Grand Rounds 3.14

Welcome to Grand Rounds, the collection of the best posts in medical blogging!

Grand Rounds has come a long way since the last time it was hosted here. By my count, eighty-nine unique bloggers have hosted 118 editions. This includes doctors, nurses, students, patients, administrators, analysts, entrepreneurs... with the occasional doula or transplant coordinator or epidemiologist thrown in, for good measure.

Many bloggers have changed over this period – I've lost track of all the births and graduations, but can't forget some of the trials and disasters some fellow bloggers have endured. Others slowly changed focus of their writing – from medicine to political commentary, or from work musings to home life. Some have merely changed their web address (eleven, by my count, with the lion's share jumping to SEED's scienceblogs family).

Twenty-nine bloggers have hosted Grand Rounds more than once, including ten of the first twelve hosts. But, in this time of year-end reflection, I'm thinking about the nine bloggers that seem to have stopped writing online altogether –- Galen, Shrinkette, Code Blue Blog, 'Doctor' from Chronicles of a Medical Madhouse, Mudfud, Iatremia, Red State Moron, Dr. Andy, and Geeknurse. Some have archives available for your perusal and fond recollection. Some, sadly, are gone. A few appear to be overwritten (does typepad recycle?).

Hopefully, our missing colleagues all doing ok. Bloggers talk to each other enough, reading and commenting on posts so frequently, that when one of them disappears, it feels like we're losing a friend.

But, with internet anonymity being what it is, it's conceivable these writers have surfaced on other sites, and we just don't know it. Or, they're just waiting for a time where their schedule permits more public reflection.

It's like they say: Great blogs don't die, they just... go on hiatus, and re-emerge with newfound resolve and a burst of creativity. This year, we witnessed the comebacks of Medpundit, The Blog That Ate Manhattan, Dr. Dork, Doc Around The Clock, and Intueri. They had their reasons for taking a break, but we're delighted to have them back -- even as the medical blogging world continues to grow...

This week, the final edition of 2006, I asked bloggers to submit their best work of the year. Some have undoubtedly been improving their writing week by week, so their best post is simply their latest. Others looked to posts that were the most fun to write, or generated the most comments. Some bloggers let me decide! Now, it's your turn -- see what you think. I've loosely organized the posts into the following categories:

Medical News and Commentary
Bloggers are renowned for their abilities to comment on the news (often, in pajamas) but on a few memorable occasions, bloggers can report news, too. Such is the case with Dr. Steven Palter of Doc in the Machine, who announced his award-winning endometrial diagnosis technology on his blog. It's part of a series Dr. Palter has written, on the radical transformation of surgery.

Mighty GruntDoc, probably the most consistent contributor to Grand Rounds and current favorite to reach Four-Time Host status first, submits this analysis of a case where law and medicine collided in the ED.

The blogger On The Wards digs deeper into an intriguing new finding on obesity -- are certain bacteria responsible for making you fat?

A new blogger on the scene, Sandy Szwarc, whose blog Junk Food Science argues from the perpective of enjoying food and accepting body shapes, pokes holes in recent reporting on the obesity epidemic.

It's getting cold outside -- and outdoor enthusiasts are paying the price. Healthline writer Dr. P.S. Auerbach provides a timely primer on hypothermia.

What if our insurance companies could provide us with "Nutrition Facts"-style info on basic surgeries and diseases? Henry Stern of InsureBlog interviewed the Chief Innovation Officer at Blue Cross Minenesota, to learn about this new initiative in health care transparency.

Reflections on the Job
Frustrated in dealing with the radiology department? The Not Dead Dinosaur coins the term Rad Rage after weeks of trying to get an x-ray properly interpreted.

Old-school blogger Dr. Anjali Taneja of To The Teeth wrote me a nice note, promoting the work of her colleague Andru Ziwasimon, who asks a simple question: Why do we cut the cord immediately after birth?

Faithful GR contributor (and two-time 2006 host) Kim, from Emergiblog, recalls giving a needy patient shelter from the storm.

Dr. G.C. George, of Odysseys of George, once wrote that being included in a recent Grand Rounds made his day. That's high praise, because shortly afterward he described this day, which captures the sheer joy this surgeon feels at work.

Speaking of a surgeon on a strange trip, Dr. Jon-Mikel Inarritu-Castro of Unbounded Medicine wrote about his most memorable patient this year: The guy who woke up with an arm... somewhere else.

Integrating what we learn in the classroom to what we see with patients is one of the trickiest parts of medicine. Dr. Signout notes that it's even trickier when the patients aren't in the hospital, but rather, encountered along the side of the road.

Geena from CodeBlog, who provided us with a memorable singalong before getting distracted this year, relates the tale of a patient with a rapidly expanding bust size.

A young resident physician, Dr. Couz, ponders a taboo subject, and precisely why patients and physicians choose to ignore it in their encounters.

Who doesn't love a year-end Top Ten list? At one point, I was thinking about compiling a few such lists here, like Dr. Charles once did... But Yan Minis has submitted such an audacious Top Ten, it may put to rest all future medical lists: The Top Ten Health Practitioners of All Time.

Medical Student Jeffrey Leow over in Melbourne writes about a role model that he hopes will influence his future practice of medicine.

The Other Side
One of the best parts of Grand Rounds, I think, is hearing the patient perspective (in fact, before my time, hospital Grand Rounds used to actually involve patients.) In that spirit, the award-winning blogger at DiabetesMine opened up the floodgates with her post, the Diabetic Partner Follies, which has "become host to hundreds of responses and astonishing emotional catharsis."

What if your medication changed size, shape and color, but everyone pretended it was the same? Rachel of Tales of My Thirties writes on one of the few times generic switches are risky with her thyroid pill switch.

Ever think about what it's like to wear a Holter monitor? Find out, when Dr. Dork becomes a patient (but remains, thankfully, a lovable dork).

Just in time for the New Year (okay, a week early) -- one of the contributors to Chronic Babe shares some tips on finding the right doctor for your individual needs.

When life gave her lemons, she wrote Lemonade Life. Allison Blass shares her frustrations on being a role model and poster child for diabetes, all while struggling with its physical demands.

A pastoral care volunteer writing at Barefoot in the Snow warns that doctors need more counseling than they're getting. She should know -- she stirringly describes of what it's like to be the frightened patient.

Urostream's blogging urologist, KeaGirl, sends in a fascinating post about the Jehovah's Witness dilemma before elective surgery -- it gets more enlightening in the comment section, when a Jehovah's Witness writes to clarify the specifics of their beliefs.

The Persistence of Memory
Most bloggers are writing from a safe distance from the Iraq warzone. But as the psychiatrist Maria from vividly demonstrates, the front lines are everywhere when soldiers come home.

Rita, the credentialer of the medical blogosphere, shared the value of compassion in her interactions with PTSD patients. Writing at MSSP Nexus, she learned Sometimes people act irrationally for very rational reasons.

At a funeral, a parent asks Neonatal Doc about advances in NICU care. It's a conversation prompted by an unforgettable loss.

Poet's Corner
Susan Palwick is a poet and novelist writing at Rickety Contrivances of Doing Good. She's started a series of poems based on her work as a volunteer chaplain in an emergency department. (check the sidebar for more).

A beloved blogger from down under offers a harrowing depiction of psychotic depression.

Maybe it's the season, but two blogging surgeons known for their cutting remarks and dour temperment submitted some funny stories this week:

Sidney Schwab was called into the OR for a obese patient in a curious predicament...

... and Aggravated DocSurg, waxing nostalgic, tries to explain that chemotherapy is a lot like a TV show or method of mass transit.

A senior cardiologist and colleague of Dr. Wes reflects on end-of-life issues. It actually makes a lot of sense.

Dr. Anonymous is upset about me being named Time magazine's Person of the Year (and here I was, thinking you were the choice). He proposes something else -- something that can be part of us, and yet, is distinctly not us...

Well, this was a busy week... but it's been a thrill hosting again, and reconnecting with this far-flung community for the end of the year. If you have any memories of these bloggers or others I may have missed, please share them in the comments!

Next week, Musings of a Distractible Mind will ring in the first Grand Rounds of 2007!

Grand Rounds Comes to Blogborygmi 12/26/06

Hey, everyone -- I'll be hosting Grand Rounds next week!

Some of you are probably asking, "Why?" Or more pointedly, "Are you still blogging?"

Yeah, I've got some explaining to do: I wanted to give my editors at Medscape a break -- Christine Weibe and Susan Yox have brought coherence to my disjointed interviewing style, every week for the last thirteen months, without reprieve. Their ideas and enthusiasm have helped Grand Rounds in innumerable ways -- and they deserve recognition and relaxation.

Plus, I've gathered data from several years, several sites, and it's pretty clear that fewer people read medical blogs around the holidays.

So, no Pre-Rounds spotlight next week -- no eager new blogger or grizzled, esteemed vet to take the center stage. It just wouldn't be fair.

And yet, canceling Grand Rounds seems unnecessarily drastic -- especially at the end of the year, a time for reflection and "best-of" lists. Plus, it would totally ruin the numbering scheme.

So I'll host! Yay. Send me an email -- with the url and description -- of your best posts of the year to nick /at/ . Submissions are due Christmas morning (Eastern Daylight Time).

I'm also looking for links, posts or remembrances from blogs and bloggers that 'retired' in 2006.



It's some combination of sound and sensation. It starts in the middle of the workday, and lurks in the back of my mind as I make my way through the ED. My pace isn't quite the same; my balance is ever-so-slightly off.

The unsettling feeling gains traction on the commute home -- spilling into conscious thought the moment I walk through the door, into the quiet, familiar apartment.

Yes, there is definitely something stuck to the bottom of my shoe.

Before I even look, I'm performing damage assessment: how bad can it be? I've only taken a few steps in my kitchen...

Fear and loathing give way to surprise and recognition -- I've never expected to find something pleasant under my shoe, but today I saw a sticky pad from an EKG lead, nestled near the heel of sole.

I pulled it off and speculated on when we first came together. Was it at the bedside of the bradycardic woman? Maybe during the central line? The lead pad reminded me of some interesting patients, some memorable rhythms.

I threw it out. And then I washed my hands.

Selection Bias

The bulletin boards of every major hospital I've worked in are bombarded by signs of variable quality, soliciting research subjects or volunteers. Passers-by are asked to call a phone number if they fit within a certain demographic, take a certain drug, or engage in a certain behavior.

Where I went to medical school, the research solicitations were amateurish and fun. For whatever reason, investigators at that hospital were performing a lot of research with alcohol (on, with, and for)... Signs were frequently up, in bright neon colors, asking for young men and women to drink alcohol and give blood (for an immunoassay), drink alcohol and enter a driving simulator, drink alcohol and take a quiz. I have many fond memories of being paid to drink -- doing my part for science.

Now, I notice in some hospitals where I work, the ads are a little more slickly produced, but the 'image' conveyed to me is not exactly upbeat. Investigators are looking for patients with refractory depression, or active genital herpes, or WTC responders with respiratory problems.

When I see that many of the contact-stubs have been torn off of these solicitations, it prompts a different reaction than when the "drinking quiz" was recruiting.

Of course, I'm glad research on these diseases is being conducted. It gives hope, for both the volunteers and all patients.

Maybe the ED is warping my perspective on illness. Since I don't spend much time in clinics anymore, it's hard to remember what patients look like when they're not having an acute infection, or flareup of some chronic condition.

When all the tabs are ripped off the posters, it hits home that there are sick people everywhere, making their way, just walking around me in the lobby, by the bulletin boards.

And that's when I really wish for another alcohol study...