Welcome to Grand Rounds, this week's compendium of the best in MedBlogging. Thanks to our uber-host, Nick from Blogborygmi, who manages and archives each week's Grand Rounds. I blog here at HealthyConcerns from the layperson or patient's point of view. I tell my stories as a relatively healthy person, and I tell the stories of people I meet...any of whom have a story about health care if only I ask them. Nick did a great job of getting to the heart of what I do here and pointing out some representative posts in his usual pre-Rounds article about the host over at Medscape.
On with the Rounds. I like to say that everyone has a story about health care if only you ask them, but of course there are many different kinds of stories:
Some of the best stories MedBloggers tell are the stories that get their readers talking.
See both sides here - I've refused scopes that were indicated by CYA standards, but which lab results and personal history indicated tincture of time and a change of meds was probably going to be sufficient to correct. (They were).
However, my father-in-law perished when his colon cancer went undiagnosed until it was well past too late to treat with anything but palliative measures.
But what would compel people to do the right thing? I'm not trying to bait you. I'm honestly looking for rational proposals, because I'm honestly on the fence about this. The single-payor folk do have a plan, but the personal-responsibility folk seem not to. Declining to sympathize isn't a plan, and declining to treat the uninsured is a perceived backward step politically that no one would sign up for. Is leaving them to experience the consequences of their choices enough? Was their wrong choice an informed one, and thus, fair?
Now you might have heard that blogs are no place for a long essay, and that blog readers have short attention spans, but Kathleen Seidel from Neurodiversity.com proves you wrong. She writes a very long and very thorough analysis of the Association of American Physicians and Surgeons. And she's got a passel of people who are talking about it on her site, and on other sites.
Dr. Deborah Serani blogs about possible genetic factors in eating disorders and get a wide range of responses, from people struggling with such a condition who thank her for helping them feel a little more free, a little less shamed...to people skeptical that we attribute everything to genetics and then look for instant cures.
Dr. Flea first lays out his own rant about Emergency Rooms (and sounds pretty saintly doing it, given that he makes house calls) but damned if a commenter doesn't come right back at him with the point of view of an E.R. doc:
Often, due to what their doctor may have said to them over the phone (and selective hearing no doubt plays a part here), my discussions engender suspicious looks/exclamations of disbelief and anger.
I'm not thrilled to see bloggers and commenters sparring, rather I am thrilled to see the different points of view get an airing and educating us all.
Hippocrates from HealthVoices tells the story (from my friend Toby, the Marketing Diva) of a doctor who regards with horror the concept of starting a blog. Two readers provide additional reasons to blog that Health Voices hadn't thought of:
There is something about the process of writing and publishing a blog that helps develop and strengthen our thoughts and ideas.
Sometimes you ask someone their story, and you can't (or don't want to) believe them!
I wish I had a great comeback for the "get over its" of the world. I wish that in that moment, I would have told Fred to bite me. In my shoes, would you have been able to?
I also feel that way when I read about the near-epidemic of prescription drug abuse at Treatment Online. What I appreciate about this post, though, are the practical suggestions author William E. Hapworth M.D. offers for how to make it easier to spot and stop such abuse.
Or when David at the Health Business Blog reports that health plans claim to be more "objective" than pharma reps when they push generics and OTC medication solutions. Um, I may not have gone to medical school, but I think, like David, I can figure out that health plan reps might also be motivated by money...just saving it rather than generating it.
Sometimes you ask medical folks their stories and have to say, "I never thought of it that way."
Like when Dr. Hebert explains what it's like to be a doctor covering other doctor's patients for the weekend. You've got no background other than the cold, hard facts on the chart. And even those cases that seem like they should be smooth sailing when you walk in the door can be feel like stormy seas instead. But what Dr. Hebert's story proves to me is that what I've been saying all along is really the case: it's the little gestures, the humanizing moments that make the difference between a good and bad experience with a doctor. Be human. We humans will appreciate it.
Or when kidneynotes tells us that sometimes automated blood pressure monitors, which you would think would be so easy people would be calmed by them in fact occasionally have the opposite effect...unnerving people with their visible digital accuracy.
Dr. Henochowicz at Medviews tells us the long engaging story of Dr. William Osler, and his keen interest in making sure he was autopsied upon his death. The good Dr. proceeds to lament the fact that autopsies are so uncommon today and explains that autopsies can be such wonderful tools to improve our knowledge. I did not know that.
Speaking of dead bodies, I learned about a current exhibition touring the country of cadavers that have been preserved and posed in various active poses. Orac from Respectful Insolence captures his mixed feelings about the display:
On the one hand, many of the specimens, through their meticulous and artistic dissection, had shown me human anatomy in a manner I had never imagined possible. On the other hand, I couldn't help but feel that there was something exploitive about the whole endeavor...
Even doctors can realize "I never thought of it that way", which is why Clinical Cases & Images points us to a new series on Medscape, which examines real-life case information. Because as they point out: "There is often a big difference between what we read in the books and what we see in our clinical practice every day."
I often rant about how the medical community seems to want to push towards consumer-directed health care, which would imply I was their customer, but then my time gets totally dis-respected...long waiting times, making me chase them down to get info etc. etc. Well, turns out some doctors feel exactly the same way. Like The Blog That Ate Manhattan, who complains about playing patient-phone-tag. Now, I never thought doctors had to do that!
I never thought a doctor would come up with a rational-sounding argument for selective care based on a physician's moral beliefs. Doctor Andy manages to do so. I've always thought doctors should provide the care that is medically desired and required, whether they have an additional opinion on whether it's moral. But I think there is still a vast difference between the procedure he uses as an example of one he doesn't think should be illegal, but that he shouldn't be required to perform: a breast augmentation, and what we're really talking about here: providing the morning-after pill or an abortion.
And perhaps I'm hopelessly naive, but I always thought that pediatricians, like parents, never get sick when dealing with their sick kids. (Yes, yes, I've obviously never had kids or been a teacher or worked with kids.) Graham from Over My Med Body sets me straight on that one, since it's one of the minuses of working pediatrics.
I also learn so much from Coturnix, who not only teaches me about a possible connection between jet lag and malaria (eek!!!) but how circadian rhythms impact peak copulatory times for the human species (woo hoo!) Both very important pieces of information, don't you think?
And wow, Dr. Choon from the Heart of the Matter was there over the last two decades as they introduced angioplasty as a procedure in Malaysia. Now, tell me you'd ever learn that anywhere but here in the Grand Rounds!!!
Sometimes patients tell stories, even about various treatment options, like no one else can
Like when Amy from DiabetesMine puts on a citizen journalism display of the highest order, reporting on potential new treatments and actually visiting the manufacturing site of a new device for her own condition. Now, read those posts and tell me it doesn't matter to know the person writing them may actually use the treatments and devices in question!
Dead Last Wiz shares some very valuable lessons learned after a recent procedure...like if you're in pain after a procedure, call and ask for pain meds: "You learn something new every day. I should have called. Not tried to be all brave and I don't like to bother doctors on the weekend."
Imagine NHS Blog Doctor's surprise when his new patient, who had been living in Germany, told him about their procedure of giving a vaginal examination at every pre-birth visit to the obstetrician. Yeah, she wasn't too happy about it either!
Sometimes, I'll admit it, the stories make my head hurt...especially when we try to figure out how to solve health care problems.
Tim Worstall asks us to think through some of the more extreme suggestions for how to transition to a single-payer system in the U.S. Yes, Tim, when you put it that way it does seem more than a little overwhelming!
Trapier Michael sets out to prove that Paul Krugman is advocating not only socialized health insurance, but socialized medical care, all arguments from other MedBloggers aside. Unfortunately he has yet to write Part III of this 3-part-series, where I'm fairly confident he means to tell us why that would be a horrible thing.
Interested-Participant helps Trapier out by describing a recent (and very odd-sounding) policy in Canada. Seems a new clinic was opening and patients would be accepted via lottery. Only far fewer people entered the lottery than need health care in that particular area. Conclusion (according to I-P):
Therefore, it appears that Canadian bureaucrats have figured out the way to make socialized health care work. Institute a lottery and plan on having only a small percentage of the total population enter.
Kate from HealthyPolicy reminds us that consumer-directed health care advocates think making patients more like consumers will wise them up, make them feel like they have more "skin in the game." So, she asks, how much skin should we have in the game? I wish I knew.
I also wish I knew the right answer to Andrew Barna's post at hospital impact, asking how much latitude non-physician providers should be given to expand their practices. I don't know, and I don't know who would be the objective party who could decide either!
Niels Olson tells us not just about our same-old national health care crisis, but the particular crisis going on in post-Katrina Louisiana:
"Charity Hospital, the oldest continuously running hospital in America, the last refuge for the sick and infirm in New Orleans during Katrina, has been closed since it was evacuated. The doctors and staff are working in a tent city outside the convention center and in other temporary accommodations. For over six months the state and the federal government have been arguing about what to do. Meanwhile, the only level 1 trauma center in the area remains closed and the indigent are returning, with nowhere to go for care."
If you want to help, then check out his information on a rally to save Charity Hospital.
Dr. Christian Sinclair from Pallimed makes my head hurt when he wonders whether folks in palliative care, as he is, should work more closely with organ procurement teams. Sure, sounds good right? Quicker response, greater good? But he outlines the dilemma, and it suddenly doesn't seem so clear:
On one hand palliative medicine professionals are good communicators as are organ transplant procurement professionals. We could minimize the trauma of discussing these issues with family members if we worked together more closely...BUT could we also portray that we are working 'in cahoots' to grab as many organs as we can, thus tainting the noble goals of palliative medicine with the mis-perception of becoming a vulture? I am not sure where to sit on this fence, but it is an idea that I have not come across much in the palliative medicine literature.
Mary from The Mote in the Light makes my head hurt by pointing out that someone who was once a sort of hero to me, Pete Singer, seems to have moved on to a new kind of logic I can't quite follow. I don't see how a man who so passionately and convincing argues for the life of every non-human animal can in the next breath argue that it is perfectly fine to kill born humans who are "defective" in some way. I must admit I've only read articles about Singer and his latest philosophical beliefs, not his book itself. The argument used to be that you wouldn't kill a person who was mentally less able than an animal, so killing animals is clearly not justified by saying we're somehow mentally superior. How that got morphed into thinking that now it is fine to kill those who are defective, I don't understand. But this is why I didn't like the movie Million Dollar Baby...the message was clearly that one was better off dead than quadriplegic, and I'm sure many quadriplegics and their families would disagree.
Dr. Baker from Mental Notes makes my head hurt by not only pointing out that kids are being prescribed anti-psychotic and other psycho-active more than ever, but also by pointing out that these kids are reacting to stressful environments and the drugs only treat the symptom, not the cause.
Sometimes, let's face it, medical stories are horror stories
Marcus from Fixin' Healthcare says that a solution for our health care system woes won't be just an economic solution or governmental solution. Nope, we've got a cultural problem, and I find his perspective downright scary, because it does ring true:
However, the greatest influence upon declining health status is lifestyle and that is a product of the culture. America has a culture that generates poor health and the health care system has no impact upon that situation, health insurance notwithstanding.
Talk about a horror story! Nurse Practitioner tells one that will make your hair stand on end, about a trusted medical staff member who was committing repeated child abuse on patients. What is the take-away? That medical personnel, and all of us really, should remain vigilant for the signs of such abuse...and report it!
And ask yourself how you'd be doing if you'd been through and witnessed what the little girl Keith Carlson from Digital Doorway describes in this post. Keith has written a post exhibiting the kind of empathy and sense of humanity that we want all doctors to have. It's just horrific that, as he rightly points out, this little girl's trauma is only one of many that children experience. Think she'll end up on those meds Dr. Baker was talking about above?
Kim from Emergiblog witnesses a sweet, frail, elderly lady go through an overload of pain, and can do nothing but hold her hands and pray with her for the hour it lasts. This story reminds me of my grandma, who spent her last 10 years bed-ridden, so it's a horror story for me to imagine my own grandma in pain like that, as I know she was at various times.
Finally, Jon from Unbounded Medicine rightly points out that sometimes medical stories are a little gory, but do not, I repeat, do not click on this link if you are squeamish. So why include it? Well, it's a cautionary tale, no doubt about it. Let's just say it makes the case that one should not fool around with firecrackers. And one should particularly NOT let them go off in one's hand. You get the picture?
Thankfully sometimes the stories make you smile.
Clark from Unintelligent Design attempts to make us smile with his list of his 10 favorite medical terms. Although I must add that the terms are much funnier when they're not ailments affecting newborns!
Brad from Anatomy Notes makes me smile by referencing one of my favorite shows, Scrubs, and coming up with the only medical explanation for what looks to be a reversed X-ray in the show's opening credits. Now that's some anal-retentive TV-watching Brad!
Aggravated DocSurg makes me smile with his post, oh, let's just call it the rant that it is, about a special super-duper bed that will cure all your ills...if your ills could be cured by a heated massage recliner.
Dr iBear signs himself up to teach a class of third graders about their cardiovascular system. Silly, silly man. At least he lived to tell us the tale! (And BTW: Dr ibear swears: "All the questions in the post are actual questions that the students asked me during my presentation.")
And I'm probably only smiling because I'm already a vegetarian, but I'll selfishly admit that Disease Proof's report on how reducing animal products consumption results in better health.
And at their best, the stories inspire and give you hope.
And I always like to end with hope.
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Ciao for now MedBloggers...come back and see us real soon :)