Doctoring Health Care Reform

Grand Rounds, December 14th 2010

Hey all.

Welcome to another edition of Grand Rounds, a collection of writings from medical bloggers, the world-wide.

Here are this week’s posts, collated into four chapters, with just a little commentary and a few selected images.

Chapter 1:  Good Doctoring:

—From the poetic Examining Room of Dr Charles, comes the imagery of a doctor’s blood on a patient’s chart. 

“It is a poem, punctuated with living iron and crimson flourish. Despite having made poor eye contact in an attempt to distance and strengthen my consideration of his symptoms, ironically I see the commonality of our bleeding. 

—The Bedside Manners blog, authored by Julie Rosen, summarizes some simple–yet, in our present-day healthcare system, not always easy to attain–tenets of compassionate doctoring. Things like good communication skills, empathy, medical education (especially for middle-aged doctors), and my personal favorite: that we should practice minimally disruptive medicine.  Amen to this feast of common sense.  Compassionate doctoring equals good doctoring.

—Dr Elaine Schattner, author of the Medical Lessons blog writes about the importance of informed consent. Specifically, she highlights the concept of therapeutic misconception–the false belief that a treatment is more valuable than it really is. And what better example could one find than squishing (chronic) blockages in the coronary arteries.   
Good doctoring mandates that our patients understand the entire plan: the risks, the (non-exaggerated) benefits, the expectations, and the alternatives. This isn’t always easy. It requires a three-pronged formula: a well-grounded and informed doctor, an engaged patient and ample time for discussion.  A medical shrangri-la?
—Dr @JediPD, a medical oncologist, and author of the Arts, Sciences and Medicine blog writes beautifully about what it means to be a physician.  Here is an example of how he describes the privilege of caring for others: 

…Patients are like butterflies caught in a gale, confused, frightened and totally overwhelmed. To sooth, to heal and to allow them to circumnavigate the jagged rocks and swirling deep pools of nature’s wrath is hallowed ground.

Wow! Those words are way out of a cardiologist’s league.

—One of the best ways to know something well is to teach it.  Dr Chris Chang from the blog of the Fauquir ENT Consultants of Virginia writes about why he keeps a blog.  His first reason is that it keeps him highly informed.  No doubt about that.  Could we bloggers get some CME credit, please?

—Steve Wilkins, author of the blog Mind the Gap, believes that–in helping patients make wise health choices–doctors have a powerful voice.  He argues that how we deliver the message is important.

Like in the example of this patient:  He is a 50 year-old healthy man, well-known for his doctor-avoidance personality.  I found it surprising when he told me he was scheduled for a screening colonoscopy.  Why?  Because his doctor strongly recommended it. Yes, such persuasiveness might work for colonoscopy screening, but…Steve…would it also work for donut and potato-chip restriction for the prevention of heart disease?

—What is a prevention strategy, asks the Colorado Health Insurance Insider blog. Following up on Dr Lucy Hornstein’s popular KevinMD post, they ask whether present-day prevention-testing represents a true prevention strategy.  I get that concept: Heart disease is prevented by healthy behaviors, not by detecting a blockage on a stress test. Right?

—Most really good doctors I know regularly attend national meetings. Interacting with colleagues surely makes us more skilled clinicians. This entry from the Doctors’ Rheum blog describes the fulfilling post-meeting sensations. Why would doctors feel so good after a productive week of learning? Because we think it will make us better, and most doctors hang a lot (of their self-esteem) on the doctoring peg.

—Finally, the Happy Hospitalist correctly observes that the more letters one lists after their name, the less helpful they are likely to be.  Is this because, more often than not, those-with-many-letters are better at multiple-choice tests than they are at mastering the obvious?  

Chapter 2: Healthcare Policy and EMR

—DrRich, author of the Covert Rationing blog describes yet another checklist item required of primary care doctors.  No doubt, the take-the-fun-out-of-doctoring people are running amok.  Few authors detail the farcical nature of excessive regulation and disingenuousness of most ‘rule-makers’ better than DrRich. Three cheers for DrRich!  Keep it up, sir.

—Some of the pessimistic think-tank cubicle people would have us believe that our healthcare system is broken.  Hank Stern’s Insurblog presents an upbeat video that looks at modern-day medicine from high above the clouds–a historical view.  From that vantage point, our healthcare system looks really good.

—In their QD: News Every Day piece, the ACP Internist blog provides a nice summary of up-to-date healthcare reform issues.  It’s a highly informative piece, but I have to take issue with their unapproved abbreviation, QD. Don’t they know that in the eyes of the quality-people, no amount of good doctoring can overcome a single unapproved abbreviation.

—On the future power of EMR, David Harlow, a health care lawyer and author of the HealthBlawg, may be somewhat of a dreamer.  In chronicling the recent story of how Facebook saved a person’s life, he suggests that patients

…”should be able to enter [health] information — either automatically, through connected health devices or mobile health tools, or manually — through patient portals that link to our electronic health records and generate alerts, when warranted, for our clinicians.”

Given that most doctors are still not using EMR, and that EMRs can’t talk with each other, his wish is futuristic, to say the least.  Is he suggesting a ‘Facebook’ of medical records?  Hey, wait a minute, could that work?

—Jon Mertz, from the HL7 Standards EHR blog, compares a good EMR to the MINT method of financial management.  Yes. Yes.  I would love an EMR that did all that.

Chapter 3  Gratitude, Positive-thinking, and a Healthy Heart:

—Jackie Fox. breast cancer survivor, book author, and owner of the Dispatch from Second Base blog, writes about her second blog-iversary. Don’t let that grin-causing blog title fool you.  Her blog is yet another example of how social media is beaming with useful, practical, and humanistic information. Thanks, Jackie.  Humor and education are not mutually exclusive.

—Dr Ves Dimov, author of the impossibly prolific, Clinical Cases and Images blog sent in his review of an interesting study on the characteristics of lucky people.  As bike racers will attest, luck is not all that arbitrary. Seeing the glass as half-full is not only a heart-healthy behavior, but Dr Ves’ review suggests that taking a consistently positive outlook may also improve your luck.

—On his blog, Kent Bottles Private Views, Dr Bottles champions the benefits of gratitude. In a review article-like format, Dr Bottles lays out ample evidence for the health virtues of gratitude. How much you wanna bet that grateful people have better endothelial function and less sticky platelets?

—Barbara Kivowitz, author of the blog, In Sickness and in Health, provides a compelling real-life insight into the benefits of companionship in dealing with illness. Chronic heart disease patients can surprise you with their resilience. They can defy their echocardiograms or angiograms. More times than not, these ‘medical-miracles’ come to the office with a devoted loved one; they are not alone in their illness. Coincidence?  I think not.

Chapter 4:  Useful and Informative:

—Dr Val Jones, chief of the Grand Rounds host site, Better Health, writes about the nonsense of plasti-phobia.  As she points out, when a glass of milk has 1000 times the potential estrogenic effect of BPA;  a cup of coffee introduces a thousand chemicals into the body; and even the wholesome apple exposes us to acetaldehyde and formaldehyde, worrying about drinking from plastic bottles seems a bit incongruent.

—Dr Ramona Bates, author of the Suture for a Living blog reviews an interesting article about the cost of risk aversion.  Should surgical specimens with an infinitesimally small risk of pathology always get reviewed by a pathologist?  And if so, who should pay?

—Think blogging is safer than bike racing?  The How to Cope with Pain blog informs us of a potential blogging malady.  No, it’s not compulsive personality disorder, rather, Carpel Tunnel Syndrome.


That’s it folks.  It was fun.  Back to winter.

Be sure to check out next week’s Grand Rounds at the Chronic Babe blog.

You can also follow Grand Rounds on Twitter or Facebook.



I would like to take this opportunity to vigorously thank those who have helped me.  Thanks for the links, the RTs and for patiently answering my stupid questions.

For the warm images of flowers, thanks go to frequent commenter, friend and chief master of the obvious, RDB.

11 replies on “Grand Rounds, December 14th 2010”

Super job, Dr John!

Thanks for hosting, and for including our post.

And I agree with Dr Wes – the pics really compliment the entries.

By the way, your friend who got the colonoscopy inspired a follow up post. Just as research shows that people are more likely to get preventive screenings as a result of strong advocacy from their personal doc, the same appears to be true with exercise and nutrition.

In fact I go so far as suggesting that maybe the real challenge isn't patient health behavior so much as it is ineffective physician-patient communications.

Excellent work! I enjoyed reading it. Thank you for the inclusion. Looking forward to your second hosting of Grand Rounds in 2011… 🙂

Thank you so much for including my blog. You were a great host and got some wonderful entries. I can't wait to dig in! -Jackie Fox

Great entries and smooth flow to these rounds. Way to go!

Is it just me or is there a greater-than-usual amount of Introspection each December?!

Comments are closed.