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)
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
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.
And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
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.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
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.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
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.
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.
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.
Mike Aref, MD, PhD, FACP, 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.
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.
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.
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.
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.
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.
Elaine Schattner, MD, FACP, 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.
Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
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).
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
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.
The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.
Technology in (Medical)
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.
Peter A. Lipson,
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.
Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.
Other blogs of note:
American Journal of
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.
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.
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.
The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.