Grand Rounds Vol 7 No 20

Updated 3/2017-- photos and all links removed as many are no longer active and it was easier than checking each one.

It is my pleasure to bring you this week’s Grand Rounds.  As I am sick of winter and looking forward to spring, I am going to sprinkle this edition with images of some beaches near the contributors.  Enjoy!

Valentine’s Day is in less than one week.  There are several “heart” related posts.  Let’s begin with them.

This first one is from @purplesque, Sumpsimus, who gives us a glimpse of a “love affair” of the real tragi-comedy kind in her post:  Another day at work.

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Corinne Rieder, healthAGEnda, discusses a part of the touching journey through her mother’s battle with Alzheimer’s in her post:  Listening to My Mother.

I can’t deny it—I miss the mother I once had. Even at age 80, she was vibrant, loving, and independent. And she was strong………..

I may miss the mother I once knew, but I have also become deeply aware of how much I love and appreciate the one I have now……..

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Kimberly Manning, ACP Hospitalist,  in her post Life at Grady: Payback

……….Sometimes, it gets to be a lot. A whole lot.  ……

Mr. Felton smiled and shook his head. "Seem like every generation get a little more chances. Here you are a doctor, teaching me about my heart." He looked me in my glassy eyes, warm and genuine. The tears pushed out onto my lashes as I drew in a deep breath. ……….

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Valentine’s Day may not be a happy one when illness enters into the couple relationship, things change, often drastically.  If the demands of illness make it difficult for the partners to connect with and be supportive of each other, should they consider divorce?   Barbara, In Sickness and In Health, discusses these changes in her post:  Divorce and Chronic Illness:  One Woman's Story.

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Aneesa, D.O.ctor, is using  "February ~ American Heart Month" to share a personal story of her aunt’s death from heart disease and provides some educational information about heart attacks.

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Ves, Clinical Cases and Images:  CasesBlog, summarizes some important lab results and parameters that both patient with heart diseases and health people should know in his post:  Heart numbers to know - by Cleveland Clinic.

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ACP Internist (“where the staff are living and dying that the Steelers win on Sunday”) post or question of the day--- QD: News Every Day--The Super Bowl is just a game, right?  Did you know that according to researchers sports fans may literally live and die on their team's victories.  ACP Internist reviews  the research for us.

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In medicine, we must use our heads to guide our hearts and vice versa.  This is true in dealing with end of life issues, with medical ethics, with healthcare cuts/budgets.

Indian Medic wants to know  who's the boss?

Often a major part of a doctors job is making decisions –….. Often it's the decision of the patient and family, but needing guidance of the attending doctor, who is expected to know the best. When all goes down well – good. But what when the parties have a difference of opinion and some problems crops up. …..?

Following is one such is incident, which made me ponder – where do you draw the line – of who takes the blame?  …….

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Women Neurosurgeons Blog  discusses how it’s critical to take  "The Social History" of our patients in order to provide optimal care.

…………..The clear implication was that our life events clearly impact our response to injury and disease in ways that remain unknown to us.  But while we may not understand the mechanism, it is evident that all health care providers have to more closely attend to understanding the lives of our patients in order to administer to their medical needs.  ……………

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In White Ink (formerly Intueri) gives us a good reminder NOT to use the wrong modality when communicating with patients.

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Elaine, Medical Lessons,  has been Considering the Significance of a Doctor's White Coat  from her perspective as a patient (pro) as a doctor (generally pro) and as a med-school teacher (it should be clean).

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Dr Rich, Covert Rationing Blog, gives us an iconoclastic view of advance directives and offers advice on how to establish one without giving too much ammunition to the Central Authority in his post:  “ Can Advance Directives Be Salvaged?”

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Julie Rosen, Bedside Manner, discusses finding common ground in the debate on advance care planning in the wake of the recent elimination of Medicare reimbursement for such services.

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James Baker, Mental Notes, asks and answers:   Who gets hurt when Medicaid gets cut? You do.   As he notes “Poor people don't stop getting sick just because you drop their insurance.  And doctors keep treating them.  It still gets paid for, too, and you're who pays for it.  But how?”

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Marshall Scott, Episcopal Chaplain at the Bedside, shares reflections in light of the ethical principles of the "Georgetown Mantra" on the recent case of two sisters imprisoned in Mississippi whose sentences would be suspended if one sister donated a kidney to the other.

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Don’t forget the other parts of the body – skin, hands, back, etc.  The first one in this section should not be skipped:

From @otorhinolarydoc, Surgeon, Interrupted, writes about life in the third world in his post:  West Timor Adventures Part 3 of 10: Clinic Starts  --  Crazy clinic and huge goiters.  Really huge goiters!

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Dr. Romanzi  educates us on the topic Death by Clitoris: Female Circumcision circa 2011

………….And therein lies the key – the divorcement of these crucial rite-of-passage rituals from the brutal practice of female genital mutilation.   ……..

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Glenn Laffel, MD, Pizaazz, uses his post  How the Brain Responds to Music  to review a cool study by scientists at McGill about the neurological underpinnings of musical epiphanies. It includes an amazing YouTube video of Jascha Heifetz playing a Tchaikovsky violin concerto, but admitted in his email “I’m more partial to the Grateful Dead piece mentioned in the opening sentence!”

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 Allergy Notes gives us  7 Tips for Allergy-free Winter.  Included is a mini map diagram of the most effective methods for control of the most common indoor allergen - the mighty dust mite.

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Happy, The Happy Hospitalist, discusses what his expectations are as he heads off to the physical therapist:  Physician Physical Therapy Goals:  Just Fix It.

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Dr Ed Pullen, DrPullen.com,  tells us that tobacco use is no longer the Leading Preventable Cause of Death in America.   Sadly, obesity has passed tobacco use. 

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Grunt Doc wants us to know about the trouble with observation in medical settings.

I have experience with this, from both sides. Both involve hand-washing. Still, a clean story.

Washing of hands is the right thing to do for health-care providers, between seeing patients, for infection control reasons. And, I’ve gotten ‘the letter’ from a VP charged with signing them, citing me for not washing my hands between patients.

Except, I did. This is the problem with observational medicine.

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We’ll use Grunt Doc’s post to move from the physical body to the policy/politics/economics of medicine.

David Harlow, Health Care Law Blog, discusses MA Governor Deval Patrick challenge to cities and towns to meet a cut in local aid dollars by redesigning health benefits and renegotiating with unions under a new proposed law in his post Massachusetts: Future Hotbed of Value-Based Benefit Design?  He feels value based design can turn what is perceived as a Draconian cut into a win-win situation.

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Paul Levy, Not Running a Hospital, shares Lessons from Cairo, using the recent events in the Middle East to make the connection between powers that be and the public’s rights.

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Ever wish as a physician you had taken an economics class in college.  NWS,  The Notwithstanding Blog, actually did and explains why, in spite of the flak he gets for the decision, economics is not only a good background to have before entering medical school, but the *best* thing to have studied before medical training begins:   "Undergraduate Learning of Economics for Make Benefit Glorious School of Medicine"

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murzee, Healthcare, etc,  has had a great series on reviewing medical literature intelligently.  In part 5 of the series, she explains inter-group differences and hypothesis testing.

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Louise, Colorado Health Insurance Insider, considers what happens  When The Media Recommends Over-consumption of Healthcare

It's easy to say that a few hundred dollars for a test (or a few thousand dollars if people opt to get multiple tests) is far less expensive than the cost of a heart attack.  But ……….  This exacerbates the problem of over-consumption of health care and rising health care costs.

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Philip Hickey,  Behaviorism and Mental Health, discusses  The Drugging of Children.   He feels children with behavioral problems are increasingly being prescribed anti-psychotic drugs.  There is nothing intrinsically wrong with these children.  They simply haven’t been adequately trained and disciplined.

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mdstudent31, Future of Family Medicine, asks How will COGME's 20th Report Affect Medical Students? in their review of the COGME's 20th Report, "Advancing Primary Care,"  and it’s 5 recommendations including the one which recommends an increase in "the average incomes of primary care physicians to at least 70 percent of the median income for all other physicians."

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Greg Vigdor, Washington Health Foundation,  gives his prescription for making the U.S. the Healthiest Nation in his post Winning the Future!  It includes: 1) Dream Big 2) Know where we are in the Journey 3) Make it about People.

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Henry Stern, InsureBlog, presents one reason why US cancer survival rates far outstrip Britain’s in his post:   Seeing through the MVNHS©

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These last two are from a couple of people I am fond of; one is a surgeon and the other a pathologist.  Both posts are meant to leave you smiling.

The first is from bongi, other things amanzi, who tells us about a great teacher with less than stellar bedside manners:  you've got to hand it to him.

The second is from Methodical Madness who share some GI humor in her post:  tête-à-tête

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Hope you all will have a great day and even better week.  Take care and come back anytime.
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Next week’s Grand Rounds host will be Grunt Doc.

If you would you like to be a future host of Grand Rounds, contact:  Nick Genes (blogborygmi.com).