Grandly Rounding, MDOD Style...

"Outta the way, fancy boy! I'm a-commandeering this here clown car!"

PLEASE EXCUSE YOSEMITE SAM, HE MISSED A COUPLE OF TIMELY SUBMISSIONS WHICH ARE NOW INCLUDED BELOW, PLEASE NOTE ONE FROM THE HAPPY HOSPITALIST AND ONE FROM SUTURE FOR A LIVING ON COMPLEX REGIONAL PAIN SYNDROME.

CHEERS.


Thanks everyone for visiting for MDOD's first hosting of internet medblog Grand Rounds. Folks have asked if there is a theme for this week and since I'm new to this the answer is... well, maybe. I am going to post everything that was sent to me and some stuff we found. I hope you enjoy it.

We have a bit of a reputation amongst our twenty or so regular readers for being hard right smart assess and we confess, it's true. But since you can't turn anywhere today without being bombarded with politics, financial armageddon talk, nor can you dine at home without getting phone calls hustling you for money for candidate X, Y, or Z, we will steer clear of all that as much as possible. If a theme emerges here it is merely due to synchronicity and alcohol. So, without further ado, let's take a trip through medical cyberspace...

Our sincere apologies to the Happy Hospitalist whose submissions were lost in my transition to GMAIL and they are great ones sure to stir the pot a bit. First, we lament often here that the 'rules of business' are not applied to medicine and that physicians are only professionals who are mandated to give their time and skills away by the federal government. When we complain, we are seen as greedy, uncaring, or any other number of pejorative terms. Check this interesting explanation offered by the HH, and then read about how lifestyle choices have impacted the hallowed halls of surgery. I wonder if any reader can give an educated politically incorrect guess as to a synchronous event that may have led to the demise of the specialty of Surgery as detailed by HH?

White Coat Rants makes a tear well in our eye with his post detailing the idiocy produced when committees morph into bureaucracies and then into government oversight entities. And this all for the sake of money shuffling and vote buying. Outside of the academy, Medicine is dying, patients are dying, and doctors are the whipping boys of the moment. Check this one out too.

Those of you in Emergency Medicine will recognize the name Paul. S. Auerbach, MD. Dr. Auerbach is one of the fathers of a relatively new offshoot of Emergency Medicine- Wilderness Medicine, and is currently on the faculty at Stanford University. As an instructor I can tell you that this discipline is low on theory and high on practicality (and that's just my style). I think you will find his post, a part of a series on Desert Survival techniques, very interesting. Dr. Auerbach, if you need anything just give a shout-out, you know, expedition doc for the Pussycat Doll's tour of the South Pacific, or for the Swedish Bikini team's naked ascent of the world's tallest peaks (bad pun intended)?

Benjamin Disraeli (and Mark Twain following) made famous the quip that there are three kinds of lies... "Lies, damned lies, and statistics." David Harlow fleshes this out in an interview with the general counsel for UMass Memorial Health Care System in the kind of depth that is far beyond the immediate comprehension of a simple car-crash physician like myself. Shutting down all CABG procedures at his facility may seem a bit drastic based on these statistics, but decide for yourself.

We empathize with the post from The Dragonfly Initiative which gets to the gritty reality of practicing Emergency Medicine as seen from the provider side. We wish we had written this.

Over at Mother's in Medicine FreshMD explores an interesting problem... how should a female physician respond to patient's compliments about her looks? The post was inspired by Pakistan's President Zardari's comment to Governor Palin that she was, in a word, 'hot'. We agree. We too would like to 'hug' her.

Bongi, over at Other Things Amanzi, gives a detailed account of a poor outcome (in spite of his best efforts late in the ninth inning) in a case of pseudoaneurysm presenting to a makeshift medical facility in South Africa. Want to know what a pseudoaneurysm is and why this particular patient ended up losing a limb? Check this one out.

How does the mainstream media do with its reporting on complex medical topics like genetics? Not very well according to Walter Jessen.

Dr. Jolie Bookspan sent me a nice post about living under the sea. Really. During her studies in extreme human physiology she actually worked in a lab tethered to the bottom of the sea. I always wanted one of these... it rated much higher than having a tree house when I was a kid. Never did get to do it though. Lots of good links here regarding how the human body responds at extremes and even some fun stuff to do with your kids to introduce them to scientific concepts and the scientific method.

A doppelganger from South Africa lays in on the line at Just Up the Dose about choosing medicine as a career. Sounds like our South African brethren have a model for training physicians which might just make its way here soon. Great.

Dr. Bruce Campbell, an accomplished head and neck surgeon draws an interesting analogy between learning to drive a car and learning how to perform surgery. This hits particularly close to home as, in my years in the military I was involved with an aviation training squadron. I came away from that experience thinking that surgeons and pilots were cut from the same cloth and were trained in very similar fashion. Thanks Dr. Campbell.

A medical student at Twenty-four Hour People posts about his 'sub-I', or, 'sub-internship' recounting some very interesting patients with a bit of sarcasm and sharp wit here.

Dr. Carty at Hot Medical News scratches us on the back a bit (ahhhh, nice...) with his post regarding the rise of the new medical power-players... the 'people with clipboards'.

Captain Atopic from Australia enters a post about medication errors and how Murphy's Law tends to rule in the land of medicine.

Could we really make it through an entire Grand Rounds without mention of the election and it's impact on health care? No, here are some common sense tips (from the Poked and Prodded blog) for all on how to save on health care in spite of whether we spin left or middle come November.

Can you imagine that the government might be very inefficient and silly at administering one of it's multi billion dollar programs (Medicare/Medicaid)? Neither can I, but evidently it does happen as explained here at InsureBlog.

Over at Nurse Ratched's place you will find a post detailing the life of one of the first "tough women of Alaska", a nurse known as the "Angel of the Yukon." Very interesting.

An humorous slap-fight is underway at the Clinical Cases and Images Blog. I must admit that I'm on the side of the radiologist in this one... we scan because we would rather defend a malpractice action with a radiology read under our belts than try to convince the jury that our physical exam skills are 'better than a CT'. I'm not saying a neurologist is not 'better than a CT', I just don't ever have one around when I need one.

The horrors of first year Medical School lecture are detailed here right down to the penny. Thanks to our friends over at The Week or Some Derivative of Said Length of Time. Memories.

The Law of Conversation of Mass is given a humorous twist by Val Jones here and don't tell me this doesn't make sense!

Do you all remember your surprise at learning that maggots and leaches had made their way back into modern medicine? Another ancient technique aimed at allergy and sinus infection sufferers is detailed here. Honestly, this cut my sinus infection rates almost to zero (though it's a bit uncomfortable).

Barbara, at In Sickness and in Health, writes with admiration about the great love demonstrated every day by ordinary people taking care of terminally or chronically ill partners. Barbara, thank you for this.

At Laika's Medliblog you may learn about an enterprising new genetics company offering, for a fee of course, to analyze your DNA and determine whether you may be at risk for certain diseases. This raises a host of ethical issues which Laika explores with a raised eyebrow.

Laurie Edwards at A Chronic Dose speculates about the impact of the financial crisis on the already extant crisis in managing chronic illness.

Ever hear of Complex Regional Pain Syndrome? No? A Plastic Surgeon in Arkansas educates us here.

Is there gender bias in medical texts? In the classroom? Personally I don't care as long as the women who go into medicine are hot and speak only when spoken to, but check this out...

Concerned about the supply of 'organic food' and the prices thereof? Can't find a good organic apple at a good price? My solution is to buy the inorganic apple and poke fun at those buying the organic kind (if you are right then you will have your revenge), but here you go. Going to polish off a few inorganic beers... back in a minute.

I think if the good Doctor (a psychiatrist) over at How to Cope With Pain were a regular reader that she would have been scared away, I mean erdoc85 just posted on 'fibro', but... All I can say is God Love 'ya doc, I could not do what you do, and, while I'm thinking about it, what percentage of your patients are 'cures'.

Yet another submission from someone who does not follow this blog, but, since I'm posting all that are sent I will let you decide about whether fibromyalgia should limit one's ability to purchase long term health insurance. Now being schooled in basic economics it seems to me that insurance companies should be allowed to manage their risk as they see fit, for the alternative is to do away with insurance as we have known it. I do not say this as someone without any 'disqualifying conditions', but, even being only partially insured, I understand why insurance companies do not want to cover me for an ailment which is likely to make me a losing proposition.


MDOD Grand Rounds comedy award winners for the week...

First, a wonderful bit of satire from Canadian Medicine lamenting the lack of 'journalistic ethics' in the medical blogosphere. We hope this wry bit of humor will lead to the establishment of at least a baseline of what might be termed 'ethics' in journalism.

Second, and again on the satire front, Colorado Health Insurance Insider takes a poke at a scary development in the American mindset, one that elevates access to health care to the level of life, liberty, and the pursuit of happiness. They almost had me with this bit of cheek until I realized that with a little bit of reading between the lines the operating mantra here is "from each according to his ability, to each according to his need". Great one guys. Really funny!