April 1st, 2008 by Dr. Val Jones in Medblogger Shout Outs
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Welcome to Grand Rounds Volume 4, Number 28, part 2. This is the most esteemed medblog carnival on the Internet, founded by Nicholas Genes, MD, PhD on September 28, 2004. Grand Rounds is meant to embody the spirit of good science and humanism in medicine, as it is a weekly collection of the very best blog posts from critically acclaimed, international health care professionals.
This noble undertaking has been carefully advanced by high-minded hosts, who happily put aside their life’s work, their families, yes, even the needs of their beloved pets, in order to provide readers with a cogent analysis of the week’s most important medical facts and opinions. I didn’t think I’d see the day when this great public service would fall into the hands of the lackadaisical. But alas, that day has come – and wouldn’t you know that it would be an Emergency Medicine physician who let us all down?
GruntDoc, a pillar of the medical blogosphere establishment, cannot be bothered to fulfill his hosting role this week, and has asked yours truly to finish his work for him. How typical of an EM physician! Get things started and then hand them off to another doctor to complete. (Witness his shameful apathy for yourself at Grand Rounds, Part 1).
Well, it’s one thing to be summarily passed the Grand Rounds baton, and it’s another altogether to be left with the dregs of the submissions. I am agog and aghast at the low-brow nature of this week’s offerings. Here is but a small sample:
The common leech as a celebrity blood-detoxification system (by Dr. Ramona Bates at Suture for a Living).
The surgical value of flatus (by Bongi at Other Things Amanzi).
In search of the perfect gluteal contour (by My Med Jokes).
In search of your lost tampon (by Dr. Jan Gurley of Gurley Doc).
I find this whole exercise utterly deflating – and unworthy of the high calling of Grand Rounds. But because I myself am long-suffering and reliable, I will not shirk my responsibilities, but rather ask a peer with lower standards (whose sensibilities will surely not be offended by flatus) to continue this week’s carnival. Please go to David Williams’ blog for the rest of this collection of health content of questionable value.
-Posted April 1, 2008-This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 21st, 2008 by Dr. Val Jones in Uncategorized
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Health tips
Are you struggling with depression? Mira Kirshenbaum suggests that talk therapy may be more effective than medications.
Does your child have mono? Dr. Stacy Stryer explains that mono has very different symptoms depending on a child’s age.
Be careful of vitamins and supplements – some of them may negatively affect your other medications. Dr. Julie Silver offers a list of the most common supplements that interact with medications.
If you see flashing lights or floating objects in your visual fields, see an ophthalmologist right away. Dr. Jackie Griffiths explains why the symptoms of retinal detachment can be quite ominous.
Are you about to have surgery? Dr. Jim Herndon suggests some questions to ask your surgeon before and after the operation.
Don’t be shy about asking for help when you have cancer. Dr. Heinz-Josef Lenz highlights some great advice from the Colon Cancer Alliance.
Looking for ways to enhance your sex life? Mira Kirshenbaum has some creative suggestions.
Do you have diabetes? Exercise might be the most important “treatment” for type 2 diabetes. Dr. Jim Hill explains.
Did you know?
Fertility decreases by 5% for every 1 point increment in BMI over 29. That means that getting pregnant becomes more and more difficult as you gain weight! Dr. Mark Perloe explains.
Men can suffer from post-vasectomy pain. Dr. Joe Scherger describes this problem and what to do about it.
Could having children increase a man’s risk for prostate cancer? Dr. Mike Glode reviews the evidence.
Your brain needs sleep to recharge its neurotransmitters. Dr. Steve Poceta explains the exact reasons why sleep is so important for the health of the human brain.
Approximately 1 in 25 children will have at least one febrile seizure in their lifetime. Dr. Olajide Williams explains that a seizure that occurs during a time of fever does not mean a child has epilepsy.
Siestas and/or power naps could reduce your risk of heart disease. Dr. Joe Scherger highly recommends this regular form of stress reduction.
There are fat zip codes and skinny zip codes. Dr. Jim Hill explains why thinner people congregate in certain places. Think upper east side, Manhattan!
A recent study suggests that calcium supplements may put older women at higher risk for heart attacks. Dr. Jim Herndon explains why he’s skeptical of this potential link.
Medicare will not pay for in-hospital complications believed to be due to errors. Kelly Close wonders how they know for sure that an adverse outcome is related to an actual error or not.
Do you know someone who engages in repetitive, jerky movements? Dr. Olajide Williams is a neurologist who explains what “tics” are and what can be done about them.
Around the globe
China: How many autism experts are there in China? About 30 for 1.3 billion people. Robin Morris describes how bleak the prospects are for parents of children with autism.
United States: In an outrageous court ruling, a physician was held responsible for the death of a young boy who was run over by a patient (while driving his car) on blood pressure medicines. Dr. Cole Brown wonders how much of a patients’ actions can be blamed on his physician?
Africa: “River blindness” is caused by a parasitic invasion of the eye. These parasites can be killed with a medicine called ivermectin, but apparently the wily larvae have developed a genetic mutation that renders them resistant to the only known medicine that can kill them. Dr. Jackie Griffiths reminds us all how tenuous our antibiotic victory over microbes and parasites really is.
Personal perspectives
Some people use diet coke in their CPAP machines! Dr. Steve Poceta tells the story of how one of his patients preferred this type of humidified air. Not sure what that will do to your lungs…
Ever wonder how to weigh the pro’s and con’s of chemotherapy in a terminally ill patient? Dr. Mike Rabow describes how he advises patients about this difficult decision.
Dr. Rabow describes some tear jerking true stories from a hospice in Florida.
From the blogosphere at large: this week’s grand rounds is hosted by Alvaro Fernandez at SharpBrains.com. The theme is: briefing the next US president on healthcare. Some really important information in there folks, so go ahead and have a good read!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 12th, 2007 by Dr. Val Jones in True Stories
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This week’s host of medical grand rounds invited individuals to submit blog posts that feature stories about “sudden change.” As I meditated on this theme – I realized that one of my patients played a key role in my sudden career change from academic medicine to joining a healthcare revolution.
As chief resident in PM&R, I spent a few days a month at an inner city clinic in the Bronx, helping to treat children with disabilities. The clinic was dingy, overcrowded, largely windowless, and had waiting lines out the door starting at 8am. Home health attendants generally accompanied the wheelchair-bound children to the clinic as many of them were orphans living in group home environments. The kids had conditions ranging from cerebral palsy, to spinal cord injury from gun shot wounds, to severe spina bifida. They sat together in a tangled waiting room cluttered with wheelchairs, walkers, crutches, and various prosthetics and orthotics. There were no toys or even a TV for their amusement. The air conditioning didn’t work well, and a lone clock ticked its way through the day with a bold black and white face.
The home health aides were eager to be called back to the examination rooms so that they could escape the oppressive conditions of the waiting room. I opened the door to the room and called the name of one young man (we’ll call him Sam) and an aide leapt to her feet, knocking over another patient’s ankle-foot orthosis in the process. She pushed Sam’s electric wheelchair through a series of obstacles to the exit door and back towards the examining room.
Sam was a teenager with cerebral palsy and moderate cognitive deficits. His spine was curved into an S shape from the years of being unable to control his muscles, and he displayed the usual prominent teeth with thick gums of a patient who’d been on long-term anti-seizure medications. He looked up at me with trepidation, perhaps fearing that he’d receive botox injections for his spastic leg muscles during the visit. His wheelchair was battered and worn, with old food crumbs adhering to the nooks and crannies.
“What brings Sam here today?” I asked the home health aide, knowing that Sam was non-verbal. She told me that the joystick of his electric wheelchair had been broken for 10 months (the chair only moved to the left – and would spin in circles if the joystick were engaged), and Sam was unable to get around without someone pushing him. Previous petitions for a joystick part were denied by Medicare because the wheelchair was “too new” to qualify for spare parts according to their rules. They had come back to the clinic once a month for 10 months to ask a physician to fill out more paperwork to demonstrate the medical necessity of the spare part. That paperwork had been mailed each month as per instructions (there was no electronic submission process), but there had been no response to the request. Phone calls resulted in long waits on automated loops, without the ability to speak to a real person. The missing part was valued at ~$40.
I examined Sam and found that he had a large ulcer on his sacrum. The home health aid explained that Sam had been spending most of his awake time in a loaner wheelchair without the customized cushioning that his body needs to keep the pressure off his thin skin. She said that she had tried to put the electric wheelchair cushion on the manual chair, but it kept slipping off and was unsafe. Sam’s skin had been in perfect condition until the joystick malfunction. I asked if he’d been having fevers. The aide responded that he had, but she just figured it was because of the summer heat.
Sam was transferred from the clinic to the hospital for IV antibiotics, wound debridement, and a plastic surgery flap to cover the gaping ulcer hole. His ulcer was infected and had given him blood poisoning (sepsis). While in the hospital he contracted pneumonia since he had difficulty clearing his secretions. He had to go to the ICU for a period of time due to respiratory failure. Sam’s home health aide didn’t visit him in the hospital, and since he was an orphan who was unable to speak, the hospital staff had to rely on his paper medical chart from the group home for his medical history. Unfortunately, his paper record was difficult to read (due to poor handwriting) and the hospital clerk never transferred his allergy profile into the hospital EMR. Sam was violently allergic to a certain antibiotic (which he was given for his pneumonia), and he developed Stevens-Johnson Syndrome and eventually died of a combination of anaphylaxis, sepsis, and respiratory failure.
When I heard about Sam’s tragic fate, it occurred to me that the entire system had let him down. Bureaucratic red tape had prevented him from getting his wheelchair part, poor care at his group home had resulted in a severe ulcer, unreliable transfer of information at the hospital resulted in a life-threatening allergic reaction, and a lack of continuity of care ensured his fate. Sam had no voice and no advocate. He died frightened and alone, a life valued at <$40 in a downward spiral of SNAFUs beginning with denial of a wheelchair part that would give him mobility and freedom in a world where he had little to look forward to.
Sam’s story was the last straw in my long list of frustrations with the healthcare system. I began looking for a way to contribute to some large scale improvements – and felt that IT and enhanced information sharing would be the foundation of any true revolution in healthcare. And so when I learned about Revolution Health’s mission and vision, I eagerly joined the team. This is a 20 year project – creating the online medical home for America, with complete and secure interoperability between hospitals, health plans, healthcare professionals, and patients. But we’re committed to it, we’re building the foundation for it now, and we know that if successful – people like Sam will have a new chance at life. I can only hope that my “sudden change” will have long lasting effects on those who desperately need a change in healthcare.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 15th, 2007 by Dr. Val Jones in Announcements, Expert Interviews
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I was recently interviewed about my blog (and this week’s edition of Grand Rounds) by Dr. Nick Genes at Medscape. For the curious among you – here is the full Medscape interview with Nick Genes (prior to editing). It gives you a little more information about Revolution Health…
1. You’ve
been involved in writing since medical school, for various audiences. Who are
you trying to reach with your new blog, and how have you found blogging to be
different than the other media you’ve worked in?
The best part about
blogging is that it’s a dialogue rather than a monologue. I find the interactive discussions and
heartfelt responses to be touching and engaging. My previous writing was more academic because
of the medium (medical journals) but now I’ve found that blogging is where I
can really be myself – there is no team of reviewers to scrub my words. So what you read is what you get!
2. I’m
very curious about Revolution Health, your role as Senior Medical Director, and
where you think this is all going. But all revolutions have their origins
somewhere, and yours seems to start… on a yogurt farm. Please share a little
of what that was like, and maybe what early influences have given you such an
interesting background. From small towns to New York City, from theology to medicine, it
seems like you’re living a very rich life.
Yes, I guess you could
say that my origins as a revolutionary are firmly rooted in dairy farming. Although it may not be immediately apparent
how the two are related, Internet startups and cattle herding have their similarities. First, you have to wear many hats – there is
no job too small or too large. If the
cows need milking, and the electric machines are broken, you do it by hand. If a cow breaks through the fence and wanders
off into town, you lure her back with short feed. If a large batch of yogurt curdles, you’ve
got yourself a gourmet meal for your pigs… you get the drift. In a large start up, all manner of unexpected
events happen – but the trick is to handle them quickly and efficiently, and
make sure the outcome is a win-win.
As far as my other
life detours… I guess you can say that I’ve been a victim of my own
curiosity. There are so many interesting
things going on, I just can’t help but want to try them out. In the past I’ve held jobs in the following
capacities:
A protestant minister,
NYC bartender, bank spy, food critic, doctor, cartoonist, computer sales
associate, yogurt mogul, nanny, motivational speaker, biophysics researcher,
graphic designer and revolutionary medical director.
So my life has
certainly been an adventure!
3. How did you get involved with this company? Did Steve
Case find you, or know you from before — or was there an application process?
Is the mingling of medical and computer technology folks going smoothly? Is it a
mix of hospital culture vs. laid-back internet start-up culture? (Foosball and
mountain bikes, or suits and meetings?) Can you make comparisons to your time
with MedGenMed?
A friend of mine had
interviewed at Revolution Health for an executive position and thought that the
company would be a great fit for me.
When I heard who was involved (including Colin Powell, Steve Case, Carly
Fiorina) and that the goal was to create a website to help patients navigate the health care
system, I thought – gee, this sounds serious, challenging and worthwhile. So I sent in my resume, got offered an
interview, put on a bright red suit and announced that I’d heard that there was
a revolution afoot and wondered where I could sign up. They hired me that same day (May 8, 2006) and
it’s been the most exciting job I’ve had to date!
About the “mingling”-
a very interesting question. There is a
hint of Foosball/mountain bike in the mix, but I think we’re a little more hard
driving than that. Since Revolution
Health is in its start up phase, there is simply too much work to do for people
to be playing Foosball. When I started,
there were 30 employees, now there are closer to 300. We are all working long hours on cutting edge
projects that I believe will make a big difference in supporting the
physician-patient relationship, streamlining the process of healthcare delivery
and improving accessibility to the uninsured and underinsured. Revolution has attracted some of the
brightest minds in the tech industry – and they are building products I could
never have dreamed of on my own. Since I have such an unusual background,
I’m bilingual in both techie speak and
physician speak, and this helps a great deal.
Because I understand what physicians and patients need, and can translate
that for the “creatives” we can build some really meaningful tools and products
together.
My time at MedGenMed
was wonderful, primarily because Dr. George Lundberg is a dear friend and
mentor. He has done fantastic work
creating a pure platform (no pharma influence or fees for readers or authors)
for open-access publishing. He taught me
to speak my mind, follow my gut and never compromise my ethics. His book, “Severed Trust” galvanized me into
action – to do my part to improve the damaged physician-patient relationship
that is at the core of our broken system (caused by middle men, volume
pressures and decreased time with patients).
After reading his book, I wanted to do something big – so I joined a
revolution.
3. Revolution
Health has some bold ideas about improving care for its members — getting
appointments with specialists, patient advocacy in dealing with insurance, and
of course, sharing information. What’s your job entail, as medical
director? Do you think you’ll find yourself making policy decisions that
could affect, directly or indirectly, chunks of the population? Could
you find yourself in a position where some specialists are not recommended
based on their insurance? Will Revolution Health have a formulary, will it
be evidence-based — or could could care be rationed ?
My job is incredibly
challenging and fun, and I rely on both halves of my brain for much of what I
do. We have 146 medical experts most of
whom I’ve personally recruited, I’m responsible for coordinating the medical
review of all the content on our portal (so that it conforms with
evidence-based standards), I facilitate relationships with major hospital
systems (such as Columbia University Medical Center), spearhead new product
initiatives (such as Health Pages for physicians), monitor and promote our 30+
expert bloggers, participate in writing press releases, creating podcasts, radio interviews,
identifying new partnership opportunities and much more.
I do think that
Revolution Health will greatly influence vast “chunks” of the population. And this is what’s particularly exciting
about working here. We really are
building a brand new navigational system for healthcare – and this will empower
patients to take control of their health and provide them with better
information and guidance in living their best.
I believe that Revolution Health will become the new virtual medical
home for physicians and patients, just the way that AOL grew to be America’s
Internet home. You log on first to AOL
to get your email, check your news, and get plugged in before surfing the
net. You’ll log in to Revolution Health
to track your health, connect with your lifestyle coach or physician guide, get
involved with a community of others like you, or track your loved ones’ health
issues through Care Pages. This is a 20
year project, so all of our plans and programming may not be apparent yet, but
the trajectory is amazing and I wouldn’t want to be anywhere else as a
physician today.
5. What are some of your favorite posts — something that
struck a nerve with readers, or captured something you wanted to express?
Please provide links!
My absolute favorite
post is the story of how my mom, a strong patient advocate, saved my life as a
baby. She refused to accept the
misdiagnosis I was given, and continued to nag the medical team until they
realized what was wrong and took me to the O.R.
If it hadn’t been for her persistence (or the incredible skill of the
surgeon who ultimately took care of me), I wouldn’t be here today. And maybe that’s why I’m passionate about
both good medical care AND patient empowerment!
Other posts that have
been well received are true stories from my medical training days. Some are controversial (like this one about
end of life issues and my first day as a doctor),
and others are warmer reflections. But ultimately, I just share what’s on my
heart and let the audience take away what they can from it.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 11th, 2007 by Dr. Val Jones in Medblogger Shout Outs
2 Comments »
Welcome to the latest round up of the best of the healthcare
blogosphere. Today it is my pleasure to offer you your weekly dose of Grand
Rounds, optimized for your state of mind.
I believe that there are two basic types of blog readers, and so you’re
getting Grand Rounds 2 ways (with a dash of cartoons thrown in for extra “feel
good” measure):
- Just
the Facts: Distractible, hurried, currently in between seeing patients –
or perhaps your kids, cats, dogs, llamas are begging for attention… or
maybe you’re an ER nurse or surgeon who has no patience for long winded
stories? You’re category one and
should proceed directly to Grand Rounds IR (immediate release – below).
- All
the Details: Calm, peaceful, you enjoy good prose and a cup of chai
latte. You like reading all the
juicy details of a grand rounds line up and will spend hours picking
through the references – or maybe you’re an Internist or Psychologist who
knows that the best medicine is found in the details? You’re category two and should proceed
directly to Grand Rounds XR (extended release – next post).
Many thanks to Nick Genes, father of Grand Rounds (who acts
behind the scenes to ensure the success of each host), and please check out
next week’s Grand Rounds at Code Blog: Tales of a Nurse.
Grand Rounds IR (asterisk
= honorable mention for great writing)
Happy Posts
*Starbucks Caters to Diabetics
Woman Saved by Bush Pilot in Frozen Tundra
*CEO Says He’s Sorry
Prayer Can Reduce Arthritis Risk?
*Disaster Unpreparedness [Cartoon]
Med School Graduation Ceremony [Cartoon]
Nurse uses Star Trek Mentor to Set Course for Kindness
Galaxy
Shrink Rap Podcast: Prank Call with Dr. Phil McGraw &
More [Cartoon]
*Cape Cod Vacation Derailed by Flood, Stroke, Famine & Infection
The Evils of Hand Washing
Sad Posts
Triage in the ED [Cartoon]
*Sad Cases in ED
Elderly at Risk of Death From Tranquilizers [Cartoon]
Life as a Nurse Assistant in Vermont
Hot Topics
Infanticide
Hucksterism
Healthcare Outsourcing (podcast) [Cartoon]
Blog Censorship A
Blog Censorship B
Arrogant Docs [Cartoon]
Should Kim See Sicko?
Helpful Tips
To Fend off Bears
To Get the most out of Medicine, Web 2.0 style
To Get into Medical
School
To Avoid Kidney Damage from Contrast Agents
To Perform A Pyloromyotomy [Cartoon]
To Diet Successfully – Gluten Free [Cartoon]
Case Reports
Wii-itis
Rare pancreatic tumor
Uncategorized
Cost-benefit analysis of genetic testing
Commencement Speech for Harvard Medical
School Graduation
New Alzheimer’s Research [Cartoon]
New Genetic Research
Book Recommendation for Type 2 Diabetes
For the full text version complete with cheerful commentary, please go to Grand Rounds XR
(next post)
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
