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.
Click on "More" to read the full post.
Headline News
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.
Opinions
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.
Medicine
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.
Finance
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
By HealthBlawg
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.
International
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.
Women's Health
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.
Sports
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'
By InsureBlog
Henry Stern talks to orthopedic surgeon Robert Roman about the pros and cons of the Birmingham approach.
Technology
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?
Weekender
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.
Family
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
By Florencedotcom
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.
Your career
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.
Entertainment
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
posted by Ryan DuBosar at
3:30 PM
10 Comments
Monday, March 30, 2009
When test results go missing, an internist searches for answers
Ethics columnist Paul S. Mueller, FACP, discusses a case study that would bring chills to any primary care provider: what happens when an internist orders test results, and then never sees the results?
From an actual case file, Dr. Mueller discusses a 61-year-old asymptomatic man seeing his internist of 10 years for a check-up. When reviewing the medical record, the internist sees PSA test results of 11.8 ng/mL. Surprised by this finding, the internist digs further. A year ago, the PSA was 8.2 ng/mL and three years ago it was normal. The patient was never told; the internist is certain she never saw it. She wonders what to do next.
Click on "More" below for advice on how to handle the disclosure of previously missed test results.
Clinicians experience negative emotions when they realize they have committed an error, Dr. Mueller writes. Nevertheless, they are ethically obligated to disclose errors to patients.
First, clinicians should act in the best interests of patients. Explain the nature of the error and its implications and continue to provide professional and compassionate care.
Second, respect for patient autonomy requires that clinicians disclose errors to patients to allow for informed decision making.
Finally, justice requires that patients be given what is due to them, such as information about their medical condition and, if injured, appropriate compensation.
In this case, the internist met with her patient and his wife to tell them that the prior PSA test result was mishandled. The patient was upset, angry and felt helpless, which internist acknowledged. However, the patient later stated that he appreciated the internist's honesty. Together, they developed a follow-up plan.
Dr. Mueller suggests these steps when disclosing medical errors
-Speak in private with the patient, his or her loved ones, and essential members of the health care team present. Avoid interruptions (such as pagers) and allow time for questions.
-Discern the patient's perception of the problem before disclosing the error. For example, you might ask, "Do you recall the results of your PSA from a year ago?" Such questions allow for correction of misinformation.
-Speak clearly and check for comprehension (such as, "Is there anything I can clarify?"). The patient should understand what happened and the consequences of the error.
-Avoid attributing blame (such as, "The laboratory must have forgotten to call me about the result"). Patients desire a sincere apology and want to know how the clinician and organization will act to prevent future errors.
-Acknowledge the patient's emotional response to the disclosure by using empathic statements, such as, "I can see that you are upset by this news."
-Formulate a plan for further assessment, treatment, and follow-up and how you will work to prevent future errors.
-Document all discussions related to the error and its disclosure.
Dr. Mueller contributes to Ethical Dilemmas, a regular column appearing in ACP Internist.
Labels: ethics, Grand rounds, patient communication
posted by Ryan DuBosar at
9:00 AM
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Monday, March 16, 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.
Click on "More" to read the full post.
Headline News
Juvenile Diabetes Research Foundation addresses end of ban on stem cell research
By Diabetes Mine
JDRF Executive Vice President of Government Relations Larry Soler was at the White House for the signing ceremony and describes the experience.
Business News
Wal-Mart, eClinicalWorks join forces for electronic health records
By the Health Business Blog
Business reporter David E. Williams is skeptical if this joint venture will address all the problems of EHR implementation.
The Perspectives Pages
Editorial
Survey shows broad support for MDs and reform
By ACP Advocate
Voters, even Republican ones, want health care reform, including comparative effectiveness research. Surveyed patients say they trust doctors to help fix the system.
Op-eds
Error reporting should be painless, not just transparent
By Supporting Safer Healthcare
Although error-reporting is supposed to be encouraged in health care, negative consequences often fall on those who committed and/or reported the errors.
Budget-conscious patients attack doc
By Musings of a Distractible Mind
In three anecdotes, patients blame the physician for the outrageous cost of health care. Will health care reform fix the problem?
Government intervention was bad for mammography
By Kennedy's Tumor
Federal regulation reduced the financial incentives to provide mammography. The process has been standardized but not improved.
Better access should cancel out 'conscience clause'
By Colorado Health Insurance Insider
Instead of forcing doctors to provide abortions despite their moral beliefs, let's focus on making sure all communities have access to reproductive services, writes Louise.
Enough talk: psychiatry's drug addiction
By Behaviorism and Mental Health
The psychiatric and pharmaceutical industries have moved in lockstep over the past half century, matching up an ever-expanding list of mental disorders with a pipeline of new drugs, opines Philip Hickey. Instead of talking to patients, psychiatrists' days now consist of "a succession of fifteen-minute med checks."
Columnist
Old diary entries recall teen's life with diabetes
By Six Until Me
Kerri Morrone Sparling, who blogs about life with type 1 diabetes, shares snippets from her teenage diary and recalls longing for a diabetes community long before one existed.
Sports Section
Myth Debunked: Heat loss doesn't happen from the head
By The Fitness Fixer
Sports correspondent Dr. Jolie Bookspan debunks the idea that the body loses heat from the head.
Exercise reduces cravings for chocolate
By Dr. Shock
Exercise can reduce the craving for cigarettes in smoking cessation. Can it also reduce chocolate cravings?
International News
EU rules on doctors' work hours may cause delays, increase costs
By InsureBlog
Henry Stern reports on new EU work hour rules in Great Britain.
Selective decontamination is effective in the ICU
By Laika's MedLibLog
A recent Dutch study found that selective digestive tract and oropharyngeal decontamination each decreased mortality rates in the ICU.
Technology News
Telemedicine expands beyond radiology
By Hospital Impact
Telemedicine systems are moving from concept to reality in rural hospitals.
Health News
Sticking it to cancer: Acupuncture in the exam room
By Own Your Health
Since 2004, a Harvard Medical School oncologist has been offering acupuncture to patients to alleviate the symptoms and side effects of cancer treatment, transforming the sterile exam room into a more peaceful environment.
How to prevent, and treat, ingrown toenails
By Doc Gurley
In part two of her "Well Worth It" series of practical medical tips, Doc Gurley tackles the prevention and care of ingrown toenails from a patient's perspective.
Best care for a bloody nose
By Medicine for the Outdoors (via Healthline)
Wilderness Medicine expert Paul Auerbach, MD, gives a primer on treating patients with nosebleeds--and includes a bonus photo of a bloodied Brad Pitt.
The Science Section
Splendor in the grass: Researchers find new allergen in dog urine
By Allergy Notes
Everyone knows dog dander can bring misery to those with canine allergies. Now researchers have found that a protein in dog urine, called prostatic kallikrein, may bring on the sniffles as well.
New drug shows promise in treating type 2 diabetes
By Clinical Cases and Images
Liraglutide, a new drug, was better at lowering A1C, weight, hypoglycemia and blood pressure than glimepiride, and is safe and effective as initial therapy for type 2 diabetes, researchers found. (If approved, it will be branded as the less tongue-twisting "Victoza.")
Neurofeedback: The next big thing in ADHD treatment?
By SharpBrains
Treating ADHD with neurofeedback, in which a person is taught to alter his or her own brainwave patterns, has showed promise in previous studies--but they were flawed in design. A new study addresses many of the previous flaws, and suggests the treatment really may work, writes Duke psychologist Dr. David Rabiner.
Lifestyle
6 Steps to Breaking that Habit
By How to Cope with Pain
Whether you have chronic pain or not, following the stages of change can help you to either break or start a new habit.
Marriage: If it doesn't kill you, it makes you stronger
By In Sickness and In Health
Some studies show that marriage improves survival and health, while others find that it increases health problems.
Expectant moms should focus on their babies, not their weight
By The Blog that Ate Manhattan
Women miss out on some of the joy of pregnancy when they worry too much about weight gain.
Entertainment News
Former Monkee battles mouth cancer
By Suture for a Living
Peter Tork's recent diagnosis spurs a discussion of mouth cancer symptoms, risk factors and treatment.
Book Review
Memoir illuminates four facets of addiction
By Neuroanthropology
Using descriptions and insights from Caroline Knapp's book "Drinking: A Love Story," medical anthropologist Daniel Lende outlines four factors that lead a person to substance abuse: vulnerability, training, intentional use and meaning.
Weather
Have a migraine? Blame the weather
By Canadian Medicine
A new Web site offers personalized health alerts based on weather conditions, but is the science behind it sound?
Restaurant review
Illness strikes hundreds, forcing restaurant to close
By The Cockroach Catcher
Four hundred diners fall ill at world-renown Fat Duck. Am Ang Zhang investigates possible causes behind the outbreak.
The Funny Pages
Make them laugh
By Other Things Amanzi
A general surgeon working in the 'notorious' province of Mpumalanga, South Africa, relates "the only time I remember when the profs laughed at my often injudicious comments." 
Cartoon Caption Contest
Each month, ACP Internist lets readers create their own cartoon captions and vote for the winner. Submit all entries by March 19. 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.
The Final Page
We hope you enjoyed our newspaper. Now that you're finished, don't forget to recycle.
Labels: Grand rounds
posted by Ryan DuBosar at
3:00 PM
7 Comments
Tuesday, February 24, 2009
Smorgasbord at Grand Rounds
The latest issue of Grand Rounds, hosted this week by "The blog that ate Manhattan," is an appetizing menu of medically related posts about food. Check out entries from around the blogosphere, including a critique of the New York City health commissioner's low-salt initiative or the relationship between diet, exercise and chronic pain, among many others. (Look for ACP Internist in the "beverages" section.)
Labels: Grand rounds
posted by Janet Colwell at
9:38 AM
0 Comments
Tuesday, February 10, 2009
Grand Rounds is up
The latest issue of Grand Rounds is up on The Health Care Blog. Host Matthew Holt provides a round up of the best medical postings on the blogosphere over the past week, including a selection from ACP Internist.
Check it out and sign up for the RSS Feed. ACP Internist is slated to guest host the March 17 edition.
Labels: Grand rounds
posted by Janet Colwell at
3:29 PM
0 Comments
Wednesday, January 14, 2009
It's science fiction week at Grand Rounds
Grand Rounds , a collection of weekly posts from the medical blogosphere (including an ACP Internist contribution), is now up at In Sickness and In Health. The host's organizing theme is science fiction movies. Check it out for an entertaining read.
Labels: Grand rounds
posted by Janet Colwell at
11:18 AM
0 Comments
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
Contact ACP Internist
Send comments to ACP Internist staff at acpinternist@acponline.org.
Previous Posts
- QD: News Every Day--Santa's take on H1N1 influenza...
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- QD: News Every Day--when evidence and politics col...
- Ghostwriting haunts Congress' hallowed halls
- QD: News Every Day--payment fix inches forward (fo...
- QD: News Every Day--not the intended effect
- Medical news of the obvious
- QD: News Every Day--flu's growing tally
- QD: News Every Day--no holidays for Congress
Archives
Blog log
American Journal of Medicine
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.
Clinical Correlations
A collaborative medical blog started by Neil Shapiro, 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.
db's Medical Rants
Robert M. Centor, FACP, contributes short essays contemplating medicine and the health care system.
Everything Health
EverythingHealth is designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
Getting Better with Dr. Val
Getting Better is the continuation of Dr. Val Jones' previous blog at Revolution Health. It is devoted to helping people understand health issues from a balanced, scientifically sound perspective.
HealthHombre
A roundup of health policy news drawn from a database of hundreds of Web sites.
Interact MD
Michael Benjamin, 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.
Kevin, MD
The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.
LSUHSC-S Medical Library Evidence Alert
Major guidelines, systematic reviews, meta-analyses and/or major reviews by national and international organizations.
PLoS Blog
The Public Library of Science's open access materials include a blog.
White Coat Rants
One of the most popular anonymous blogs written by a doctor.
