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“Killer” Grand Rounds From Down Under

Grand RoundsBetter Health’s Grand Rounds this week is hosted by the ever-so-crafty Life in the Fast Lane team of Australian physicians at the Utopian College of Emergency for Medicine.

These docs “take great pleasure in sharing their medical experiences, clinical knowledge and insights into waiting-room medicine with health-conscious technophiles to facilitate the learning process by providing diverse and hopefully entertaining reading material.” It’s always worth a read (and a chuckle), no doubt.

With the theme of ”Killer Posts” (just a hint — hate to blow the surprise), this edition of Grand Rounds is sure to educate in more ways than one! Experience it HERE.

Grand Rounds From The Shores Of South Africa

It’s not just the soccer world cup that’s on South African shores, but the great Grand Rounds (something that some would say is far more important than the world cup — okay, only one guy would actually say that, and he’s in a psychiatric institution in Outer Mongolia) is also presently hosted in South Africa! Proudly South African!

Time to see what the bloggers have dished up for us this week. Read more »

*This blog post was originally published at other things amanzi*

Grand Rounds: Call For Submissions

Better Health Grand Rounds logoGrand Rounds will be hosted by Better Health on Tuesday, May 18th, 2010.

Please send your medical blog submissions via email by 12:00AM midnight CDT on Sunday, May 16th, to: maria.gifford@getbetterhealth.com.

Please include:

  •  ”Submission for Grand Rounds” in the subject line of your email.
  • Your name (blog author), the name of your blog, and the URL of your specific blog submission.
  • A short summary (1-3 sentences) of your blog post.

(NOTE: There is no specific theme for this session of Grand Rounds.)

For more information, please see the Grand Round Submissions Guidelines. We look forward to receiving your submissions and featuring them here next week.

Medical Blog Carnivals And Health Wonkishness

This week, healthcare reform looms large in the minds of medical blog carnival hosts. Evan Falchuk’s healthcare reform edition of Grand Rounds is up at his See First blog. Rch Elmore hosts the current Health Wonk Review at his Healthcare Technology News (check out the flying pigs photos and more; cf. the HealthBlawger’s “First Hundred Days” edition of Blawg Review for another reference to flying pigs).

The next edition of Health Wonk Review will be hosted right here on April 15th. The themes we will be exploring in that bi-weekly exegesis of health wonkery include the following:

  • Metaphors
  • Lying
  • Song (esp. the blues)
  • Art (esp. painting, drawing)
  • Inventors and their contraptions
  • Fast food
  • Liberation
  • Cosmetic surgery/medical spas
  • Impressionist 19th century novels
  • Immenseness
  • Mortality
  • Racial integration

And, of course…

  • Death and
  • Taxes

Please submit your best examples of health wonkishness in these categories no later than 9 a.m. EDT Wednesday April 14th, thank you (extra points for early submissions), and come back on the 15th to learn more than you ever wanted to know about healthcare policy and to see the meaning of these categories revealed. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

Last Call For Grand Rounds Submissions – Inaugural Edition

Dr. Val is hosting the historic inauguration day Grand Rounds at MedPageToday. Please send your submissions to this email address: valjonesmd AT gmail dot com. Put “Grand Rounds Submission” in your email title and please use this format for the body of your email:

  1. Post title
  2. Post url
  3. Short description of the post
  4. Blog title
  5. Blog url

Although I have never done a themed Grand Rounds before, it would be terribly remiss of me not to acknowledge healthcare reform on the very inauguration day of our new President, Barack Obama. So please send me your best posts about the change you’d like to see in healthcare. If we do a really great job of this, maybe Tom Daschle will take a looksie? Don’t laugh, but DC is a small world – I share a hair stylist with Tom’s wife, Linda!

Please send me your submissions by midnight, ET, Sunday January 18th. I will include all submissions, but will give more weight to those that are about healthcare reform.

For those of you who are reading this and wondering what on earth I’m talking about – please read about Grand Rounds here. It’s the weekly summary of the best blog posts from the medical blogosphere.

My inaugural Grand Rounds will be published at MedPageToday at 8am, Tuesday, January 20th. (This link will work from that time on). I hope that we’ll reach an unprecedented number of readers on this platform.

I look forward to receiving your submissions!

Warmest Regards,

Val

P.S. Please enjoy Barbara Kivowitz’s Grand Rounds this week – it has a Sci Fi theme! The January 27th edition of Grand Rounds will be hosted by: Chronic Babe.

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

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Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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