Tuesday, February 16, 2010
Grand Rounds: Welcome to the hospital
Good morning! You made it to our hospital's auditorium in time for Grand Rounds. I'm your attending physician. Before we visit the patients, we'll start with a few biology lectures. I hope you retain this information when we move on to teaching rounds.
For example, most of us need to know more about what chronic pain is and how to treat it. It's a very different beast than acute pain, but the subject wasn't taught enough while you were in med school. How to cope with pain is an important lesson.
Also important are the three biggies you'll see in patients this morning, and I mean biggies literally: obesity, diabetes and hypertension. We're seeing more and more of these disorders in the wards, and another of your instructors this morning, Joel Topf, MD, will tell you that the increase in fructose consumption is driving this.
Some of the patients you'll be seeing later this morning have Alzheimer's disease. It's a shame, but take note: Fewer patients in this group develop cancer than the rest of the population. It seems strange until you realize how Alzheimer's and cancer are related at the cellular level. Diana Gitig, PhD, earned her degree in cell biology and genetics from Cornell and has all the research for you.
Patients can get psychological benefit just by having the tools to handle their physical ailments. Professor Ves Dimov, ACP Member, tells us that in patients with a nut allergy, for example, an EpiPen can reduce daily anxiety as well as potentially save a life.
For our last lecture of the morning, medical librarian Laika Spoetnik assembled the literature examining chronic fatigue and a novel theory behind its origins--the human virus XRMV. She's digested the peer-review literature for you. And you should thank her for that, because it's a lot to learn.
Now, we'll head to the wards for teaching rounds. This way, please.
Try to keep a straight face with this next patient, a fisherman who got a fishbone lodged in his elbow while preparing his catch for the market. Our Captain Ahab got admitted for fluoroscopy-guided removal, and his arm--if not his ego--is now recovering nicely.
This next patient will remind you why you went into medicine. She drove herself to the doctor and got admitted with congestive heart failure, but could only think about her sick husband at home. As you'll see when we walk in, illness and old age are no match for true love.
Our last patient is ready to leave today, so we're going to practice some Bi-directional, Concordant Discourse to make sure she follows her discharge orders. In a nutshell: She'll talk, I'll listen.
It's usually pretty obvious when you need to call in a neurologist or cardiologist for an urgent consult with a patient. But what exactly constitutes a psychiatric emergency? Shrink Rap gives us the 411 on mental illness 911s.
Our next stop is the outpatient clinic. Our first patient, Fibro World, has found a new method for dealing with her chronic pain. She imagined that she was swimming out to rescue her mother from an iceberg and found that the visualization lessened her discomfort.
Next up, we have a mother who's concerned that parenthood is causing her to gain weight. Not to worry, says InsureBlog, since a recent study found that mothers may gain more weight than their peers, but childless wives and even single women pack on the pounds, too.
Just off the ambulatory care clinic is our rehab department. Not all exercise is always good exercise, and that includes yoga. Jolie Bookspan details the problems that some yoga poses can cause, even when done correctly.
If you're tired from all the rounds, stop on by the physician's lounge. In the unlikely event that you smoke, you might want to steer clear of the Happy Hospitalist. Or offer him a surgical mask or a peppermint, his preferred methods of protection from the smell of a cigarette smoker.
The other docs in here aren't avoiding you; they're just busy cross-posting on each other's blogs and revising the settings on their Twitter pages, as the Clinical Cases and Images: CasesBlog explains.
But Dr. Nancy Brown, over here at Teen Health 411, wishes they would step away from the computer and set a good example by limiting non-work screen time to two hours a day. If that's too much of a hardship, at least try working out while watching TV.
Swapping tales in the doctor's lounge is one thing, but writing about patients in a public forum is a different matter. Some important advice? Change identifying characteristics, let some time pass, and stay respectful.
Before you leave for the day, stop by the administrative wing. If you're going to practice medicine in a hospital, you'll have to learn these lessons, too.
One of the points of contention in discussions of health care reform is deciding how health care resources are spent. One doctor's call for more judicious utilization of tests could be another doctor's rationing of care. Louise, our insurance insider, discusses both sides of the argument.
In our legal department, David Harlow is talking to Cyndy Nayer and Wayne Burton, FACP, from the Center for Health Value Innovation, about improving health and outcomes.
Also present in the administrative wing is our hospital ombudsman, who's listening to one family's struggle to navigate bureaucratic hurdles and get the proper treatment and diagnosis for a loved one.
OK, that's a lot for one day. I hope we didn't scare you away from hospital medicine. As a matter of fact, I hope to see you back here more often. Any questions or comments? There's a button for them below.
(Written by the ACP Hospitalist staff: Jessica Berthold, Stacey Butterfield, Ryan DuBosar and Jennifer Kearney-Strouse)
Labels: Alzheimer's, diabetes, hospital medicine, hypertension, obesity, pain management, patient communication
posted by Ryan DuBosar at
7:00 AM
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Send comments to ACP Hospitalist staff at acphospitalist@acponline.org.
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Blog log
Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:
Albert
Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the
University of California, Los Angeles School of Medicine, where he
also did his internal medicine training. Certified by the American
Board of Internal Medicine, Dr. Fuchs spent three years as a
full-time faculty member at UCLA School of Medicine before opening
his private practice in Beverly Hills in 2000.
Zackary
Berger
Zackary Berger, MD, ACP Member, is a primary care
doctor and general internist in the Division of General Internal
Medicine at Johns Hopkins. His research interests include
doctor-patient communication, bioethics, and systematic reviews.
CasesBlog
Ves
Dimov, MD, ACP Member, is an allergist/immunologist and Assistant
Professor of Medicine and Pediatrics at the University of Chicago,
where he evaluates and treats both pediatric and adult patients.
David
Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally
renowned authority on nutrition, weight management, and the
prevention of chronic disease, and an internationally recognized
leader in integrative medicine and patient-centered care.
db's
Medical Rants
Robert M. Centor, MD, FACP,
contributes short essays contemplating medicine and the health care
system.
DrDialogue
Juliet
K. Mavromatis, MD, FACP, provides a conversation about health topics
for patients and health professionals.
Dr.
Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal
medicine for more than a decade and is an Associate Professor of
Medicine at an academic medical center on the East Coast. His time is
split between teaching medical students and residents, and caring for
patients.
Everything
Health
Toni Brayer, MD, FACP, blogs about the rapid
changes in science, medicine, health and healing in the 21st century.
FutureDocs
Vineet
Arora, MD, FACP, is Associate Program Director for the Internal
Medicine Residency and Assistant Dean of Scholarship & Discovery
at the Pritzker School of Medicine for the University of Chicago. Her
education and research focus is on resident duty hours, patient
handoffs, medical professionalism, and quality of hospital care. She
is also an academic hospitalist.
Glass
Hospital
John H. Schumann, MD, FACP, provides
transparency on the workings of medical practice and the complexities
of hospital care, illuminates the emotional and cognitive aspects of
caregiving and decision-making from the perspective of an active
primary care physician, and offers behind-the-scenes portraits of
hospital sanctums and the people who inhabit them.
Gut
Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist
at the University of North Carolina School of Medicine, and the
Program Director for the GI & Hepatology Fellowship Program. He
specializes in diseases of the esophagus, with a strong interest in
the diagnosis and treatment of patients who have difficult-to-manage
esophageal problems such as refractory GERD, heartburn, and chest
pain.
I'm
dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic
hospitalist with an interest in basic and clinical science and
education, with interests in noninvasive monitoring and diagnostic
testing using novel bedside imaging modalities, diagnostic reasoning,
medical informatics, new medical education modalities, pre-code/code
management, palliative care, patient-physician communication, quality
improvement, and quantitative biomedical imaging.
Informatics
Professor
William Hersh, MD, FACP, Professor and Chair,
Department of Medical Informatics & Clinical Epidemiology, Oregon
Health & Science University, posts his thoughts on various topics
related to biomedical and health informatics.
Just
Oncology
Richard Just, MD, ACP Member, has 36 years in
clinical practice of hematology and medical oncology. His blog is a
joint publication with Gregg Masters, MPH.
KevinMD
Kevin
Pho, MD, ACP Member, offers one of the Web's definitive sites for
influential health commentary.
MD
Whistleblower
Michael Kirsch, MD, FACP, addresses
the joys and challenges of medical practice, including controversies
in the doctor-patient relationship, medical ethics and measuring
medical quality. When he's not writing, he's performing
colonoscopies.
Medical
Lessons
Elaine Schattner, MD, ACP Member, shares
her ideas on education, ethics in medicine, health care news and
culture. Her views on medicine are informed by her past experiences
in caring for patients, as a researcher in cancer immunology, and as
a patient who's had breast cancer.
More
Musings
Rob Lamberts, MD, ACP Member, a med-peds and general
practice internist, returns with "volume 2" of his personal
musings about medicine, life, armadillos and Sasquatch at More
Musings (of a Distractible Kind).
Musing
of an Internist
Justin Penn, MD, ACP Associate Member,
attended medical school at the University of Washington School of
Medicine and trained in internal medicine at the University of
Rochester, where he is serving as Chief Resident.
Prescriptions
David
M. Sack, MD, FACP, practices general gastroenterology at a small
community hospital in Connecticut. His blog is a series of musings on
medicine, medical care, the health care system and medical ethics, in
no particular order.
Reflections
of a Grady Doctor
Kimberly Manning, MD, FACP,
reflects on the personal side of being a doctor in a community
hospital in Atlanta.
Technology
in (Medical) Education
Neil Mehta, MBBS, MS, FACP,
is interested in use of technology in education, social media and
networking, practice management and evidence-based medicine tools,
personal information and knowledge management.
White
Coat Underground
Peter A. Lipson, MD, ACP Member, is a
practicing internist and teaching physician in Southeast Michigan.
The blog, which has been around in various forms since 2007, offers
musings on the intersection of science, medicine, and culture.
Other blogs of note:
American
Journal of Medicine
Also known as the Green
Journal, the American Journal of Medicine publishes original clinical
articles of interest to physicians in internal medicine and its
subspecialities, both in academia and community-based practice.
Clinical
Correlations
A collaborative medical blog started
by Neil Shapiro, MD, ACP Member, associate program director at New
York University Medical Center's internal medicine residency program.
Faculty, residents and students contribute case studies, mystery
quizzes, news, commentary and more.
Interact
MD
Michael Benjamin, MD, ACP member, doesn't accept
industry money so he can create an independent, clinician-reviewed
space on the Internet for physicians to report and comment on the
medical news of the day.
PLoS
Blog
The Public Library of Science's open access
materials include a blog.
White
Coat Rants
One of the most popular anonymous blogs
written by an emergency room physician.
6 Comments:
Nicely done! Thanks so much for hosting.
Nice job, guys!
Thanks for hosting, and for including our post.
Great job. Happy
A Grand Round as a Grand Round should be (literally). Nicely done. Thanks.
I really liked your presentation of both doctor and patient perspectives - well-balanced and informative. Thank you for a great edition!
A great presentation with a lot of well-written posts, thank you! I like the clarity of how you presented the ideas without the added confusion of explicit sources.
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