or basting the turkey like me, have a look at all the submissions for this edition. You won't be disappointed by our cornucopia of submissions.
Welcome to the second edition of the “MetaCarnival”!
Carnival administrators send in two submissions from their respective compilations and these submissions compose the “MetaCarnival” which is posted once a month. Let’s get started!
This article from the American College of Surgeons' monthly newsmagazine Surgery News pricked my interest. Dr Ernest Block, director of the trauma program at Orlando Regional Medical Center, tries to make a case for the "regionalization" of acute care surgery. In English, this means he wants to justify life-flighting acute appendicitis and hot gallbladders out of surrounding community hospital ER's and depositing them at the doorstep of the glorious Orlando Level I Trauma Center. Dr. Block rationalizes this proposed plundering with an economic argument.
then check out this post (Inexorable Trend) by Movin’ Meat as he continues the dialogue
I can't add much to Buckeye's commentary -- it's dead-on. This is a play for dollars and training cases, and completely unjustified from an economic, efficiency, and quality of care perspective. But there's another, tangentially related point here. Buckeye asks whether trauma surgery, as a specialty, is viable. In my humble opinion it is not, at least not on a large scale. As a niche it will persist as long as guns and motor vehicles do. What will happen, I predict, is that "Trauma surgery" ultimately will, in fact, transform itself into (or be replaced by) a new specialty of "Acute Care Surgery," which might be more simply described as "Surgical Hospitalists."
That's it. I'm taking a tip from the hospitalist movement. I'm rebranding. I'm no longer a primary care physician. "PCP" now seems to be synonymous with overworked, underpaid "loser" who at least by some people's opinions aren't carrying their weight. That's not me.
So starting today I will be known as a "PREHOSPITALIST". That my ticket. I see patient's before they get to the hospital and try to divert them before they get sick enough to be admitted. I see the sickest of the sick. End stage renal disease, transplant patients, double transplant patients, end stage copd, end stage chf, end stage anything, and frequent fliers.
So come join us this Thursday night at 8 pm CST (or 1 am GMT) both to listen to the show and to participate in the chat room. That's where all the fun is.
Tips for first time Blog Talk Radio listeners (from Dr A):
For first time Blog Talk Radio listeners:
*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.
*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.
*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.
*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. There is also a "Click To Talk" feature where you do not need a phone to call into the show - only a microphone headset. Hope these tips are helpful!