Tuesday, April 10, 2007

Grand Rounds Vol 3, No.29

G'day and welcome to this weeks edition of Grand Rounds. Dr Dork is pleased and honoured to host your journey through some highlights of this weeks medical blogging.

No time to shave today

Dr Dork has elected to follow the early tradition of Grand Rounds, as established and maintained by Nick Genes, venerable beyond his years in this regard. To elucidate, a few posts that have stood out, in this editor's opinion, have been selected for each category, to keep this edition of Grand Rounds to a readable size.

There were roughly quadruple the number of submissions for the (arbitrarily) designated size of this edition. Many quality submissions were regrettably left out this week, apologies to all. Dr Dork wouldn't have made the cut himself amongst the field of entries this week.

For those with particular preferences and predilections, the 30 selections for this week have been compiled into the following categories:

  1. Rants
  2. In Practice
  3. Of Patients and for Patients
  4. Education
  5. Research and Advances
  6. Healthcare Policy and Reform
  7. Medicine in the Media
  8. Miscellany and Mirth

Lastly, In Parting, we have a bittersweet farewell from the greatly admired Barbados Butterfly.


Fallen Angels rants on discourtesy in the healthcare blogosphere in Doctor Bloggers

Dr Dino berates the local lawmakers for the misguided enforcement of BMI Measurement in Schools.

Susan Palwick of Rickety Contrivances of Doing Good (perhaps the tongue-twistiest healthcare blog title) shares her anger at observing abusive behaviour towards an ED "frequent flyer".

In Practice

Dr Kenneth F. Trofatter discusses the evaluation of Recurrent Early Pregnancy Loss as part of an ongoing series on the topic. An increasing problem, one presumes, as many elect to become parents later and later, it seems.

Fat Doctor shares a moral dilemma as an overzealous schoolteacher almost berates her into support of developing SuperBugs.

Azygos shares a poignant tale of a patient's death from Multiple Sclerosis, and touches on the dangers of a fragmented care system in Paul

Signout, in the midst of a trying cardiology rotation, is touched by the power of a simple gesture of thanks in What we're supposed to do.

Dr Shazam of Mr Hassle's Long Underpants (still one of the best blog names, period) shares the electricity, and the enervation, of emergency room codes in Fallen Star.

Of Patients and For Patients

Dr Rima Bishara gives a comprehensive summary for parents, examining sports injuries in children.

Adam of Daylight Atheism gives a disturbing account of the situation faced by those in the Congo, where a single, lone psychiatrist, Dr Alain Mouanga, struggles to turn the tide of abuse inflicted upon the mentally ill.

The Bohemian Road Nurse shares her deeply personal experiences of battling alcoholism, a common affliction throughout the healthcare professions.

ChronicBabe shares some advice on time management for those struggling with their health...advice which we could all heed, irregardless.


The inimitable Orac looks in detail at the subtleties of early cancer detection, particularly in regards to breast cancer in a highly informative two-part post.

Vitum medicinus shares a compendium of people he admires most in his class at medical school. Reminds one of the different paths many of us walk to the same destination.

Research and Advances

GrrlScientist identifies a major flaw in the much lauded "treatment" for ABO blood type incompatibility which has been bandied about in recent weeks.

Docinthemachine blogs on new developments in genetic pap smears which could lead us one step closer to eradicating some common STDs.

Dr Domenico Savatta looks at surgical options, including some recent research of his own, in treating prostate cancer. Very relevant to us old codgers.

Dr Charles revisits some of Kinseys ground-breaking and controversial work with a "Kinsey-style" sex survey of the health blogosphere. Go on. Be honest!

Healthcare Policy / Reform

Australian Parliamentary Debate

Dr Kevin takes a break from his frenetic link-blogging to give us a thoughtful and considered discussion of the growing problem of defensive medical practice.

Amy at Diabetes Mine previews Michael Moore's much anticipated "sicko" documentary. Even those of us on the other side of the globe will be interested in his take on the American system.

Medicine in the Media

N=1 from Universal Health berates the New York Times in Heart Disease, Treatment and Thrills for a recurring debasement of the nursing role.

Kerri at Six Until Me considers from the perspective of a diabetes sufferer the recent macing of a Mr Universe whilst hypoglycaemic in Doug Burns, Maced ?

Walter at HighlightHealth examines an inflammatory television "investigation" of pharmaceutical dispensing errors.

Jon Schnaars at Anxiety, Addiction and Depression Treatments comments on recent research looking at the questionable use of "check-list" questionnaires in psychiatric diagnosis and arbitrary exclusion criteria in Checklists Often Fail to Address Important Aspects of Depression Diagnosis. Dr Anonymous takes another look in is depression really depression ?

Miscellany and Mirth

Aaaaaah...Dr ? Are you Ok ?

Dancing Bare gives us a taste of Gilbert and Sullivan with an ode to Dr. Mom.

Roy of Shrink Rap gives an emotive, heartwarming view of the necessity of humour in preserving sanity in the face of tragedy in laughter is a drug. Dr Dork couldn't agree more. Ijeoma Eleazu reminds us that April is national humour month for American readers.

Dr Karen Little, a South African intern, of Just Up the Dose, shares with us some stomach churning experiences in a post succinctly titled ew.

Dr J of Northmed does some brain-twisting with medical acronymony

Nurse Ratched shares with us some outstanding additions to her vast collection of medical pulp fiction. Ah, those were the days....

What ? Time for my sponge bath already ?

In Parting

Charity Doc shares an ode dedicated to the much admired Barbados Butterfly whose wings have been sadly clipped.

It is common knowledge, after some dubious leakage to a major Australian newspaper, that Dr Barb was (in this Dork's, and many others opinions) inappropriately reprimanded by her hospital administration. Dr Dork recalls his many 100+ hour weeks from his hospital training days. Even back then many administrators preferred to deny the ridiculously unsafe hours many doctors worked. Unsafe for patients and doctors both. Dr Dork suspects this is what got Dr Barb in trouble...but we will, sadly, possibly never know.

Dr Dork has badgered Dr Barb into providing an "approved statement", which follows.

Dear Blogosphere,

Thanks to everyone for your well wishes, kind words, expressions of concern
and thoughtful tributes in recent weeks – I was amazed to realise the extent
to which the Barbados Butterfly blog had touched and inspired others since
its beginning in 2005. As the blogosphere has reported, the BB blog has been down since March 15th 2007.

The 2006 post “Tips For Surgical Intern #1” stated that in a bad situation
you can either leave it, reframe it, accept it or change it. In some
situations change is the only option. It may be daunting and difficult, but
that must not dissuade us from trying. Surgical training is necessarily
hard, but there are some paths that trainees should not have to walk. Long
term readers will recall my Darker Days series:

“I do know that as a profession we need to do better. We need to promote a
culture of safety. We need humane leaders - both clinicians and
administrators. We need to value our colleagues and create work environments
that we feel confident about and excited to be a part of.”

I am grateful that there are people who are both willing to accept the need
for change and willing to act. My blog is down and I shall miss sharing my
stories with you, but I sleep restfully (my pager notwithstanding!) and
continue to wield my scalpel with a smile. We live in exciting times.

“If nothing ever changed, there would be no butterflies.” – Anonymous.

Best wishes and much love to all,
Barbados Butterfly

That's all for this week. Next weeks edition of Grand Rounds will be hosted by The Fat Doctor.

Addendum: the pre-emptively curmudgeonly Dr Nick Genes interviewed Dr Dork for Medscape Pre-Rounds here.


Karen Little said...

Well done - Great Rounds. And thanks for including me ;)

Dr Dork said...

Hi Karen,
Blimey, that was quick !
Your post was very entertaining.

Emoticons are banned here. The Terminator T-1000 has been dispatched.

Kind regards

#1 Dinosaur said...

Excellent, as anticipated. Many thanks for including me in the fun, and especially thanks for letting us know that BB is ok. (Any linkage available to the "major Australian newspaper" leakage mentioned?)

Fat Doctor said...

So glad that BB is OK. Great job this Tuesday...I can only hope to measure up next week!

Dr Dork said...

Hi Dino

Follow the links within Barbs "approved statement".

Howdy FD,
My aim was purely not to 'stuff up' too badly. I did re-publish 4 times due to typos...d'oh! All the best for your 2nd edition.

Kind regards

Roy said...

Nice job, DrD. I particularly liked the way you included BB's "farewell" statement. Grand Rounds is a good forum to spread such news. And thanks for fixin' those typos!

Dr. A said...

Great job, and thanks for including me. I also enjoyed the farewell statement as well. BB will definitely be missed.

ChronicBabe said...

Love Grand Rounds today, Dr Dork - excellent work! Those pics are just in time...it's a big pain day over here at ChronicBabe HQ, and I was in desperate need of a laugh. Many thanks for your good work -

Kerri. said...

Great edition here, and thanks for including my post.

Also, thank you for the update on BB. I had been wondering what had happened ... shame to have such an inspiring voice silenced.


N=1 said...

Thanks, Dr. Dork, for a terrific edition of Grand Rounds. Thanks, too for including my ranting and raving (no response yet by the reporter). I especially appreciate the gravitas you bring to GR, as well as conveying the farewell from BB (I really miss reading her blog - maybe she will consider blogging about something else - she's a wonderful writer).

Kim said...


Great categories, great photos (that ranting baby was worth a visit right there!) and some blogs that are new to me (time for another extension of the blogroll!)

As for the debating kangaroos, add about 433 more of them and you have our House of Representatives! LOL!

Thanks for hosting (and for the update on Dr. Barb....)

Dr. Deb said...

Wonderful GR this week, Dr. Dork. And including Barb's letter was so poignant and touching. Your badgering was well worth it.

Susan Palwick said...

Thanks so much for this wonderful edition, and for passing on the news about BB (whom, like everyone else, I'll miss). And thank you for including my post, even though I submitted it late!

Dr Dork said...

Hi Roy, Dr A, Kerri,

I'm honoured, and saddened, to "host" BB's departure.

Why do people always assume my personal pics are some kind of joke ?

Please let us know if a response ensues...one doubts it.

Kim, Perhaps some coyotes instead ? Or maybe raccoons ?

Dr Deb,
Thank Barb, not me. She steadfastly displayed concern for we hundreds/thousands of "anonymous readers", despite her trials and travails.

Your submission extended the post deadline in and of itself. Decrying wolves does not invalidate their existence.

Kind regards

N=1 said...

Hi Dr. Dork:

Response received and included in updated post. (Times reporters usually respond to my emails, but this is as far as I get. What next, this N=1 wonders?)

jmb said...

Great job, Dr Dork. Duly organized in a manner suiting your blog personality.
I even joined Medscape to read the interview, well done there too.

Ijeoma Eleazu, PharmD said...

Thanks for including me with all those great posts!

SeaSpray said...

I love your pictures and good work!! :)

Bo... said...

Thank you so much, Dr., for including my post. It was the hardest post I've ever written and I agonized over whether to punch the "publish" button many times. Thanks for hosting the GR and it was a great job! I'm sitting down to have a bunch of good reads with a cup of....some good coffee!

Rita - Supporting Safer Healthcare said...

Fine job Dr. D. I too was happy to see that "Barb" continues to do well, although I imagine that anyone brave enough to use a scalpel on a living, breathing person is brave enough to handle most anything. :)

Kenneth F. Trofatter, Jr., MD, PhD said...

Dr. D,
Thanks for including me in this week's GR. I laughed and I cried. Especially liked Dr. Little's dissertation. We will have to get together to share some OB/GYN horror stories together! Keep up the great work!

Walter said...

Great edition Dr Dork. Thanks for including me in this week's Grand Rounds.

Signout said...

Wow, I can't believe I made the cut! Thanks for including me in this fantastic Grand Rounds.

Midwife with a Knife said...

Great job on grand rounds. Thank you for doing such a great job. The pics were hillarious, too. :)

John J. Coupal said...

If Dr. Simian had glass in his (her?) eyeglasses, he (she) wouldn't look so quizzical about the goingson.

Ex Utero said...

I too am very appreciative of BB's epilogue letter.

Very nice job all around Dr D.

Godwhacker said...

Great read! And finally you posted your real picture!!! ;)

Dr Dork said...

Ex U, MWWAK, signout, walter, KFT, Rita, seaspray, IE, JMB

Thanks for the +ve feedback...never hurts.

n=1 - intriguing!

I'm wearing contacts.

Faux intelligentsia...'nuff said.

Barb is/was one of the blogs I read from start to end when first discovering this medium of communication. I hope she returns.

Your honesty and insight with such a common (and oft denigrated) affliction, is brave and beneficial to many.

Kind regards,

911DOC said...

hey doc,
g'day from the northern hemisphere. thanks for linking my site on your excellent blog. i have now linked you and will visit regularly. have a fellow physician just returned from iraq who staffed one of the MASH units with some aussies and he was very impressed with their skills and training. as we say in my part of the world, "y'all come back anytime".

Dr Dork said...

Howdy 911DOC,

No worries - I link what I read. I can imagine a cultural clash with EM physicians from US / Australia...

"epi-what ?"


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