Grand Rounds: What Docs around the Globe are Thinking-and Blogging


This collection of blogs compiled by Dr. Pullen will make you cry or scratch your head, give you some perspective, and maybe even teach you something about the practice of medicine.

This article originally appeared online at, part of the HCPLive network.

Welcome to Grand Rounds Vol. 6 Number 47. The theme this week is “In the Office.” This is to be interpreted loosely. My office is an outpatient family medicine office, some of the author’s offices range from a South African Emergency Room to a Vancouver, WA, psychology office. Others are submitted by patients discussing their experience at the office or posts about some of the absurdities we face as physicians in our “office lives.” As usual the medical writing community sent good stuff. My choice for best in each category is listed first. The rest are in no particular order.

These Posts Will Make You Smile or Cry or Scratch Your Head:

A combination of a good story, good writing, and experiences that you can relate to personally make reading this article especially intense. Keep a tissue handy when you read: Life at Grady: Tears on the Ward by Kimberly Manning on ACPHospitalist.

JefferyMD posts on the awkwardness of being inexperienced both clinically as a very green third year med student, and as a young male trying to empathize with subtleties of a young woman’s early menstrual cycle concerns. His site is worth checking just to see the site name graphics. I like the MD being hoisted by a crane. The writing is good too: On the Wards — I Apologized to a Patient.

The Happy Hospitalist urges us all to stand behind our hospital’s campus-wide no smoking policy, and to confront anyone we see breaking the rules. Don’t be intimidated by either this advice to buck up and do the right thing, or by the really long post title: Hospital Smoking Ban Policy Enforcement and the Doctors, Nurses, Family and Patients that Can’t Wait to Get Their Nicotine Fix.

A Medical Resident writes about the physician persona and how this relates to their role as an emergency medicine resident. You’ll enjoy the perspective: Chaos, Cacophony, and Conundrums: The Rhythm of a Night in the ED.

At “other things amanzi” bongi, a South African surgeon who uses no capital letters on his site writes about the extreme cultural difference and surgical training experiences between Belgium and his part of South Africa. I think I’d rather live in Belgium, but do my surgical trauma training in South Africa. Read and enjoy: different places deliver different opportunities for experience.

These Posts May Teach You Something About the Practice of Medicine:

After reading Will Meeks post: What is ‘Ego Depletion?’, I now have the explanation of a bona fide psychologist for what we call “tired talk” at my house. I guess this is why life’s dilemmas seems more manageable after a good night’s sleep than it does at the end of the day.

This is just the type of thing I had in mind when I hoped patients would submit about their experience at the office. Dot, a fibromyalgia patient who posts with her Mom at Fibro World gives us advice on how to make the office experience better for her and other patients: 7 Things Doctors Can Do to Help Fibromyalgia and Chronic Pain Patients without Medication.

Julie Levengood at The Doctor’s Rheum discusses the need to figure out the patient’s real concerns, and not just fix the problem the doctor sees as the important issue. She has good advice for many of us in our daily toils in her post: Dr. Fix It.

Nicholas Fogelson at Academic ObGyn compares fetal electronic heart rate monitoring to the Asian practice of determining a person’s health and disease status by feeling their pulse for a few minutes. Both put an inordinate amount of weight on a single vital sign. I like both the comparison and the writing, though I did have to look up what NICHD (National Institute of Child Health and Human Development) means. You’ll enjoy: Traditional Healers, External Fetal Monitoring, and the NICHD.

From Suture for a Living is an article discussing the anxieties of a woman with a palpable lump that’s really a part of her saline breast implant. Educational and interesting reading: Palpable Implant Valve.

Dr. David Rabiner writes an analysis of the long-term effects of neurobiofeedback treatment for ADHD which sounds like it may be one more option in communities where this resource is available if the study is replicated and its role can be better defined.

These Posts Shout Out on Some of the Screwy Things We Do in the Name of Health Care:

On David Barlow’s Health Care Law Blog, with the cute HealthBlawg site name, David lets us all know that we are not only responsible for our own business’ HIPAA compliance, but for the compliance of our vendors and subcontractors. This is one more reason to be afraid to be in private practice. Maybe I should just retire before I end up in court or jail because of the idiocy of a vendor. Privacy and security of patient records: The lesson of the weakest link.

Dr. Rich writes a long and detailed an post about the long, detailed, an increasingly less than clinically useful chart notes physicians spend their time in the office completing in vain attempts to comply with the Medicare mandated E&M Coding rules in his post E&M Guidelines Undermine Patient Care, and That’s the Point.

From ACP Internist comes an article by a patient making fun of his doctor, oops I should say “medical care provider” on being graded by his insurance company on whether he (the patient) gets his annual checkup done. Checkmarks for check-ups, the mandatory annual exam. Do the rest of you feel as I do that you spend too much time doing things to comply with recommended care and documentation specifications protocols (soon to be mandates?) which leave less time to provide the care your patients want or you know they need?

Submitted by the very Val Jones who helped create and propagate this Grand Rounds forum is a post from Alan Dappen MD, a physician who practices what some call a concierge medical practice: Leaving The Organization But Not The Practice Of Medicine.

On his blog Providentia: A Biased Look at Psychology in the World, Romeo Vitelli writes a historical piece on the treatment for what may have been delirium tremens of the artist Edvard Munch in 1907. Munch was admitted to a private mental institution to undergo intensive treatments. A sort of cuckoo’s nest of the time: Curing Munch.

Thanks to Nick Genes and Val Jones for promoting and organizing this forum. Be sure to visit A Cartoon Guide to Becoming a Doctor for next week’s grand rounds, and get your submissions in for Grand Rounds Volume 6 Number 48. The theme for next week is “humor” so send in your posts with the highest chuckle factor.

Ed Pullen, MD, is a board-certified family physician practicing in Puyallup, WA. He blogs at — A Medical Bog for the Informed Patient.

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