Grand Rounds 2.07

Welcome! As this is National Medical Staff Services Awareness week, this week's Best of the Medical Blogosphere is dedicated to my hardworking colleagues around the country.

It started out as a typical day in the Medical Staff Office. I leaned back against my leather executive chair and surveyed the top of my gleaming rosewood mahogany desk. The view out the large window was lovely, a sail boat skimming across the sparkling blue water of Lake Erie. (Hey, it's my story; I can have whatever kind of office I want!)

Suddenly I sensed someone standing behind me. Turning, I see none other than Leonard McCoy, M.D., "Bones" from the original 1960's Star Trek. "Dr. McCoy" I presume?

He looked instantly suspicious. "How do you know my name?"

"Easy, I had a big crush on you when I was 12."

"Okay" he replied. "I need your help, and I'm counting on you to be discreet."

"Discretion is the better part of credentialing" I responded. "What can I do?"

"Due to a disruption of the time-space continuum I've accidentally ended up here in 2005. Spock and Scotty should be able to perform a level one diagnostic, realign the warp drives, and beam me back up within a few hours. But in the meantime I must be careful not to interfere with the normal development of your culture; its Star Fleet's prime directive. Therefore, no one can know that I'm from the future. Can you help me be inconspicuous?"

"Sure, but the blue velour t-shirt with the little boomerang logo has got to go. Anyone from my generation will be able to identify you as a crew member of the USS Enterprise. Let's find some surgical scrubs!"

A few minutes later our misplaced Star Fleet Medic was anonymously clad in slightly wrinkled cotton scrubs and sporty blue surgical shoe covers. He eyed me warily. "I can't believe you had the nerve to make fun of our twenty-third century fashions when you are willing to walk around wearing something like this.

"No one pays any attention to people who wear scrubs in a hospital, it's the perfect disguise" I assured him. "Come on, I'll take you on a tour."

"Is there any danger?" he asked, reaching for his phaser, which I can only hope is set to stun.

"Well, if we run into David Williams from the Health Business Blog, he'll tell you all about the dangers of Consumer Driven Health Care, and Chiisai Tokoro may want to warn you about how easy it is to be gullible during a Med Mission. Oh, and just the other day DocShazam told us about a patient who had a scary encounter with her dentures, but overall, we should be safe.

As we walked past the Psychiatry Department loud cheers and chants could be clearly heard. "I never realized psychiatry could be so much fun" Dr. McCoy said, trying to peer around the door.

Well, Shrinkette is from the west coast you know, and they tend to be... progressive, out there.  She's trying out Roulette Therapy and it seems to be a big hit with her patients.

Nurse Kim from Emergiblog hurried toward us. "Hi, on your way to the Emergency Department?" I asked.

"Yes" she replied "the paramedics are bringing in a trauma. Paramedics, ya gotta love 'em" she said as she ran past. Dr. McCoy just stood watching her with a smile on his face. "Who was that?" he asked. "She's a real doll!"

"Hey, remember I'm the one who had the adolescent crush on you, no flirting with the ED nurses!"

"Time to get your mind back on serious business! Here's the Pulmonary Lab. That's Dr. Jennings just inside the door; he's a contributor to Pulmonary Roundtable, a discussion of the latest treatments in pulmonary disease, complete with twenty-first century CT scans.  And next to him is Clinical Cases and Images, who posted some Chest X-rays with Annotations on Flickr.  He's our 'techie.'"  Dr. McCoy's eyes lit up.  "No, no" I said shaking my head, "I didn't say Trekie, I said techie - you know, he keeps up with all the latest gadgets and web tools."   

"Oh, too bad.  Perhaps I could consult with him on a case or two, as long as I remember not to mention that my most recent patient was that annoying Vulcan who accidentally left me stranded here in 2005."

"It would probably be good not to mention that" I agreed.  We have a hospitalist who is always jotting Notes from Dr. RW, and you complaining about an annoying Vulcan might just make him wonder whether you're A Disruptive Physician."

"Ah, here's a patient you'll want to meet, Amy from Diabetes Mine. She's always doing interesting research."

Amy grinned and said "I've learned that Cannabis can be used to treat diabetes (yep: pot, grass, weed, ganja...). This is legit!"

"What?" Dr. McCoy said, clearly astounded. "I can't believe it. I wouldn't consider smoking Marijuana! Well, there was that one time when I was in medical school, but I didn't like it and didn't inhale."

"This sounds like a discussion for the Bioethics Committee" Dr. Bernstein of the Bioethics Discussion Blog said as he walked by. Come to our next meeting, we're discussing the ethical dilemma of Ventilating the Dead. I've also invited Orac, who wants to address the group on parents with Misguided Faith in Alternative Medicine. Sorry, I've got to run.  Resident Joe, who thinks this place is a Medical Madhouse, has posed the perplexing question How Many Have You Killed?

"Strange" McCoy muttered to himself as we continued our tour, "I usually just shake my head sadly and say 'He's dead Jim' and that's the end of it."

Just then Greg from Information is Free came by.  "Have you seen Dr. Bernstein?" he asked.  "I'm proposing a new headache study, Migraine prevention through interruption of marital contracts, and I want the Bioethics Committee to take a look at it.

"You just missed him" I said, pointing down the hall.

Before we turned the corner we could hear Aggravated DocSurg and Matthew from The Health Care Blog heading our way enthusiastically discussing the need for health care reform.

"We need more Doctors for Medical Liablity Reform, I don't need to tell you how aggravated I get about lawsuit abuse" DocSurg fumed.

"I understand" Matthew responded, "that's why I think that you should participate in the First Healthcare Reform Competition.

"This is our Genetics and Public Health Blog area" I explained to Dr. McCoy as we passed the office of  Dr. Lei. "By the way, how have you solved the privacy and information use issues surrounding Public Support for Genetics in the future?" I asked. 

"Ah - I'm not supposed to interfere with the normal development of your culture, remember?"  He responded sardonically. "I could tell you but... he patted his phaser..."

"Never mind, forget I asked" I replied quickly.  "I suppose that rules out any questions about the future of Advanced Reproductive Technologies and Adverse Pregnancy Outcome too." I sighed.  "Red State Moron would love to have a chat with you about that."

"Well look" McCoy said smiling, "at least I'm not the only person running around the hospital in this ridiculous outfit. Here comes someone else wearing blue pajamas."

"Oh that's Dr. Bob from The Doctor is In" I said. "He's a surgeon."

"He any good?" McCoy asked.

"Yes, he's not only experienced and careful; he's also willing to admit it when he makes a mistake. He understands That Terrible Power that comes with performing surgery.

I spotted Elisa from Healthy Concerns walking fast, a frown creasing her brow. "I'm running late because my new doctor hasn't figured out The Secrets to a Smooth Doctor's Visit" she said, shaking her head.

"I don't want to hear any complaints about doctors" Intern Nick from Blogborygmi chided as he and Tim from Medical Connectivity joined her. "I just finished standing in line from Station to Station and dealing with a bunch of unsympathetic administrators.

"Perhaps the principles of Improved Patient Flow would help both of you" Tim said. "Let me tell you about this great conference I just attended."

I directed Dr. McCoy to our Physicians' Lounge, where I see Dr. Andy, our pediatric allergist/immunologist doing some stretches over in the corner.  "Off for a lunchtime run Dr. Andy?" I ask. 

"Yes, Barbados Butterfly and I are going out. We only have time for a few miles - not much of a workout for those of us who are serious runners.  But she has to get back to check on her 79 year old woman with an incarcerated inguinal hernia admitted last night through the ED, and I want to follow up on my young patient who had a near Fatal Reaction to Food.

"By the way" Barbados Butterfly turned to Dr. Andy as they sprinted out the door, "does a Trendelenburg trolly make you nervous?"

"Speaking of food," McCoy asked looking around hopefully, "I know you haven't invented replicators yet, but isn't this the age of fast food?"

"Well," I hesitated, "we here at the Nexus Clinic prefer that our guests select from a healthful menu of lean meat, fruits and veggies. Would you care for some sunflower seeds from the vending machine?"

"Or maybe some Augmentin?" Doc Around the Clock asked, grinning. I hear that the hospital spent a bazillion dollars on this clever Vending machine that dispenses drugs.

At that moment Trent McBride from Catallarchy walked in with another pathologist, arguing about whether Increases in Cancer Markers after running a marathon are a matter of correlation or causation, and Tara from Aetiology asked if anyone had read up on the new bacterium-cancer link.

The Cheerful Oncologist joined the discussion and described his recent conversation with a patient manifesting a disgruntled attitude about healthy life-styles. The C.O. explained why he closed the encounter with some advice to invest in long-term health insurance and The Riddle of the Sphynx.

"Have any of you ever had a patient encounter just make you, well, Uncomfortable?" Dr. Charles asked.

"Does Tearing Up count?" Grunt Doc asked. "Some patients just change you forever, you know?"   

Dr. Helen looked on thoughtfully. "And sometimes" she said, "being the patient** is what changes you forever.

"I just wish we could get patients to follow medical advice" Dr. Emer said with a sigh. "Maybe we should try some Creative Strategies to Health.

"So, do any of you think they'll create a safe cigarette in the future, or is that idea just Smoke and Mirrors? Medpundit asked.

"How would we know?" Dr. McCoy asked. "Does one of us look like someone from the future to you?"

"Ah, no" Medpundit said, "I was just asking... By the way, have you ever chatted with Shrinkette?"

With that Dr. McCoy and I quickly said our goodbyes and left the lounge to continue our tour. We stopped by the Nursery for a quick peek at the babies and ran into Doulicia, who explained her argument for insurance-backed postpartum support.

We passed the Public Relations Department, where Nurse Geena of CodeBlog was recording a public service announcement about when to call an ambulance for help, and the Insurance Department where the Workers Comp Insider was explaining that Carpal Tunnel Syndrome is second only to back injuries in lost work days.

Bob from Health Care Law Blog came by, pushing a large cart.  "What's all that?" Dr. McCoy asked. 

"Legal Medical Health Records" Bob replied. 

"You mean to tell me that some poor doctor has to slog through all that paper just to figure out a patient's medical history?

"Doctors, nurses, coders, billers, record technicians, attorneys, patients.  We're moving toward the electronic medical record (EMR) but it takes time and money" Bob said.

"That's right" Tony from Hospital Impact added as he stopped by on his way to Administration.  "We're lagging way behind in electronic communication.  Only 12% of patients use the internet to choose a hospital.  So far, comparison shopping is for cars and computers, not hospitals.

Sorry to rush off, but I'm heading to a meeting with Henry of InsureBlog.  He's going to try and explain Medicare's new RX program to me.  I missed the webinar. Kevin MD will also be there to explain the Blogosphere's response to Merck's Vioxx Victory.

As Tony hurried away, Dr. McCoy slowly turned and asked "Is it my imagination, or are all of you MEDICAL BLOGGERS?"

"Yep. The cream of crop I might add - you've just had a glimpse into the 2005 best of the medical blogosphere."

"Blast it Rita, I'm a doctor, not a blogger!"

"Well in that case, perhaps it's time to expand your horizons and become both" I replied.

Just then, with that old familiar beaming sound, he dissolved right before my eyes.

Next week's Grand Rounds will be hosted by DocShazam.  If you'd like to host, contact Nick at Blogborygmi.

** If you read nothing else from this week's Grand Rounds, be sure to read Dr. Helen's powerful story. - Rita

Technorati Tags: Grand Rounds, Medicine, Medical Blogs, Medical Blogosphere

Comments

[JonMikel, M.D.]

Great story, also so complete the medblogs list.
I'm another StarTrek groupie.
You just missed mine.

Regards,
Jon Mikel, M.D.

[hgstern]

.
"Blast it Rita, I'm a doctor, not a blogger!"

Priceless!

What a terrific job! Thanx for hosting, and for putting in so much effort and creativity.

[Rita]

Thanks - I have to give Nick credit for the "I'm a doctor" line. When he heard I was using a Star Trek theme he suggested I include it.

I confess to being a bit bleary-eyed this morning, but hosting and creating the story was fun.

Rita

[bob]

Incredibly creative. Great job! Thanks for including a link to my health care law blog.

[Tony]

very creative! one of the best!

[MedSleuth]

Excellent job at Grand Rounds this week. Very well written and put together. Thank you for the effort and time put into this entertaining and informative post!

[aidan]

well done, thank you! this is chock full of reading, is this the largest one yet?

[Rita]

I don't know if it's the largest,there were 39 different contributors. About a third of those (I don't want to mention any names DR. CHARLES) arrived in the last couple of hours before the deadline. :)

[PaedsRN]

Nice work! A very interesting read.

[AmyT of www.diabetesmine.com]

Excellent! I knew it was just a matter of time before Medblogging met Star Trek...

[DP]

Great job--I love the Star Trek theme with Dr. McCoy!