How Much Grand Could a Grand Rounds Grind? GR Vol. 6 No. 19

It happens every year.
I try to get a little shut-eye, but then these guys in hats come around and yank me out of bed.  They proceed to parade me around a huge throng of people (most of whom are not wearing hats), obsessing about the presence or absence of stratus clouds.

What a strange group of people.  I seem to be the center of attention for the day, though, and that\’s not all bad.  It\’s my day on February 2nd, and nobody has ever taken that from me.

Until this year.

Let me back up a little.  My name is Phil, and I am a woodchuck who lives in western Pennsylvania.  Yeah, I know I was supposed to say \”groundhog,\” but I like throwing people off.  I am also called a whistle pig and a ground beaver, so it could be worse.  I personally prefer the woodchuck thing because I like the \”how much wood could a wood chuck chuck…\” poem.  Shouldn\’t I be able to decide what I am called?  What\’s wrong with \”Woodchuck Day?\”  It beats \”Whistle Pig Day,\” doesn\’t it?

Sorry, that subject gets me emotional.  I live in a town known as Punxsutawney, which is an Delaware Indian (or Native American – see, it\’s not so bad to have more than one name!) word meaning \”town of sandflies.\”  I can vouch for the appropriateness of that name.  It\’s not much of a town otherwise; which is why I suppose they go around in hats and pester me each year.  What else is there to do?

There are a lot of llamas in our town too.  I think that\’s why Dr. Rob came in the 1st place.

But this year we\’ve been invaded!  Turns out that there is a whole other group of strange people who get all excited on a regular basis, and this year they invaded Punxsutawney!  They are lead by a guy named Steve, and for all the doting they do on him you\’d think that this was \”Whistle Steve Day!\”  He took the much-anticipated day of my emerging and turned it into a way to show off a new thing he made; I forget what it\’s called…something beginning with an \”i,\” I think.

So you see, I have be relegated to second-fiddle, which doesn\’t suit me well.  That\’s why I took Dr. Rob up on the offer to give my particular woodchuckian perspective on medical blog posts.  Plus, I thought he said \”Ground Rounds,\” and it seemed up my alley.  Ah well, you can\’t blame me for wanting to get out of Punxsutawney as quickly as I could.  I\’ll show you other pics of the day in Pennsylvania to prove it.  This guy is crazy!

Everyone thought last year\’s stunt by the llama was crazy, but that was nothing compared to this year!

Since Dr. Rob inexplicably got a gazillion submissions, I am grouping them.  It makes things easier to digest.

Group 1: My Faves

Some of the posts stood out from the rest.  This is not to say the rest weren\’t great, but certain posts just resonate with a large North American rodent.  I\’m not sure if that\’s good or bad.

The first on the list of Faves is a Post from the blog named Nourish: Living, Laughing, Whining (great name) which tells about Jacqueline du Pre\’, a woman who played the cello but lost her ability due to Multiple Sclerosis.  Marie Cooper, the author of the post identifies with her in the pain of facing a horrible illness. Like the pain I feel facing Steve.

The next is from Dr. Charles, who writes about being a doctor and going to a patient\’s funeral. Dr. Rob says Charles expressed the emotion perfectly.  Dr. Charles is a good writer.

The third of my faves is from Dr. Robert Centor, who\’s a smart dude (so I am told).  He discusses the reason nobody is choosing primary care: it\’s not because of what people say about it, it\’s the job itself.  I think he is basically saying that primary care should suck less.  Dr. Rob agrees.

My final fave is from a psychologist named Will Meek.  He explains the difference between remembering and reliving hard things. Why do I like this so much?  First off, I have a lot of trauma to deal with, getting lifted out of bed every year (the whistle-pig side of me is quite sentimental, you know).  Second, there was a guy once who relived Groundhog\’s day a bunch of times.  He should have read this post.

See!  He took over!  At least he wore a hat, though.  Even the llama wore a hat.

Group 2: What Docs Do

I get a skewed view of doctoring by just talking to Dr. Rob (he\’s a skewed kind of guy), so reading posts about docs being docs was quite enlightening.

The Happy Hospitalist taught me what the difference between a hospitalist and an intensivist.  If there\’s a Happy Hospitalist, is there an Idiosyncratic Intensivist?  I am sure there are lots of them.

Dr. D taught me how doctors diagnose the weird stuff.  It turns out you don\’t have to be mean and abrasive (like that doc on TV) to be able to make \”good catches\”!  Who\’d have thought?

Lockup Doc talked about how some doctors make you feel at ease, while others make you feel like you are a nuisance put on their schedule to give them justification to abuse illegal drugs (kind of like that mean and abrasive doc on TV).  The interesting thing here is that Lockup Doc takes care of prisoners!

Why do people need a thorough physical exam before getting surgery?  Dr. DJ (sounds like a rapper) talks about how people hide stuff that can hurt them later, necessitating a thorough physical exam.  He wonders if that is unique to India.  Dr. Rob says that it\’s definitely not.

Kent Bottles…no, that\’s his name…I am not saying he bottles things.  He might bottle things, but that is not relevant.  Dr. B talks about how some smarty-pants surgeon is telling everyone to use checklists all the time. Dr. B thinks that this guy may be right, but there needs to be room for imagination and deviating from the checklists.  I find that it\’s very important to have creativity as a woodchuck.

Group 3: Yowza!

Some posts made me say \”yowza!\”  That\’s woodchuck for \”wow, what a controversial topic covered in the blog post.\”

Dr. Wes talks about the healthcare legislation that has stalled in congress.  The amazing thing about this post is that the comments section is about 5 times as long as the post itself.  Great discussion, but Dr. Rob confessed that his Adderal ran out before he got to the end of the comments.

A blogger named Phil (good name!) on the Behaviorism and Mental Health Blog says that Schizophrenia is not a disease!  Dr. Rob was impressed by his bold stance that is definitely against the mainstream, and the way Phil put forth some solid points.  I was impressed by his name.

Mary Clark has a chip on her shoulder.  I think it\’s a Pringles, but I can\’t tell for sure.  LOL ROFL – That was a bit of woodchuck humor.  Anyway, Mary is very frustrated about two people who got surgery who clearly would have chosen otherwise.  Not all docs (or woodchucks) disagree with Mary.

Toni Brayer wonders about how doctors and hospitals get rated.  How can this information be useful to patients?  She says it can\’t.  Of course, she\’s from California, so you have to expect that kind of thing.  She probably got sick on some tofu or sushi.  (More woodchuck humor)

I have to admit, I was a little star-struck when I saw the iPad for the first time.

Group 4: Taking Care

What\’s the best way to take care of people\’s health?  There were some good posts on that topic.  If only they\’d cover the best way to avoid guys named Steve.

Metformin for Type 1 Diabetics?  Amy Tenderich at Diabetes Mine once thought the idea ridiculous.  But then after looking into it more, there are definitely times it\’s a good idea.  Who\’d have thought of such a thing?  I am probably the only woodchuck with that knowledge.  Thanks, Amy!

What\’s best, low carb or low fat diets?  The blog On The Wards discusses the research on the subject.  It turns out that they are the same.  I am glad about that.  Some woodchucks eat bugs and other yucky stuff, but I stick to the veggies to maintain my chuckish figure.

Bruce Siegel, who writes at the Robert Wood Johnson blog talks about some people from Minnesota who are working together to improve the quality of care.  He has the quote of the day:

You could dismiss this as another example of “Minnesota care”—where all the clinics are strong, the doctors are good-looking and the scores are above average. But Minnesota is only a harbinger of things to come in other parts of the country as the movement for high-value health care continues to pick up steam—with an extra boost coming soon (we hope) from the quality-related provisions of the national health care reform bill.

Group 5: Hah!

Some posts were either funny, or they were unexpected.  I usually like unexpected things, but Steve and his disciples are making me rethink this whole issue.

My first \”hah\” came when I read the post by Dear Dr. Ramona Bates on her blog, Suture for a Living. It turns out that there\’s a surgery to make a navel!  I guess people would look funny without one.  Rumor has it that Dr. Bates learned the procedure at the Navel Academy.

Step aside Scoobie and Astro, the new dog darling is Ruppy – a genetically-engineered dog that fluoresces!  Jamie Newman at the ACP Hospitalist blog uses Ruppy, who\’s a combination of beagle and sea anemone genes, as evidence that very different things can work together.  Pretty clever!

The spoof article in BMJ about evidence based medicine and parachutes made a lot of people (and woodchucks) say \”hah!\”  Not so for Jacqueline at Laika\’s Medlib Blog.  She thinks that rejecting EBM is equivalent to rejecting science as a basis to medicine.  She\’s right about that; I just hope she doesn\’t bash the article on Ruppy.  She does have a picture of a dog using a parachute, so I\’m optimistic for Ruppy.

From \”Down Under\” comes a post by Chris Nickson in the blog Life in the Fast Lane. He talks about a real mean dude who comes into the ER, goes to the ICU, and gets a rude surprise.  It\’s not a funny \”hah\” at the end, but perhaps there\’s a bit of justice in it.

Steve looked pretty smug when he found out I already own an iPhone.  I swear, I was borrowing it from the llama!

Group 6: Huh?

Understand this: I am a rodent.  My brain is not real large.  So there were some posts that made my brain complain to me.  Dr. Rob assured me that they were great posts, and that the smart people will get a lot out of them.  I wonder how Dr. Rob knows about smart people.

The first one is from David Williams on the Health Business Blog.  He interviews two real smart dudes who made software that improves the process of case-reviews. It seems like they are on to something good, because you can\’t fix something if you don\’t know where it\’s broken.

The second \”Huh?\” was an article on the Health Care Law Blog by Robert Coffield, who is a Lawyer!  Does that surprise you?  Dr. Rob thinks some lawyers specialize in \”huh?\”.  But Mr. Coffield isn\’t one of them, and he actually points to some really good resources for getting an idea about IT laws for different states.

Group 7: Feeling Better

Whew!  There are lots of submissions to cover!  My paws are starting to ache.  If only I had a tablet with a touch screen….  Well, the point of medicine is generally to make people feel better.  Here are some good posts on that subject.

The first one comes from the blog How to Cope with Pain.  I was interested in this because Steve is being a real pain to me.  Anyway, the article is about how values affect how people deal with pain.  Good stuff.  Useful.

Steve (no, not that Steve) over at the Funky Heart blog talks about being an adult survivor of childhood heart disease.  He sees how just his existence is an encouragement to parents of kids with heart disease.  Very true stuff.

Being sick is lousy, but a lot of times it\’s harder on the people taking care of the sick person.  Barbara at In Sickness and in Health asks the question: Caregivers, do you tell your ill partners about your stress? Tough question.  I\’ve already told you all about my stress (named Steve).

Group 8: Dumb Stuff

I was surprised to find out that Dr. Rob doesn\’t have the corner on the \”Dumb Stuff\” market.  There\’s enough dumb stuff to go around, and bloggers like to tell about it.

Dr. Val (who gets my vote for empress) writes on the Better Health blog about her experience getting licensed in Maryland and California.  Maryland took no time flat, while California is still working on it over 500 days later!  Perhaps they are all sick on tofu or sushi.  For a state that needs doctors, making it hard for Val is very dumb.

The ACP Internist blog brings up a very surprising fact: many medical students don\’t have a clue when it comes to electronic medical records. Considering how hard they are being pushed, that\’s a dumb thing to be happening.  Just ask Steve, a computer is your friend!

Scott Marshall is a Chaplain who has a bone to pick with Sanjay Gupta.  It\’s not that Sanjay has fancy gig at CNN, and not that he has a cool sounding name.  It\’s that in his book he compromises as a doctor for the sake of being a journalist. Scott says the book is a good read, but it could lead people to make dumb conclusions.  Scott\’s no dummy.

I finally got my paws on the iPad, and what does Steve do?  Whoa, don\’t drop the goods, buddy!

Group 9: Following Rules

Rules are there for a reason.  There is often a good way to do things that should be followed.  Other times there are just dumb rules that should be changed.  Steve certainly ignored all the rules in my fair town today.

Fee for service medicine is just the way we do things.  Is that right or wrong?  Lots of people want to change it.  Michael Kirsch at the MD Whistleblower blog muses about the pros and cons of FFS.  Interesting stuff, and he has a new spin on the idea of  \”putting an end to tonsillectomies.\” Read it; it\’s more woodchuck humor.

Dr. Ed Pullen\’s blog has an article about taking medication correctly.  It\’s not therapeutic to just want to take your medication, you have to actually take it.  He gives some good rules patients can follow to do it better.  It\’s hard for me to remember to take medications during hibernation.

If you are in the hospital, the last thing you want is to go right back.  It\’s kind of like Punxsutawney.  Amy over at the Health AGEnda blog writes a post with a link to a guide to prevent readmission.

Group 10: Reader Beware

Some posts are for mature audiences only.  No, they don\’t have any gratuitous sex like they do on Animal Planet; they are just…well…I guess you should read them yourself to understand.  Maybe you should ask your mom first.

Elizabeth over at Life. Not Terribly Ordinary justifies the name of her blog, giving a recount of a very busy day.  It\’s a great view into the very busy life of an academic doctor.  It also uses some words that would have had my mother washing my mouth out with dirt.

The Inside Surgery blog takes on a big controversy: the use of acupuncture for battlefield medicine.  It\’s not a real graphic article (aside from gratuitously poking people with needles) and it uses no cuss words, but I suspect there will be some fonts a flying in the comment section.

Nobody ever accused Patient Anonymous for being subtle and reserved.  That\’s pretty obvious when you read her post So, Is This What Medical School feels Like? Brace yourself for some strong words and stronger emotion.  I hope she doesn\’t ever run into my mother.

Group 11: That iThing

OK, I confess: I am turning into a fan-hog of the new iPad.  Steve has this magnetic appeal that makes me want to go out and buy something I never thought I needed.  Even Dr. Rob uses a Mac!  I don\’t really know what I\’d use it for, but I still want to buy 50 of them.  Predictably, the Medical blogs had things to say on the matter.

Dr. Anonymous (who is, ironically, well-known) is the first to jump on the iPad bandwagon.  But wait!  He takes issue with the assertion that it\’s a perfect device for healthcare.  Couldn\’t cool aps be written for it?  Sure, but it\’s not about the aps, its about the hardware.  Dr. A doesn\’t think the iPad has what it takes for medicine.  Say it ain\’t so, Steve!

Finally, Peggy over at The Blog That Ate Manhattan chimes in about the iPad.  Being an OB/GYN she first scolds everyone for snickering at the name.  I know for a fact that Dr. Rob snickered a lot – saying that the virus scan should be called the iPap.  Shame on Dr. Rob!  Anyway, the post analyzes the claim that the iPad is perfect for healthcare.  She too is mystified at where exactly it would be used.  But she should give up on trying to get Dr. Rob to grow up.  It will never happen.

Conclusion

It\’s been a pleasure to get out of my hole and away from the hullabaloo in Punxsutawney.  You medical bloggers are bright folks and the world should pay more attention to you.  I read more common sense this week than I have heard in my entire life from Washington DC.

Pathetic Dr. Rob is now a fan-boy.  HE TOOK MY IPAD!!
I\’m going to have to bite him (if the llama doesn\’t get to him first).

Addendum:

After the deadline, I got an email from Paul Auerbach From Healthline.  I add this on because of the importance of the topic:

I just returned late last night from two weeks of medical relief work in Haiti, so apologize for the late submission. Please consider the following posts, which are a series of what we experienced, for submission for this week\’s Grand Rounds. I realize that it would be highly unusual to list so many posts, but I offer it nonetheless. If you read them, you will understand.

http://www.healthline.com/blogs/outdoor_health/2010/01/haiti-january-22.html

http://www.healthline.com/blogs/outdoor_health/2010/01/from-haiti-thursday-january-21.html

http://www.healthline.com/blogs/outdoor_health/2010/01/haiti-january-23.html

http://www.healthline.com/blogs/outdoor_health/2010/01/haiti-january-24.htm

lhttp://www.healthline.com/blogs/outdoor_health/2010/01/from-haiti-january-25-2010.html

http://www.healthline.com/blogs/outdoor_health/2010/01/haiti-january-26-2010.html

http://www.healthline.com/blogs/outdoor_health/2010/01/from-haiti-january-27-2010.html

http://www.healthline.com/blogs/outdoor_health/2010/01/haiti-january-28-2010.html

Thanks for the opportunity!  Next week GR is hosted by Edwin Leap.