Let me get another day or two post-op and I’ll share some of what’s been going on lately. And remember: I’m always posting something on Twitter, so remember you can always follow me there (and read excerpts in the sidebar to the right). More soon!

For the record, I fully expect to be disappointed in some things I really feel strongly about not moving forward the way I thought or that he originally promised. Part of being a good leader is adapting to new situations and information; being a better leader is conveying why things have changed for those who were expecting otherwise. We’ve had enough of this “stay the course” because “I’m the decider” bullshit for a lifetime.  I think everyone on both sides of the aisle should be in a position of compromise on domestic affairs in this time of financial crisis.

Having gotten “current events” out of the way, I want to return and remain on the inauguration itself. I saw it partially live, but since I was caring for my daughter that morning, I was unable to see Obama’s swearing in, speech, and after coverage until later from the DVR. Fortunately, one item I did see live just before having to switch off was when Sen. Feinstein announced the names of Itzhak Perlman, Yo-Yo Ma, Gabriella Montero, and Anthony McGill to play the commissioned inaugural work by John Williams, “Air and Simple Gifts.”  I about fell out of my chair when I heard Perlman and Ma’s names. Mind you, we had just heard Aretha Franklin in the broadcast which was already over the top awesome (not to mention that gem-studded bow hat!), but to have Perlman and Ma on the same stage LIVE as a surprise (I hadn’t done any prior scouting or reading of events) was incredible.  Wind instruments aren’t my thing, so I didn’t know the clarinetist, but Gabriella Montero is a phenomenal pianist and gifted collaborator on several cross-over projects; she’s also certainly Venezuela’s most popular export to the classical music world along with Gustavo Dudamel.

The point is, before the music even began the tremendous surge of pride at how serious music and the arts had been given here was overwhelming.  This was no “filler” cocktail quartet music–this was the unquestionable musical “main event.  It also instantly occurred to me that 3 of the 4 musicians were not originally of this country (Perlman and Ma however are both naturalized citizens), and the fourth was African-American. What incredible symbolism of unification and diversity in just the musicians themselves!

Then the music started.  Once they started playing, the realization hit me like a brick across the head: “OH. MY. GOD. It’s 20-something degrees and Perlman and Ma have their multi-million dollar Stradivarius instruments warping in the cold?!”  Just as my heart recoved from throwing a PVC it then hit me: “Wait…the piano!!!!  How is it being kept in tune?!”  You have to understand–it takes HOURS to tune a piano; there are 88 keys but over 200 strings/pegs to adjust since most keys have more than one string (most have 3)–all of which need to be in unison among themselves and in proper relative pitch with every other key.  I think, “So instrument valuation aside, adjusting the four strings of a cello or violin, or pushing in/pulling out the segments of a clarinet would be comparatively simple, yes, but….”

And suddenly I hear that familiar tune, used so gloriously by Aaron Copland in “Appalachian Spring” that’s become part of the very fabric of  American musical existence.  And then it continued. And continued.  “Aw hell no….” I thought to myself, realizing that this was the focal point for Williams’ work.  I was so disappointed, feeling the event was cheated, wondering how Williams could have not come up with something more personal, more evocative of this special moment in history.

The whole point of a commission is to write something new, not re-work a tune that elementary school children could recognize that was already popularized and made iconic by yet another American composer.  GOOD LORD!

I even tweeted the fact that I thought the composition was less-than-desirable in real-time, so this is not a revisionist point of view, but I did look up what people thought afterwards and I’m comforted to know I’m not alone. In the process, I also discovered what probably everyone now knows about the “live” performance and that what we heard on TV and what was broadcast locally over the speakers was in fact a pre-recorded performance from the previous day for the very technical reasons I was thinking as I was watching.  I didn’t feel bad when I found out, because obviously I know why and also that they were in fact playing in real-time; the honor to the event was still maintained if you could hear any of them acoustically. There were just too many damning technical factors to consider outside the players’ control to do the event justice for everyone while still have them on stage in that weather which Yo-Yo Ma himself described as “wicked cold.”

Regardless though, I’m happy to see that classical music got a prominent moment to shine, even though it was via Williams channeling Aaron Copland cheered on by Wolf Blitzer’s voiceover in the middle of the performance–but I won’t go there lest I get upset all over again…

You will be added to the collective.

Through the power of collective blogging (and Twittering), yet another storm is brewing about Wellsphere in the face of their being bought out by HealthCentral for an undisclosed millions of dollars. HealthCentral currently has over $50 million in VC funding, so this isn’t chump change. Wellsphere claims thousands of medical “experts” in its network and boasts unique page views in the millions per month through its presence among its network “partners” (ie, unwitting bloggers).

Well, it’s more “penetration” than “presence” in the end, because the kicker here is that Wellsphere not only doesn’t pay their partners a damn thing, but worse, outright steals content from bloggers’ own sites and rebrands it as Wellsphere’s own unique content without any attribution whatsoever. Dr. Val exposes all of this quite plainly in a recent post, and many other stories are coming out on Twitter with the search hashtag of “#wellsphere.”

Full disclosure dictates that I reveal that I too was contacted by them last year; however in a moment of what I can only describe as serendipitous procrastination or distraction–whichever–I let the email sit there for a good while. When I took another look, I just didn’t see the point. I never got so far as to read the heinous Terms of Service agreement, because just on its face it seemed like I wasn’t going to get anything except a pretty badge on my sidebar (woowoo!  not.) and a warm glow for knowing I was going to help promote health information to their general online community. And it’s the last point that makes this whole thing stick in my craw–the CEO heading this whole thing may very well have been a complete and utter scumbag, but the request letters came from the Chief Medical Officer person–a physician named Dr. Geoff Rutledge. Through him, the entire modus operandi was predatory, taking advantage of what would be an accurate soft spot of medical bloggers who would of course feel altruistic about disseminating health information and/or being a part of a health network.  It’s the blogging equivalent of a schoolyard bully offering his protection services for lunch money.

If I could turn back the clock knowing what I know now, I’d have signed up gladly. I would have put the little badge on my page, and watched my page hits go–nowhere.  Meanwhile, my content would be sucked and rebranded as Wellsphere’s own. So I’d make posts like “Wellsphere — You’re a Bunch of Thieving Mongrels” and change my “featured blogger” bio to include heinous, non-consensual acts done to me at the hands of Wellsphere’s handlers.

But if you have more to add on this story, all is not lost! Tonight at 9pm EST The Doctor Anonymous Show on Blogtalk Radio will be devoting a part of tonight’s broadcast to this issue, so please tune into follow more and support the cause.

Because resistance is NOT futile.

The setup is that I’m brought in as the science “expert” with another blogger who does this weekly doing the main commentary. In essence, I’ll be the wingman on a two man team providing some scientific backbone in a real-time blogging session that will also take some fan questions along the way. This upcoming episode promises to be a good medically-tilted one about a boy who was seemingly “cured” by drinking some spring water.  I can hardly contain myself if that teaser delivers the medical hoax debunk-fest think it’s going to.

The live web cast for the show is here and I assume it will be active around 15-10 minutes before the show actually starts. If you have time and interest, it would be great if you could join us for some multimedia primetime fun!  Hope to see you there!

Tuesday is an historic day as we swear in our 44th president, Barack Obama. Personally I’m jealous I don’t live in the DC area anymore (Fairfax County across the river, same difference) because I’d love to be part of a part of a part of something that day. Oh well. But it’s just a day in the end, and much work needs to be done in our nation, one of the most pressing issues being health care reform. I’m neither a practicing physician nor a policy analyst, so I’m not going to embarrass myself with attempts at unoriginality against such smarter people, but I can say what works from a patient’s perspective, especially one who can see both sides of the issue natively. “What do you mean? What do patients have to do with health care reform?”  They’re intimately involved in it! Left out of so many policy discussions, the patient-end of the equation is critical, but more on that later.

This last November I had a silly incident with my wrist and the side of a car that hurt at the time but I blew off, blaming as much my clumsiness as anything else. After weeks of not feeling better and rest/anti-inflammatories not making a difference, I finally got it looked at and wound up at this hand-specializing orthopedic surgeon, MRIs in hand (ha ha) showing a tear (that’s a separate post).  I was very impressed with him and his approach, appreciating his conservative management style. I normally don’t let on I’m a med student for a variety of reasons, but he asked what I studied (chart said “Occupation =  student”) and when I told him, he became even more effusive and engaging. Interestingly enough, we talked mostly about policy issues! (it’s on everyone’s mind right now!)

Regarding my condition, he said he wanted to do a steroid/lidocaine injection into the joint space to give short-term relief, re-evaluate in a month. As many of you know, I’m a classical pianist, and while I don’t play regularly these days, the very idea of a complication that could compromise that aspect of my life mortifies me, so I’m happy with baby steps. He’d be back in a bit and added, “Oh, and I have a letter for you,” as he handed me a piece of paper that for whatever reason I noticed immediately was both hand-signed and on good cotton-fiber paper stock. Still a bit taken aback, I asked, “What’s this about?”  He smiled and said, “I’m an old-fashioned guy, that’s all. I’ll be back in a bit,” and closed the door, instructing the other side for his assistant to begin the prep for the injection.

As I waited, I read this hand signed letter. Here are the relevant excerpts:

A Personal Letter From Your Doctor, MD

Dear Mr. Cantu:

Thank you for coming in today to consult with me regarding your medical care. I appreciate and respect your trust in me as your doctor and orthopedic surgeon. I strongly recommend you share in the responsibility of treating your condition. You can do this by following any medical advice given and keeping scheduled follow-up appointments. Timely follow-up is extremely important as delay in treatment could lead to deterioration or, even worse, permanent dysfunction.

On occasion, delays occur in the office. I ask for your patience as these delays are due to attending patients with complex issues. We will try to keep you informed when such delays occur. I assure you that should your medical problem require extra time, it will be fully provided.

Lastly, it is the policy of this office that all proven conservative (non-surgical) treatment options will be embarked on firstly. Surgical intervention is only offered if conservative treatment fails to alleviate your symptoms.

[closing paragraph, thank you, etc]

Is that awesome or what?  I also noticed in the letterhead the abbreviation FRCS for Fellow of the Royal College of Surgeons in the UK (he’s also an American FACS here, for what it’s worth). He had mentioned training in Canada (his ethnic origin is Caribbean of some kind, didn’t ask) but obviously there is some of that “English gentleman” thing going on here. I know good and well it’s a form letter coming off a laser printer at the last minute before entering the room, but it doesn’t matter. And if doesn’t matter for me, someone who sees what the wizard is doing behind the curtain, imagine how much more it can make a difference to an average patient, particularly older patients, who truly feel that they “connected” with their doctor in a unique and personal way–and on the first visit!

But the story doesn’t end there. After the injection I was waiting for 10 minutes or so to make sure it all got nice and happy in the joint space. Sir Orthopod came in and sat down, and started dictating in front of me. I thought this was a bit odd, though it’s happened on occasion before, but it was always when I was in a physician’s office already or in a hallway; in other words, it seemed like it was just occurring as a matter of course. This was different–he came into my exam room on his own volition, sat down, and started dictating into a digital recorder. He even paused once or twice to make sure he got something right, which he did, my thinking he was taking advantage of my being there out of convenience as I sat and listened patiently.

I thought during this he might just be more at ease because by this time he knew I was a medical student and felt comfortable dictating the technical behind-the-scenes in front of me, but in talking with him later, he said that he does that with all his patients. I was shocked! On the surface, it sounds like no big deal, but there’s a lot that can be said that can be taken the wrong way/misunderstood by someone who can’t parse the terminology/jargon, or feel that the physician “didn’t tell me that,” when in fact s/he did, they just used laymen’s terms in the conversation. But the surgeon said he does that intentionally to further avoid liability and increase transparency. It’s rare and more comes up with worker’s compensation and disability claim-type cases he said, but it’s very hard to claim “I had no idea,” when his standard practice–and that’s the key–is to dictate in front of the patient. The dictation is transcribed to the official record, and if the patient is present, that’s yet another opportunity to both 1) correct the record as it’s being dictated should the physician get something wrong, and 2) provide a legal support structure against false/misleading claims. Add a personal letter signed by hand, encouraging patient cooperation and apologizing in advance for minor inconveniences, etc. and you have a framework for the following:

• a happy patient who feels listened to and cared for (less likely to sue, far more likely to refer word-of-mouth to friends/family)
• a physician who knows how to invest, having just spent about $0.02 on a sheet of good paper stock and 1 second signing a letter for literally countless dollars of saved legal headaches, increased referrals, pleasant encounters, etc.
• a physician who spent ZERO extra time, but by dictating in front of the patient provided extra legal protection, greater fidelity of the medical record, and further fosters a sense of transparency and trust with the patient
• a patient whose medical expectations are manged from the start, thinking that because they were referred to a surgeon they need/will have surgery
• a patient whose expectations are managed WRT office wait times not only by telling them it can happen but assuring them their care will not be compromised when its their turn. This also takes the heat off of the front staff, and happy staff makes all the difference too.
• and perhaps most importantly, a patient who is invited to take an active role in partnership for their own care, hopefully achieving greater compliance for not only better outcomes but lower healthcare costs by avoiding complications, unnecessary procedures, etc.

The small steps taken by this doctor might seem trivial on the surface, but to me they’re genius because they accomplish so many good things in an honest way so effortlessly. The goal here is patient satisfaction and success with the added legal protection a bonus. This is just one relatively medium-sized solo practice in a small-medium south Texas city. Imagine if small changes like these were implemented everywhere, how much morale and rapport could improve, frivolous lawsuits could be avoided (or at least provide further disincentive), and how much the climate could change for the better all-around. I’m not idolizing this guy, I’m thinking beyond him to the bigger picture.

The other thing about his attitude, reflected in his letter, is the participation of the patient in their own care. We keep talking about health policy and reform from a top-down approach, changing insurance policy structures, provider reimbursement schedules, etc. rather than a bottom-up approach. While anyone really involved knows it’s a two-pronged approach, the media, and more importantly, too many patients feel they are mere bystanders in both the discussion and the solution, and I appreciate this physician opening the door to that reality for his patients. More on patient responsiblity in a separate post.

Dr. Val said

I don’t think that’s related to their medical school curriculae – it’s the sad result of a broken healthcare system that wears thin our common human decency. Doctors are exhausted by clinical volume, henpecked by bureaucracy, delirious from lack of sleep, and stressed out by the daily grind of bad news, disease progression, and death. When well-groomed adults of sound mind require a checklist in order to smile appropriately, you know something’s terribly wrong.

Let’s remember that this is written by a psychiatrist (this will come up again later). The freedom to think, meta-think, and think again is a luxury (and necessity) that is part and parcel with the specialty. A psychiatrist being “overworked” is quite a different thing than, say, a surgeon, physically and time-wise. It’s no wonder that the more “harried” doctors like surgeons and way over-stretched IM-based specialists would most likely fit a “bad doctor” stereotype needing the bullet list given in the article.

Let’s re-look at the list and find out where, if any, each bullet point can get just a tad unreasonable:

• Ask permission to enter the room; wait for an answer.
The physician is not housekeeping at a hotel, and many patients can’t answer. I am guessing the spirit here is to give the patient some privacy and autonomy, but it’s not always appropriate or practical. You think physicians–multiple ones in the same hall at that–are going to yell through a closed door, “Mr. Sanders? Mr. Sanders? May I come in? Are you decent? *wait* *wait* Mr. Sanders? I just want to talk to you, can I do that?” If you stop to think about how it would play out, it’s just comical.

• Introduce yourself; show your ID badge.
Introducing oneself is a must, I agree. But more important than the name is their specialty or purpose. Doctors, nurses, techs, etc. flow in and out as a matter of course; any one person’s name will NOT be remembered on first meeting usually. “The surgeon” or “the heart doctor” means something to the patient, however.  Showing the ID badge is a bit much, but I agree it should be reasonably visible (not hanging all “cool-like” off the scrub bottom’s cargo pocket) should there be a concern, its absence being the true red flag.

• Shake hands.
In normal conversational etiquitte this goes without saying, but not every patient is in a position to shake hands. Patients might have IVs on the dorsum of one or both hands, or be weak where a handshake (particularly coming up from a bed in a supine position) might be taxing. At the doctor’s discretion, perhaps a small pat on the shoulder from above or the like establishes a “connection.” Some patients may be standoffish or even hostile, and with so much to do and accomplish besides some physical token of greeting on top of the verbal one, just skip it already, it’s not worth the trouble. Psychiatrists live for dancing this dance, reading volumes in the smallest gestures and pondering the meanings; most everyone else uses their time on more practical matters.

• Sit down. Smile if appropriate.
This is where the author really jumped the shark. Sit down?! Where, exactly? Most hospital rooms have ONE chair apart from the bed, and a family member is often sitting in it. A doctor is going to sit in the patient’s bed during the interview? This psychiatrist-centered view is starting to really show its limitations and other-worldly approach. After all, psychiatrists are used to being in rooms where there are more chairs than people, so of course, why not sit down?  And what exactly is considered appropriate to smile or not smile?  I smile naturally almost all the time when meeting someone, like a reflex. Some don’t. I’m not going to second guess all of this now.

• Explain your role on the health care team.
Of all the bullet points so far, this is by far the most useful. If there is one thing that confuses the hell out of the poor patient in today’s overly-specialized/referred environment. No arguments here, solid advice.

• Ask how the patient feels about being in the hospital.
After the previous useful directive, we just had to go back to shrink world–it couldn’t last forever. Asking something like this is fine, if it’s worked into the general conversation and there’s oodles of time on everyone’s hands, but asking directly as written is awkward at best. (“It sucks, what do you think!?”) A far better and more reasonable approach would be “Is there anything else you need, any concerns that we haven’t addressed?” — in other words, be practical. Time is of the essence, and one can make a patient feel listened to and respected beyond their disease without falling into an open-ended, potentially never-ending pit of feelings.

I know that some of what I’ve written above sounds insensitive, but it’s done intentionally and not without a little bit of sardonic wit to balance out the candyland view of the author. It’s ironic that the author’s original purpose was to establish a practical workflow to make patients feel more “listened to,” I suppose, but offered a sample checklist that is, in my opinion, beyond impractical. Perhaps this would have been better tackled by someone in another field who sees [non-psychiatric] inpatients on far greater volume. The author himself wrote about being “good enough,” and I think the smallest common-sense steps can get us there.

I know I kind of beat this to death a little bit, but I do feel strongly about not only good physician-patient interaction having been on both sides of the bed, but also I’ve seen quite a bit of “doctor bashing” in the media lately, and it’s unfair. There are definitely bad doctors who need a serious attitude adjustment to be sure, but there are far more good doctors with good hearts and intentions, twisted into an impossible struggle in a no-win environment.  Knocking before entering a room and waiting outside for a patient to get off the phone to receive an answer like “Come in” shouldn’t even be part of the discussion.  Let me know your thoughts.

So what do I do?  Well, obviously not the above. With shell access to my hosting account (for Windows users, think DOS command prompt), up until a few months ago, I would get the new version as usual, only I’d upload the .zip file (or in my case, the .tar.gz “tarball”), unpack it on the server, and replace the installation in a couple of seconds; the time to upload (which would be vastly shorter because it would be a compressed, continuous file) would have no bearing on the “out of sync” problem above, because I’d unpack the files in a few seconds. This is a tried-and-true workflow that nobody could argue with in terms of simplicity and speed.

However, there is an even more elegant method that I started utilizing as soon as I found out WP supported a version control utility called Subversion. Version control is used in the software industry to track changes on various files so one can roll back to a previous version. People do this all the time with, say, a document in Word by saving multiple copies, but imagine 50 developers all making changes simultaneously to a source tree of hundreds of files. You have to be able to track changes so that you can fix what breaks while not discarding what got better.  Anyway, I don’t want to get overly technical, but I wanted to give a slightly better understanding of what Subversion is more than the simple statements in the video. Speaking of which, here it is:

Video of WP Upgrade

Cool, eh?  It’s important to know that the above was recorded in absolute real-time, no edits, and that it was really, truly my live system. Aside from the file and database backups before recording, you saw my real, unadulterated upgrade process (while I wasn’t worried having done this many times, the fact that it was done on a Sunday afternoon when traffic was low wasn’t an accident, either ). Once your svn tree is in place, tracking updates large and small really is that easy. There are no big installation files to download or upload (the `svn’ client gets the individual files it needs, but it’s a fast server-to-server transfer) and unlike dropping a new installation on top of the old one, the old, deprecated files are cleaned away. Note that this is the workflow for an existing subversion WP repository; how to convert a “standard” (ie, uploaded) WP install to a subversion-enabled one is the topic for a future post (if there’s interest).

Anyway, I this helped, or at least inspired you to look into checking with your hosting provider to enable shell access if you have it. Please, please, give me feedback on this because I have lots of ideas on similar videos on WP ginsu outside of the web dashboard, most notably using MySQL queries (the database that powers 99% of WP instances) and the like. I admit command-line management isn’t for everyone, but for those willing to start adding to their toolkit, it opens up a limitless world of possibilities.

So in addition to a general “welcome,” I wanted to invite you to come back since this blog is always a work in progress.  I hope you had a chance to read last week’s Grand Rounds edition hosted by me and found it an enjoyable read. Make sure you read the current edition at Sharp Brains which will be featured in next week’s Medscape mailing.

Thanks again, and I will be back as a student this coming year–I just can’t say where or as what, exactly. I’ll be blogging soon about some of my future decision points on this topic, so feel free to subscribe to my RSS feed to keep abreast of current posts.  Cheers!

In this case, I have video of a shell session (like a DOS command line) showing how to use Subversion to upgrade WordPress. I actually I have another unrelated video as well, but they have two things in common: they need their audio replaced with another audio track (recorded on a better mic). Now if it was a straight 1:1 audio swap, that’s trivial. But I do need the help of a video editor w/rudimentary capabilities to stretch out the video on a frame for a few seconds extra, or whatever, to make sure the audio is synced up. Simple stuff that they all can do if the audio/video is muxed together, but not so much if discrete tracks.

iMovie ’07 (I refused to upgrade to ’08, which would have actually put me backwards in this too) can do all this easy, except it MUST convert the video to one of DV (720×480)/DVwide or MP4 (640×480). The captured video is not in a “standard” broadcast dimension, so converting into iMovie ruins it, especially because of the text on the screen, in this case. QTPro can do simple video editing but not replacing sound unless it’s a perfect 1:1 swap.

Anybody have experience with 3rd party video shareware/cheap editors that can do basic editing of this kind while allowing for add’l audio track but play nice with QuickTime and non-std formats too? Yeah, I didn’t think so. But I can be surprised.

Hello! Above is the video post I did as a wrap-up for last night’s Doctor Anonymous Show in true Dr.A. fashion, except Dr. A. did his before I got to do mine! However, I still did it, because, as Wilford Brimley would say: “It’s the right thing to do.” haha

Thanks again to my star-studded panel: Ramona Bates of Suture for a Living, Mother Jones, RN of Nurse Ratched’s Place, Val Jones of Getting Better with Dr. Val, and Bongi of Other Things Amanzi. I am still in awe that these A-list bloggers all took 90+ minutes out of their Thursday to spend with me.  Awesome.

Also thanks to Vijay of Scanman’s Notes for calling in all the way from India; you made it a cross-contiental event x2!

Whether  you were there or missed the show, go the link above so you can listen to the archive, download it to your computer/music player, whatever you like.

I know I haven’t posted anything since Grand Rounds on Tuesday, but I had to catch up on “real life” things and then get ready for tonight, so it’s been a bit hectic! I promise I have some cool stuff in the pipeline, so when things slow down this weekend on the “more popular” blogs (heh), come on back and I’ll have goodies for ya.

Hope to see you tonight! If you can’t make the show, don’t worry–the archive of the show will be available later tonight at the BlogTalkRadio site about an hour or so after the show ends.  Download it to your iPod and enjoy!

Welcome to Grand Rounds! I am privileged to be your host for this week’s edition of the best posts of the medical blogosphere. As in the previous two times I’ve hosted, I will integrate music into this edition, but unlike before, I will focus on one piece of music: Tod und Verklärung (Death and Transfiguration) by the German composer Richard Strauss. I said when asking for contributions that adherence to a theme was not necessary; moreover no single theme could really encompass the excellent variety the medblogosphere has to offer. Since this musical selection is quite long–over 20 minutes at least–I have decided to present only excerpts so as to tell the basic story as we go along, placing musical interludes in the list of posts. Hopefully I still keep to the spirit of the piece while not detracting too much from the excellent contributions.

Death and Transfiguration is a “tone poem,” literally, a musical literary depiction. In this case, it is of a dying artist on his deathbed in his last moments, and what is experienced up to, including and after death. A patient in a bed knowing it can be the end is certainly scared, and perhaps even confused. Mother Jones of Nurse Ratched’s Place learned how to comfort a confused, hospitalized elderly woman in a very significant way in the early years of her career. In another mental health story of an elderly lady, Sara at My Sad Alter Ego appropriately rails against a fellow clinician pointing out that depression does not equal lack of competence.

The patient lies in his bed, breathing heavily, his heartbeat marked by syncopated triplet rhythms in both the strings and timpani. Falling sighs contrast against a flute and clarinet asking a wordless question in unison. There is not yet struggle, but there is certainly no peace.

HEALTH POLICY AND BUSINESS:

The near-code-blue status of primary care has received so much press recently, but in the end what has been done? What needs to be done? DrRich of The Covert Rationing Blog has some excellent insights and advice.

Dr. Val shares her insights at the dubious practice of Fecal Transplants (yes, you read that correctly) at her site, Getting Better with Dr. Val.

Mike Cadogan of The 28 Hour Diet shares his feelings on the general trend towards open peer review in scientific and medical publishing. I think he’s spot on.

Another spot-on editorial, and a shocking discovery for me, was Ramona Bates of Suture for a Living on the subject of medical method patents and the dubious practice of legally patenting something as ephemeral as a surgical technique. Is, say, a left-handed version of one safe from infringement?

Medical costs are skyrocketing, and since many of us are involved on the patient-end of healthcare, it’s sometimes alarming to read and be reminded that not all providers may act in the best interest of the patient, as a sobering post by InsureBlog indicates.

Violence in the ED is a disturbing and increasing problem, particularly in urban settings, as Marjan Siadat of Detroit Receiving writes.

Giving addicts sterile needles and a safe place to inject may seem like enabling on the surface, but Sam Solomon of Canadian Medicine shares there are quite a few good reasons to do so.

Suddenly he is startled awake with agony, struggling. The low strings groan with his pain. Driving rhythms, piercing brass motifs indicate his torment. The timpani, once quietly beating a halting rhythm, now pounds forcefully as though his heart will leap out of his chest. Relief is temporarily granted as he sighs back, exhausted.

DISCOVERY AND LEARNING:

Jolie Bookspan of The Fitness Fixer in her post 14,000 Miles On a Bike reminds us that most intervertebral disc problems happen over time, and so too over time, they can also be repaired sensibly without invasive intervention.

How to Cope With Pain gives tips on how to be a “Computer Athlete” by showing sensible ergonomic suggestions.

Medicine for the Outdoors’ Paul Auerbach with a post entitled Sawyer Water Filter shows how a simple micron filter attachment to an ordinary bucket allows a pure gravity-enabled water filtration system that makes water from almost any source potable. It’s truly amazing, elegant technology.

Walter Jessen of Highlight Health shares remarkable new research indicating we might be closer to unraveling the genetic basis of autism. Not surprisingly, vaccines are not mentioned in the article.

Ves Dimov at Clinical Cases and Images Blog is one of the pioneering physicians using Twitter to share conference proceedings in real-time, as he did at the Annual Meeting of American College of Allergy, Asthma & Immunology. Likewise, Twitter can also be used for USMLE Step 1 board preparation. Med students, this is an invaluable resource, since now First Aid can quiz you!

Nancy Brown of Teen Health 411 shares tips on teen oral health that may not be obvious.

Robin from Survive the Journey shares some new research that indicates Cushing’s Disease has a higher prevalence than common wisdom indicates.

At Sharp Brains, Dr. Rabiner talks about a quantitative EEG method for screening ADHD as opposed to observational/behavioral methods. The improvement of this new method is astounding and shows great promise.

PERSONAL STORIES:

Dinah from Shrink Rap talks about how simple medical jargon can be taken the wrong way by patients who don’t have the context clinicians do.

Christine at Corn Allergic shares a story where a conscientious nurse made a simple blood draw less of an anxiety-producing event (and not for the needle, either) by both being resourceful and non-judgmental.

Our patient begins a reverie, remembering his youth. theme. The strings’ rhythms drive forward, so full of exuberance they’re practically tripping over themselves. He must be thinking of a past love, unable to contain the rush of his passion, emotionally climbing higher and higher — until the brass for the first time fully states the “Ideal” theme in the piece (1:44). This represents his soul, the totality of his being, his essence. He has found himself through this 6 note theme, and having done so, can finally move on, secure in himself and who he is, ready to face whatever fate is to come with pride and dignity.

Cris Cuthbertson from Scalpel’s Edge shares a personal letter spelling out her point of view on the differences between non-MD researchers and physician-scientists. (she also has great tips on preparing medical presentations)

Doctor Anonymous shares his thoughts as part of yesterday’s official observance of World AIDS Day. It is, as he pointed out, the 20th anniversary of the event, and we have made incredible strides in that time.

Bongi at Other Things Amanzi shares a story from his past about not looking down at people on your way up–they just might do the same to you when it’s their turn!

And finally–TRANSFORMATION:

Barbara Kivowitz In Sickness and In Health shares how Gratitude Can Change You. Read how there is transformational power in giving thanks in a tangible way.

ADHD isn’t a disorder, it’s a personality type. That’s what Dr. Rob of Musings of a Distractible Mind writes in “The Doctor is Distracted.” ADD/ADHD confers its own strengths and weaknesses, and just like everyone else, each individual has their own unique aptitudes. The key is adapting and transforming “liability” into leverage.

In Reflections in a Head Mirror, Bruce Campbell shares a beautiful story about how love transforms perceptions, making the previously impossible possible.

Jacqueline at Laika’s MedLibLog really took off with the theme, so I’m saving this for last. She writes a very thorough review of a symposium on fear focusing mainly on a speech by an Israeli lecturer showing many neurological elements in fear processing and response. Post-traumatic stress disorder is featured prominently as an example of how extreme fear eventually can transform a person into someone else. She offers another German composer, J.S. Bach, to accompany her piece as well.

Finally we arrive at the end of our patient’s mortal journey: a pause, another short, violent struggle, and after his last agonal breaths, death arrives (0:52). However, no sooner than the tam-tam signals this event than the harp, low strings, brass, and winds indicate the soul’s release, loosed from his mortal coil, floating finally free. Sumptuous, almost agonizing pedal points stretch out like harmonic taffy as the “Ideal” theme transforms, grows and is passed around the entire orchestra. A final victorious flourish at our triumphant final key of C major (6:06) and our fully transfigured soul now rests quietly in peace.

One may be wondering why I chose this rather heavy musical topic. For one, it fits in with a healthcare theme. Death and end-of-life issues are ever-present challenges in healthcare. Paul Levy just spearheaded a blog cause on this very issue. Facing our mortality isn’t easy for anyone. However, the main reason I chose it is because, metaphorically, it represents what I’ve gone through this last year. I decided not to tie in my own story along the way so as not to detract further from the contributors, but regular readers and friends know about the limbo status of my scholastic endeavors, unforeseeable health issues that took me out of commission for 9 months, and a divorce forced upon me in the middle of it all. One can allow dreams, relationships, etc. to simply die, or be transformed in the crucible of experience into something new. I hear Strauss and it reminds me I must do the latter. I have to believe this–like the musically idealized portrayal–is how things will turn out eventually. I invite those not already readers to join me in searching for my “C major chord,” speed bumps and all, and I’ll be there to share yours.

Finally, I do want to offer a small dedication to those that lost their lives in the tragedy in Mumbai last week. I think this post is an appropriate place to offer that, even though the topic was already conceived when the horror of those events unfolded. May the souls of the departed as well as the families and friends that mourn them find peace.

Thank you for reading! I hope that beauty and catharsis was found in spite of a weighty topic. I also want to thank Dr. Val and Colin Son for their work on keeping Grand Rounds what is is and giving me the honor to host once again. One of the things that makes Grand Rounds special is the variety of hosting topics and personalities one gets each week. So with that, I pass the baton to next week’s host, Sharp Brains. I look forward to their edition. Cheers and good health to all!

Links:
The Dr. Anonymous Show on BlogTalkRadio (this Thursday at 9pmEST)
Grand Rounds 5:11 – Death and Transfiguration

Update 03December: Confirmed panelists are Ramona Bates, Mother Jones, Val Jones, and Bongi (schedule permitting). It’s a star-studded event, ladies and gentlemen! Even Dr. A. is jealous! hehe

Finally, I installed this one in time for tomorrow and will continue to make tweaks. I’ll replace the mountain graphic with something more personal and start populating the sidebar with all the things I couldn’t in the other theme. I wanted to have it ready all at once, but reality and the 80/20 rule set in.  If you have any comments or suggestions, let me know!

The starting bid is $200, and while that’s out of my poor student price range, I am hoping there’s a reader or two out there for whom that might not be, or at least can forward this to others in a position to help. Remember it’s for charity, and as a recipient of Ramona’s work, I can assure you first-hand that the craftsmanship is outstanding. Thanks!