The Airbus 380 super jumbo jet, the world's largest, made it's maiden commercial flight today, flying from Singapore to Sydney with 455 passengers.
No doubt about it, flying would be a great deal more pleasant under these conditions:
If you're a supervisor or manager, you know how challenging it can be to handle your responsibilities well. Being bossy is easy; being a good boss is hard work. Being a great boss takes a combination of talent, emotional intelligence, and wisdom.
In Good Boss, Bad Boss, Psychology Today writer Willow Lawson states, "a worker's relationship with his boss is nearly equal in importance to his relationship with his spouse when it comes to overall well-being. Even friendly coworkers or a rewarding occupation cannot compensate for a negative relationship with the boss."
A few weeks ago I had the pleasure of having lunch with one of my former supervisors. Patty lives in another state now, but when she comes back to Ohio for a visit we always try to get together. She was probably the best boss I've ever had. I've thought about her style over the years and tried to figure out where I could emulate her and where I needed to find my own voice.
What made her a good boss? The first thing that comes to mind is that she had a sense of humor. She hadn't been in our department very long and I was still trying to decide what I thought about her, when someone brought a singing holiday welcome mat into the office. I can still picture her jumping on and off that silly door mat singing along loudly (and quite off-key) and grinning at me.
She didn't take herself too seriously.
Patty knew her stuff and kept up to date with industry trends. She was involved in her profession on a national level and was always looking for ways to expand and share her knowledge.
She was a student, as well as a teacher.
She knew I was looking for more challenging work, so when the opportunity presented itself she introduced me to the world of medical staff administration. She stood up to TPTB to send me to conferences and get the training I needed to not just do the job, but to understand the underpinnings and know why it was important.
She wasn't afraid to "give away" some of her authority.
Patty was manager over several different hospital departments. Prior to her joining our staff we all knew one another in that "greeting in the hallway" kind of way. She instituted staff meetings that brought us all into the same room at the same time. Lunch was included. Before long, we all had a part in providing that lunch and arranging those meetings. Sometimes it involved a trip to the deli to help her pick things up, or a trip to the party store for some inexpensive fun decorations. The lunch meetings developed themes, and the agendas became artwork.
I suspect that her boss thought there was a bit too much party and not enough work getting done at those meetings. But if he did, he was wrong. We hammered out problems, jumped in to help one another, and became a team.
One of our projects was revising a large filing system. (Oh yeah, big fun.) It was important, it needed to be done, but, yuk. A group of us came in on a Saturday. We sat around a large table like an old-fashioned quilting bee, laughed, talked, (ate of course) and got to work. The only down side that I remember was the music we listed to on the radio. Did I mention that Patty has terrible taste in music? Some funky rock and roll station. Didn't matter though, we got through that ugly job and had fun in the process. We even felt kind of special that we'd been invited to help.
She knew how to bring people together.
Being a boss isn't easy, and it can be a thankless job. If you're fortunate enough to work for a talented leader, make sure you let them know they're appreciated. 
Thanks Patty.
It's a week for celebration! It is National Medical Staff Services Awareness Week, and the second anniversary of the MSSPNexus Blog. What better way to celebrate than by hosting edition 3.07 of Grand Rounds. Welcome! 
Some of you may remember that last year about this time Leonard McCoy, M.D., "Bones" from the original 1960's Star Trek was accidentally beamed into my office. So this year I figured I'd better keep my wits about me and my eyes open for any fluctuation in the time-space continuum...
Deciding that the rumblings in my stomach required attention, I headed for the hospital cafeteria, dreaming of something green and leafy of course.
On the way I noticed a man who appeared to be a bit dazed. A stethoscope dangled haphazardly from the pocket of his lab coat. "May I help point you in the right direction?" I asked cheerfully as I approached.
"I'm not sure" he replied as he turned toward me with a bemused smile and a hint of New England in his tone. "I can't quite figure out where I am."
Instantly my Credentialer Senses went on high alert. (Similar to Spidey Senses, but in this case they sniff out doctors who may not be 'as advertised'.) In all my years working in medical staff administration, never have I personally uncovered a total fraud, one of those Dennis Roark types who just decides one day that being called doctor might be kind of cool. But something about this "doc" seems a bit off, and I begin to wonder who this slightly confused soul standing before me might prove to be.
"Where is it you want to go?" I asked, noting that the photo ID badge he is wearing is not standard issue.
"The Emergency Department" he responded with a touch of arrogance, "I have a patient waiting."
I grew even more suspicious in view of his inability to locate his own patients, and began to wonder whether I might have just met my first physician impostor.
"Okay, who are you, and what are you doing wandering the hallways of the Cleveland Clinic?" I asked.
"Cleveland? That's quite impossible! I can't be in Cleveland, I am Charles Emerson Winchester, III, Chief of Thoracic Surgery at Boston Mercy Hospital!
Uh-oh, it's that time-space continuum thing again. Something about combining Medical Staff Services Week and Grand Rounds seems to cause a disruption in the classic television force field. 
Dr. McCoy would sympathize.
"Sorry Dr. Winchester, Cleveland it is; but take heart, since you're an aficionado of classical music, you'll love our orchestra."
"Yes well, be that as it may I have patients to attend to and no time to dawdle, will you assist me in locating them?"
Smiling reassuringly, I extended my hand. "I'll need to see your license, DEA, and proof of malpractice insurance please. I'll contact my colleagues at Boston Mercy, run a check for OIG exclusions, and query the National Practitioner Data Bank. Take a walk with me; we'll stop by my office and pick up a few forms."
"What!? he asked in his best 'I save lives every day and who are you to question my credentials' voice. "I believe that my word should be quite good enough! I graduated summa cum laude from Harvard Medical School I'll have you know!"
"Oh I'm sure everything will check out fine. In the meantime, I just happen to be hosting Grand Rounds this week. I believe that our friends in the medical blogging community will be able to both entertain and educate us while we wait."
"By the way, it's Medical Staff Services Awareness Week, did you happen to bring me a present...?"
"Well," he said patting his lab coat pockets "I do believe that I have an extra Godiva bar if that would suffice."
"Chocolate? That'll do. Hand it over!" (Note to all potential medical staff applicants, chocolate is a good gift...)
"Thanks for the treat Dr. Winchester, and now I have one for you, this week's collection of the best of the medical blogosphere - Grand Rounds."
From Is there A Doctor in the House, the touching story of It.
From Surgeon's Blog, the story of Big Joe: living proof of our fallibility; of useful tests that can mislead; of procedures aimed toward helping that sometimes make things worse.
Six Until Me ponders her well-stocked medicine cabinet, and wonders what would happen to it if she ever really got sick.
From Emergiblog: Consider yourself a little crazy? Perhaps nursing is the career choice for you.
Aggravated DocSurg reveals how a date with IRIS may help you avoid the need for a central line.
Aidan Charles (The Examining Room of Dr. Charles) has just announced publication of his second book! Trinities is a collection of tales, essays, and poems drawn from his favorite blog posts. Congratulations to one of the medical blogosphere's most gifted writers.
The Tangled Neuron's Antipsychotic Medications and Alzheimer's chronicles one phase of a daughter's search for answers about her father's dementia.
Straight From the Doc tells of research with engineered heparins, which may prevent the formation of the protein clumps that form in the brain and contribute to Alzheimer's.
True Confessions from Hsien-Hsien Lei of A Hearty Life. She reveals that KFC is one of her favorite fast food indulgences, trans fats and all.
The Diet Dish reminds us that large portions don’t always equate to boat loads of calories and small portions don’t always mean minimal calories in Portion Distortion.
Fixin' Healthcare offers tips on how to avoid gaining weight over the holidays.
Anxiety, Addiction & Depression Treatments wants to go on record in support of the Winterhaven, Florida Chief of Police who took a stand on obesity.
Good childhood nutrition can help ward off coronary atherosclerosis and heart disease later in life according to Disease Proof.
Nutrition & Life offers some common-sense tips on healthy living.
The Family Fork suggests that salt intake is linked to obesity, particularly in children.
Medpundit argues that shortening waiting room times for all emergency room visitors regardless of the nature of their illness, does not necessarily improve healthcare and reduce errors.
Rickety Contrivances of Doing Good spends a busy night in the ED and questions whether the "lunar effect" of the full moon is real.
Clinical Cases shares how custom Google search engines help patients find reliable medical information.
Movin' Meat explains why the decision not to settle a baseless malpractice claim is a lot like letting a bear maul you while hoping that he won't get all your food.
The Daily Rhino says that the summer after medical school finals is a glorious time - all the perks of being a doctor (i.e. telling people you are a doctor, and are thus superior to them) but none of the responsibilities. But after a few beers one Saturday night, it became quite another story.
Just Up the Dose reveals what she learned about the silkworm's scarf during her recent Urology rotation.
Anatomy Notes provides a lesson on referred pain. Sometimes the brain gets confused, making you think that one part of the body hurts, when in fact another part of the body, far removed from the pain, is the real source of trouble.
Medical student Anthony Rudine is concerned that some patients pay the price for physician training.
Medical student Kristen Heinan finds it hard to let go of what happens at the hospital when she's out in the "real world".
The Medical Blog Network has released HealthTrain, an Open Healthcare Manifesto. Part of HealthTrain's goal is to work toward a new "integrity standard" for healthcare open media, including blogs. As of 10/20/06 there were 32 signed supporters, including several bloggers represented in this edition of Grand Rounds.
Neonatal doc wonders why some women don't seem to mind sporting a moustache.
Summer Sethi reminds us that radiologists are in demand
Not My Second Opinion investigates porphyria, hypertrichosis, and lepromatous leprosy, with a nod to Halloween.
It's a Nursing Thing asks for suggestions on performing trach care without turning an already critically ill patient hypoxic.
Fruit of the Womb advocates a preconceptional visit to your Ob/Gyn since the best prenatal care begins before conception.
"Am I going to get well?" The Cheerful Oncologist does his best to answer.
Wandering Visitor wonders why with the possibility of developing a disease like Melanoma so many people are still baking on the beaches and going to tanning salons to look "healthy?"
Cancer Treatment & Survivorship addresses whether patients should discuss complementary & alternative therapies with their health care providers.
Diabetes Mine offers sound advice on the use of DexCom and Continuing Glucose Monitoring (CGM) in the management of diabetes.
Hospital Impact posts a patient letter, a daughter's thanks for the string quartet that played for her dying father in the hospital's palliative care unit.
Dr. Anonymous joins the Walmart Free Antibiotics discussion and reminds docs to have the courage to 'just say no' to unnecessary antibiotic prescriptions, and patients to hold back their wrath if they don't get the prescription they were hoping for.
InsureBlog jumps into the Walmart discussion with kudos to the retailer for establishing a low-cost generic prescription plan.
Health Business Blog, reporting from the Harvard Business School alumni health care conference, thinks the Biogen CEO talks sense when he discusses regaining our perspective on risk.
Dr. Enoch Choi of Tech Medicine chronicles of the woes of trying to appropriately immunize children while complying with recently passed California law.
UK Community Pharmacist opens a new blog with a post about documenting patient interventions.
Dr. Deborah Serani looks at the world-wide epidemic of school violence.
Teen Health 411 warns of the dangers of excessive web use by teens, and adds that maybe it's time we encourage them to interact with people in the community and make some friends the old-fashioned way.
Barbados Butterfly reflects on recent referrals; who needs sleep anyway?
Inside Surgery advises Stay off the roof! Falls are the second most common trauma fatality in the US in people aged 18 to 49 years of age.
Medicine for the Outdoors answers the question "should patients with head injury be kept awake?"
A Chronic Dose heads to the gym and confronts her own insecurities in the form of blond ambition.
The Fitness Fixer gives lessons in good stretching technique (forget lunge and lean.)
Stay tuned for next week's episode of Grand Rounds, hosted at The Rumors Were True. This week Topher compares learning a stack of stuff in medical school to eating a stack of pancakes every morning. I submit that hosting Grand Rounds is much the same - eat up! : )
Just who do you think you are?
I still remember how she looked as she hurled those angry words at me. It was a challenge intended to forcefully remind me that, in my co-worker's opinion at least, I had no right to question her actions.
In the years since that episode, I've asked myself that very question a number of times. Who do you think you are? It's a valid query, at least when it's not being aimed like a poison-tipped arrow.
I've discovered that when I think of myself as a creative, compassionate leader I act like a creative, compassionate leader, and therefore become more of a creative, compassionate leader. It's a pretty self-evident concept. No rocket science or brain surgery involved.
Who I think I am exerts a powerful influence over who I become.
Author James C. Hunter, (Servant Leadership) expressed it this way - we're not human beings, we're all human becomings.
Who will you become today?
Josh Dobbelstein drives as close to the middle of the road as he can. Over on the side... he knows the enemy hides bombs.
Just the other day he dove to the floor of a vehicle he was riding in when he mistook the sound of a trucker hitting his brakes for a machine gun.
They are the kinds of precautions that keep soldiers at war alive. But Dobbelstein left Iraq more than 16 months ago, and for him they are vestiges of a war he can't seem to shake.
CNN News reported this week on a clinic that helps veterans cope with the after-effects of war.
There is a lesson here for all of us. Sometimes people act irrationally for very rational reasons. When someone reacts in a manner we deem strange, it's good to consider that they may in fact be coping the best way they can with the after-effects of some unseen experience or trauma.
I tell this story from time to time to illustrate that point. It's not one of my proudest moments...
During the late 1980's I was an evening-shift Emergency Department patient registrar in a community hospital. You know, the person who unsympathetically demands your social security number, date of birth and insurance card shortly after you stumble through the door in pain, throwing up, bleeding and/or gasping for breath. I was pretty good at it. I entered data into the computer system efficiently, and managed to remain relatively calm while the poor patients suffered all the afore-mentioned woes.
There were patients I knew by name.
"Hi Mr. Jones, what seems to be the problem this evening?" (As opposed to say, three nights ago when you were here last.)
There were also patients that broke my heart.
The sixteen-month-old who toppled off a patient cart to the floor in one of the treatment rooms while her mother stood in the far corner shaking her head and saying "I'm not picking her up. I told her to sit still, maybe this will teach her to listen!" (Yes, Social Services was called in case you're wondering.)
The hollow-eyed parents of a teenager killed while driving home from school on a sunny Spring afternoon. The combination of too much speed and too little experience irrevocably changed their lives in one deadly instant.
One person remains vivid in my memory for a different reason.
He was Vietnamese, probably in his late twenties. He came in to provide information on a patient who had arrived by ambulance. Anyone who has ever worked in an ED knows that speed is of the essence when generating a computerized chart for a patient already undergoing emergency evaluation and treatment.
Suddenly, and for no reason that I could fathom at the time, he began speaking excitedly in Vietnamese. In apparent fear he jumped up and literally ran out of my office, and right out of the building. I was... perturbed. I stood there feeling quite aggravated, all the while picturing the ED nurses with their hands extended asking "What's taking so long? We need that chart!"
When he finally returned a few moments later and offered absolutely no explanation for his odd behavior I rather brusquely finished my task and ran the completed chart back to the waiting clinical staff.
Some time later that day that I figured it out.
His sudden agitation and run for the door coincided with the Life Flight helicopter landing just outside of the ED, a sound I was so used to it barely registered. Vietnam; helicopters; and someone who would have been a young, frightened boy in the late 60's or early 70's. How narrow my view of the world not to have grasped the connection sooner. 
I realized later that as soon as he watched the helicopter land he calmed down and came back into the building. As for offering an explanation, how does one explain fearing the sound of helicopters blades cutting through the air to someone who has never had reason to fear?
It's a lesson I won't forget.
It isn't often that attending a professional conference alters your perspective completely, but that's what happened to me a few years ago. It was an Ohio Association Medical Staff Services session that dealt with physician impairment.
What made this session noteworthy? In addition to the educational speakers from OPEP, several recovering physicians bravely faced an audience of medical staff credentialers (and we, as you may know, tend to be a cynical and suspicious lot; it's a job hazard) and told their stories. Each was at that moment 'clean and sober', some for a few months, others for many years, but each had a compelling, poignant, exceedingly human, story to tell.
I walked out of that room with far more understanding and compassion than I went in with.
My paradigm shift? It remains our responsibility to protect patients, but it is accompanied by an equal responsibility to extend help and care to afflicted practitioners. Not all will accept it, but evidence shows that a significant percentage will.
Consider this account. A resident was called in late one night to care for a patient because the attending had shown up at the hospital drunk. Concerned for the attending physician, the next day the resident approached a senior member of the medical staff and asked what could be done to help him.
"Don't worry about him," was the reply. "As soon as we get one more documented instance we're getting rid of him."
Of course, that documentation soon followed and the physician was dismissed from staff. Several months later he died from an alcohol overdose.
A valuable life carelessly tossed away.
About 15% of physicians will suffer from some form of addiction during their lives. However, those who receive treatment also have a phenomenal rate of recovery; they are intelligent, educated, and highly motivated. With treatment between 80 and 90 percent recover and learn to live sober.
As a conservative estimate at least 4% of your professional staff members are currently abusing alcohol, drugs, or both. Get educated. Find out how to help those who will accept help, and how to protect your patients from those who won't.
Federation of State Physician Health Programs
Ohio Physician Health Program
I've lived in the medical community for nearly thirty years. Nice place, although a bit chaotic at times, especially over on ED Street.
One of the features I like about the neighborhood is how many doctors and nurses show up at the block parties. I've always believed that people who are drawn to the care-giving professions are among society's elite. Besides, I can occasionally lean on the backyard fence and wheedle a bit of free medical advice.
However, I've come to understand my neighbors in a whole new light since the Community Center opened. It's a great gathering spot, very multi-cultural and high-tech; a bit of a 21st century coffee house. Friends and strangers gather to discuss the events of the day, read a story, or just quietly observe the spirited conversations swirling about them.
Although I've lived in the neighborhood for years, until the Community Center came along I didn't really comprehend the depth of compassion doctors often feel when their patients suffer. Or the intensity of their frustration when all the answers they have are bad, uncertain, or just plain scary. I didn't truly understand how much courage it takes to be a healer.
I've listened in as nurses share their stories filled with pain, tenderness, and humor. No one deals with life and death quite the way a nurse does. I flash back to a time when teary-eyed and frightened I held on for dear life to a nurse's hand. I don't know her name, but she has a permanent place in the scrapbook of my life.
Paramedics are the neighborhood heroes. While everyone else is tucked up somewhere at least relatively safe, they are out on the street, responding to the urgent calls of the sick and injured. They work under conditions that would make Hollywood special effects gurus cringe. They tend the ill, mend the injured, and soothe the panicked. We sleep better at night just knowing they're around. 
Thanks to all of you for contributing to the Community Center, and for sharing your wisdom, compassion and heart.
Strive not to be a success, but rather to be of value. ~ Albert Einstein
Proving once again that medicine is a tough field... A new web site allows the public to rate and comment about doctors online; RateMDs.com. The site claims that as of today 20,379 physicians have been rated, with 74 new ones added yesterday. Developers assert that the site is changing the way the world looks at medicine by providing patients with the unique opportunity to rate and read about their doctors.
Those who post ratings and comments do so anonymously, and each physician listed gets an overall rating expressed in the form of a smiling, frowning, or neutral icon.
The FAQs note that 'comments should be about professional ability. New ratings are reviewed, and we reserve the right to delete comments or an entire rating.' To the question 'I'm a doctor. How do I get my name removed from your site? The response is ' The short answer is, you don't.''
The potential for abuse is obvious given that posters may remain anonymous. On the other hand, if posters had to list their names few negative comments would ever get added.
I looked up a couple of different physicians I know, one rated positively one negatively; and I have to say that the comments accurately reflected my personal views and experience. 
In reality, this is just a modernized version of "word of mouth" advertising, with the catch being that we have no way of knowing anything about the credibility of "the mouth."
This site, or others like it that follow, will no doubt begin to be checked as part of a routine credentialing process, so the implications to healthcare providers are considerable.
Aggravated DocSurg is living up to his name today - he's really quite aggravated. The target of his wrath is the Joint Commission on Accreditation of Healthcare Organizations. He labels them The Death Star of American Medicine. Medpundit and Bard Parker have joined in the fray.
As a veteran of many encounters with JCAHO surveyors over the years, I feel I must take issue with some of the statements made by my aggrieved fellow-blogger.
Watching hospital administrators lose bowel and bladder control the minute a JCAHO inspection is brought up has always reminded me of Vader's underlings wilting in his presence..What is most galling to me, however, is that hospitals must fork over a hefty sum for these frequent torture sessions, and the inspections are done not by practicing physicians or nurses, but by folks who long ago gave up the difficulties of actually caring for patients for the safety of a clipboard to hide behind.
We agree; the Joint Commission is powerful. Accreditation is voluntary, but pity the reputation and finances of the poor institution that fares badly on a survey. However, while many surveyors have retired from active practice, a number have not. For those who have, I doubt they've forgotten all 'the difficulties of caring for patients.'
A hospital that wishes to bill federal programs may choose to be inspected by the government, in the form of CMS surveyors, instead of JCAHO. Can't say I've had that pleasure, but some of my colleagues have reported that a JCAHO survey is far less painful. There's also a potential new player on the horizon in the form of TÜV Healthcare Specialists.
My experience with JCAHO accreditation is based primarily on hospital compliance with Medical Staff and Leadership standards. Understanding and implementing those standards is a challenge; many of them are inconvenient and expensive. It is for that very reason that healthcare needs accrediting bodies. Hospital leaders aren't overly fond of inconvenient and expensive standards. If no one was "looking over their shoulders" some standards would simply be ignored.
Case in point. Several years ago I did consulting for a number of different hospitals. The first day at one of them an administrator I met told me to work on temporary privileges for a surgeon who was at that very moment, in the OR. No records, no verification of credentials, no screening, but in the OR performing surgery nonetheless. Turns out this was not an isolated occurrence. When I vigorously argued about this practice, the administrator's response was that it was his job to bring in money to help keep the hospital financially solvent, it was my job to worry about credentials.
Thanks to a team of Joint Commission surveyors, that practice came to an abrupt end, thank you very much.
Joint Commission accreditation is a far from perfect process. My biggest complaint over the years has been that survey focus is often surveyor dependent. Some surveyors have "pet" standards which they focus on to the exclusion of others. That seems to be less of a concern with the recent change to tracer methodology, where patients are "traced" through the facility.
So my Aggravated friend, there is another side to this story. Resistance may not be futile, but sometimes it's just not healthy.
The JCAHO mantra can really be translated as "Resistance is futile. You will be assimilated!" As a result, I suppose JCAHO is really The Borg.
Technorati tag: JCAHO
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
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