Hi! Welcome to Grand Rounds!

Hi! Welcome to Grand Rounds!

Welcome to Grand Rounds for February 9th.  How are you?  Sitting here, finalizing the posts, I am stricken by my utter inability to say anything nearly as entertaining as Dr. Rob did last week.  I mean, I don’t have a single llama picture to offer you!  I’m very disappointed in myself.

So, I’ll try to intro this Grand Rounds with a reminder.  Let’s set the stage.  This morning, as I write this, my two cats are staring out the window at song-birds; happy not to be out in the frosty grass like their dog friends, but deep in their cat souls wondering ‘why am I here, what’s it all about?’  Later, of course, they’ll forget and bite each other, walk on the stove, cough up fur-balls and sleep blissfully.  But somewhere beneath the fur and collars, their tame nature will still wish for something to stalk.

Why are we here?  Why all this medicine?  Why do we study and work, why do our nursing, physician, legal, scientific and patient bloggers care about their issues?  Why do we blog?  (A remarkably relevant question).  What’s the point of all of this effort to learn, to do, to advocate, to work toward health and science?

This morning my children piled into the car with their mother and left for their assorted music lessons (guitar, violin, bagpipe, banjo and saxophone) and Latin class.  (Indeed, we are home-schoolers!)  As they drove away, and I sat in the kitchen watching the cats, smelling the residual scents of croissants, chai tea and hot cocoa, I realized that normality, mundane, joyous normality, is what medicine (even blogging) is all about!

We do all of this not for an end in itself, but so that others can be well!  So that others can live long, pain-free lives with wives and husbands, children and cats, dogs and frosty mornings!  We do this to make life better; not to be smarter or shinier or for any other real reason.  Beneath it all lies the dream of wellness, longevity and function for everyone.

Or at least, that’s what I hope we want.  Otherwise, we might as well assemble ships in a bottle, or watch the birds on the frost in the morning and wonder when the cats will start coughing.

So, in light of that, enjoy these well-done posts and learn something!  But always keep in perspective the reason for the learning, the asking and the searching.

First off, should believing doctors pray for patients?  Let’s start off with some controversy.  I’ve done it and I do it from time to time.  Is it any worse than saying those powerless words, ‘I hope you feel better?’  Read this thoughtful post and see what you think.


Paramedic Greg Friese gives reminders about how we should use, and not use, exam gloves in the EMS setting.  I’ve often wondered about the wisdom of using my pen with the same gloved hand that I used to intubate!  I mean, I sometimes put my pen in my mouth.  Might as well bathe the cat with my tongue.


Dr. Sidharth Sethi, pediatric nephrologist, gives us an overview of myoglobinuria; particularly relevant in light of the tragedy of Haiti’s many collapsed structures.


Wow!  I had no idea bath salts could be so, stimulating!  I mean, my rural patients would put Epsom Salts on thoractomy wounds, but as a way to get buzzed?  Well, if they thought it might work, maybe.  Read this fascinating post from Australia.  And the Aussies and Europeans think we’re weird!  OK, we’re weird.


This post at Supporting Safer Healthcare is a good reminder to carefully monitor those providers we trust with our lives, as a complementary activity to homeland security.  Admittedly, I can think of some physicians I’d love to see interrogated by the federal government.


Early screening for ovarian cancer; certain symptoms may serve as useful warnings, but even the symptoms rarely represent cancer.  A bad disease, to which I lost a dear friend and co-worker several years ago.


GruntDoc points out something I face every day.  Emergency medicine residency does not accurately reflect the reality of emergency medicine practice.  Great post!


And while we’re at it, ways to stay calm in the ER, as we discover it’s not what we thought it would be!


Breaches in patient safety can be devastating; but so are the emotional consequences for those who make them.


Dr. D makes an excellent point.  A medical workup has consequences!  And good intentions may still cause harm.  Useful material for the patient, or professional, who says, ‘I think you need to do more tests.’


This post at geripal is a nice discussion of reality vs. media.  Even though the media likes to take data and run too far with it, the truth beneath the data is still hard.  Persistent vegetative state, for the most part, means the patient has no awareness.  Of course, it doesn’t mean that we don’t love and value them.  But we have to face the science.


The power of narrative in end of life care.  Simple things can be so very powerful.


‘Dear Oprah and Dr. Oz…’ an open letter from the engaging and articulate Kerri Sparling, on her understandable disappointment with their recent on-air discussion of diabetes.  Frankly, Oprah has too much influence to get this wrong!  And I speak as the father of an amazing diabetic son.


Dr. Will Meek asks an important, and sometimes uncomfortable question:  ‘Are you living or existing?’


Dr. Val explains Dr. Rich’s discussion of the ethics of rationing.  Kind of a tutorial…and both writers are very much worth the time you invest!


Dr. Paul Auerbach, wilderness medicine expert, holds forth on Ibuprofen vs. Tylenol with codeine for kids with fractures.  I can say that Ibuprofen works well for injuries sustained while playing ‘bicycle vs. tree chicken.’  Don’t ask.


Lockup doc realizes some people think his job is odd; psychiatrist in a correctional institute.  But sometimes, the jobs no one else will do become the best, most rewarding jobs of all.  And doc, I think what you’re doing is fabulous, and tremendously important!


Forget that demeaning NY Times Crossword!  Take the Fibromyalgia quiz!


Cost transparency in Colorado.  Pity we can’t have more in Washington!  But that’s what you get in a swamp; no comparison to those majestic peaks and years of independent thinking the West has enjoyed!


Is it really a surprise?  But at least someone is talking about something we all knew was self-evident.  Excessive Internet use is not healthy.  (But finish reading Grand Rounds before you go outside beneath the glowing ball in the sky.)


More primary care will bring costs down.  I believe it!  Everytime someone says, ‘well, go to the ER and let them check you out, my office is too full,’ a potentially inexpensive visit gets costly and takes longer.


A few posts from acphospitalist; ‘News of the Obvious!’


Improving chronic care is an issue well known to Neanderthal ER doctors like myself.  We see far too much of it for our patients’ well-being.  I’d love for there to be more money and more docs to care for the chronically ill!  My medical attention span lasts roughly two hours…I’m not the guy for chronic problems.  Unless divided into two hour increments…


Dear Dr. Rob and assorted Apple loving llamas and groundhogs…this post says the iPad isn’t the thing we want after all.  But can Phil the groundhog be wrong about electronics?


Doctors behaving badly and abandoning patients.  Unprofessional and rude to say the least.  I try to behave badly only toward other physicians!


Avastatin, Lucentis and drug pricing.  (Doesn’t Avastatin/Lucentis sound like an incantation at Hogwarts?)  Actually a very eye-opening piece!


Protecting privacy in the photos from Haiti’s devastation.  How does HIPPA apply?  I never thought about it till this way, but everyone, even the dead far away, deserve a little dignity.  Maybe, as physicians, we get a little callous and careless about  the images we share!


What’s a CXO?  If you know the answer, you can keep reading.  And you can thank your guidance counselor for one more cool job you didn’t know existed!


A great question at this post:  why do we do so well in a crisis like an earthquake, but not so well with the nearby, commonplace problems that plague humanity?


Do demented elderly women really benefit from routine mammograms?  It’s doubtful.


Chronic pain causes changes in the brain; and the rain in Spain….well anyway, it’s poetic but important.  And it may certainly explain much that we see in the chronic pain populations, and also our inability to manage them!


Hyperlordosis as a cause of back pain and disc injury.


Nurses that ‘squat.’  No, not that way.  Read the post.  It’s a great point about career development!


Finally, two posts on Haiti:

First, do you know anyone who should be on the list of volunteer heroes in Haiti?  You can submit their names here.


Second, I leave you with a poignant description of why we practice medicine.  My friend Diane is a PA, working for one year in Haiti.  She was there when it happened.  And here she describes what some of it was like.  She wouldn’t call herself a hero; she just did what love requires.


So that’s it for the week!  I’m now going to finish my shift and do my standard end of work-day commitment papers for one more depressed, suicidal patient.

The work goes on.  And so do we; mostly for the right reasons, too.  And that, after all, is what lies behind our blogging.  Not clever words or cool concepts, but suffering humanity.

Have a blessed day,


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