Monday, June 15, 2009
Grand Rounds at ACP Internist
Welcome to Grand Rounds at ACP Internist, a newspaper serving internal medicine. We're paying tribute to the daily newspaper. Read on for the latest headlines, opinions, features and even the funnies.
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Rx for health care: good medicine
By See First Blog
Evan Falchuk joins the chorus of comments that have arisen about Atul Gawande, MD's, influential New Yorker article on the U.S. health care system. Unfortunately, most readers are missing the most important point, "that we need to put good medicine back at the center of health care."
For health care reform, keep it simple
By Colorado Health Insurance Insider
Sen. Ted Kennedy's health care reform bill includes good ideas but attempts to do too much.
For best care, doctors must keep the whole patient in mind
By Not My Second Opinion
A family medicine doctor provides clarity for a confused patient whose dizziness led her to see several specialists--and get several diagnoses. To prevent such situations and fix our broken healthcare system, doctors need to start treating the whole patient.
Even evidence-based medicine has its exceptions
By The Jobbing Doctor
Of course, doctors should practice evidence-based medicine. But they should know when it's time to break the rules, as well, a 30-year veteran writes.
Predicting the shape of health care reform
By ACP Advocate
Potential consensus legislation could include higher Medicare payments for primary care physicians but might be "too little, too late."
When it comes to diabetes, misinformation abounds
By Six Until Me
Kerri Sparling writes about some of the most common diabetes misconceptions and stereotypes she's encountered in the 22 years since her diagnosis.
Letter to the editor
Duncan Cross responds to a Wall Street Journal editorial that holds patients responsible for health care costs by suggesting the members of its editorial board either have perfect health or a virulent strain of contagious rectocephaly.
Insight into asthma
By Allergy Notes
Allergy Notes highlights some intriguing research on how Leukotriene B(4)-BLT1 axis may contribute to airway remodeling in asthma.
Some evidence isn't ready for practice
By Laika's Medliblog
There is a lot of talk in medical circles about bridging the gap between evidence and practice, but even the gold standard randomized controlled trial doesn't always give useful answers.
Factor patients into the health care cost equation
By Marianas Eye
David Khorram discusses the ways in which patients' behavior can drive up health care costs.
Slow and steady might win the health care reform race
Health care reformers may be biting off more than they can chew. The Massachusetts approach of addressing one thing at a time--access, cost and quality--might be worth considering at the national level.
Don't blame Canada
By Canadian Medicine
Some commentators have pointed to Canada's health care problems as an excuse to avoid further federal involvement in the U.S. health care system. But this argument is no more than fearmongering, Canadian Medicine writes.
Health and Lifestyle
If changing a habit is hard, try 1/2 instead
By How to Cope With Pain
Sometimes tackling a habit is too hard. Make incremental changes instead for healthier choices about diet, exercise or smoking cessation.
Gynecology rules, but birth process is more boredom than miracle
By Vagus Surgicalis
A New York Times piece on maternal mortality prompts an Australian medical student to reflect on his recent OB/GYN rotation.
Lessons learned from a bittersweet birth
By Beyond the Short Coat
A medical student recounts his very first delivery--of a baby destined to die from severe holoprosencephaly--and his subsequent interaction with the patient's family.
Addicted to ultrasounds
By Reality Rounds
A NICU nurse wittily recalls her obsession with weekly ultrasounds while pregnant--until a wise medical director puts her in her place.
Arthroscopy results no better than pretend surgery
By The Fitness Fixer
Knee surgery is done, recommended, repeated and taught, but the evidence base shows it is more often not needed. A study shows that having arthroscopy is no more effective than having fake surgery.
Your mattress, your health, your choice
By The Back Pain Blog
PubMed archives shed light on sleep studies that examine whether quality mattresses help back pain.
Hip replacement technique may benefit 'young actives'
Henry Stern talks to orthopedic surgeon Robert Roman about the pros and cons of the Birmingham approach.
Tricky diagnosis? Consult Dr. Google
By Clinical Cases and Images
Ever wonder how you can use Google Squared to create an automatic differential diagnosis list? Find out on the latest post.
Cloud computing for automated patient reminders
By Medicine and Technology
Systems can gather medical information and alert clinicians and patients if a problem is detected. These types of automated reminders are not difficult to generate with the right algorithms that are driven by evidence-based practice guidelines. Will electronic health records lead to improved patient outcomes?
Catch more than a sunburn at these beaches
By Medicine for the Outdoors
California and Illinois beaches have particularly high levels of bacteria and swimmers may want to check online water quality reports before diving in.
Add footwear to the list of essential protection
By Teen Health 411
It's a good idea to keep your shoes on this summer in the locker room or at the pool, where viruses and fungi often lurk.
Not a DIY project: curing depressed teens
By Doc Gurley
Paying for professional help, in the form of cognitive-behavorial therapy, is worth the money for the parents of depressed teens, according to new research.
From caregiver to 'care-taker'
By In Sickness and In Health
When a serious illness strikes, the role of caretaker often falls to the patient's significant other. But what happens when the caregiving partner gets sick?
Curing bad behavior in the hospital family
In an effort to improve patient safety, the Joint Commission is targeting disruptive behavior, yet another area where health care can take a cue from the aviation industry.
Saying no to new business
By Novel Patient
It takes some hunting to find an internist who wants a new patient with multiple complex chronic illnesses, according to this first-person investigation.
Be honest about your experience (or lack)
By Suture for a Living
When a patient asks how many procedures a physician has performed--or even if they don't ask--telling the truth is the right thing to do.
Nurse Jackie Disappoints
By Digital Doorway
Our "TV critic," Keith Carlson, RN, offers his reaction to the premier of Nurse Jackie, a new Showtime "dramedy" that showcases a drug-diverting, fib-telling, take-no-prisoners nurse who does little to advance the image of nurses in the public eye.
Jenny McCarthy feuds with science
By Dr. Val
Dr. Val suggests a boycott of Oprah and provides evidence-based rebuttals to Jenny McCarthy's anti-vaccination propaganda.
The Funny Pages
Cartoon Caption Contest
Each month, ACP Internist lets readers create their own cartoon captions and vote for the winner. Submit all entries by June 18. Pen the winning caption and win a $50 gift certificate good toward any American College of Physicians product, program or service. (We have a gift shop and non-clinical books for the lay reader.)
Medical News of the Obvious
Every Monday, ACP Internist skewers studies that shouldn't have needed to be done. Read more every Monday at Medical News of the Obvious.
"Bob at the Carnival"
Bob the Male Nurse Action Figure goes to the carnival, a part of the continuing photographic adventures of Bob the Nurse.
The Final Page
We hope you enjoyed our newspaper. Now that you're finished, don't forget to recycle.
Labels: Grand rounds
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- Throwing the baby out with the snake oil.
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- DDW: NOTES worth a mention
- DDW: Managing IBS
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- DDW: Point-of-care Web sites
Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.
David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.
Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.
Reflections of a Grady
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.
The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.
Technology in (Medical)
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.
Peter A. Lipson,
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.
Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.
Other blogs of note:
American Journal of
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.