Grand Rounds Vol. 5 No. 13

Grand Rounds Vol. 5 No. 13: The Best of 2008

It’s the time of year when the “Best of ” lists start popping up everywhere. As a writer, I pay the most attention to the holiday book lists and that is where I got the inspiration for this edition’s theme. Quality writing is a gift to everyone who reads it, so I challenged the medical blogosphere to send me the best writing of the year–the funniest, most poignant, most controversial, etc. What follows are the Best Posts of 2008, as selected by each of the 49 bloggers who submitted to this week’s Rounds.

(*= Editor’s Choice. Think of these posts as the best of the “Best Of…”)

Best of Health Practice
The way doctors, nurses, and other health care professionals interact with patients and with each other, the way our bodies interact with the environment around us, the way the health care system interacts with emerging technology—these are just some of the topics covered in the Health Practice category. There was a lot of wisdom passed around in 2008.

*Kim at Emergiblog offers a post on empathy she is particularly proud of—and once I read it, I could see why. A must-read, indeed.

*Doc Gurley chose “How To Break Bad News,” thinking its message would appeal to new readers. I have to agree, and I’ll add that its content is important for everyone.

*The Happy Hospitalist describes what a real life Code Blue resuscitation is like in “Don’t You Dare Touch Me.” When you read it, you’ll understand why.

Canadian Medicine is most proud of this post about the dangers of anonymous blogging. It’s an extremely relevant topic for everyone involved in medical blogging, and a great treatment of it.

Notes of Anesthesioboist discusses Code Indigo. Not sure what that means? Be sure to read this powerful post.

Medicine for the Outdoors considers this post on the environment to be the most important subject matter covered on his blog all year. His explanation of why is thoughtful and detailed.

Other Things Amanzi describes a textbook case that is anything but usual.

Clinical Cases and Images Blog asks, “How Should Hospitals Use Twitter?” It’s a good question, so make sure you catch up on the conversation.

Allergy Notes continues with the theme of Twitter as quite the hot topic in 2008 in the post Allergy and Immunology Journal Club on Twitter.

Dr. Shock ponders if psychiatrists should wear white coats. According to one study, 96% percent of patients preferred their psychiatrist sans white coats. Do you agree?

Sharp Brains sends along “Art Kramer on Why We Need Walking Book Clubs,” where they discuss how emerging brain research areas are going to have a major impact on our lives in the next 5-10 years.

Teen Health 411 suggests a recent post about developmental assets and teens, calling it “the closest thing to a guidebook for conscious parenting I have ever seen.”

Receiving shares an interview with Dr. Lewis Goldfrank, a world-renowned emergency physician and toxicologist who is dedicated to social justice and human rights.

The Angry Medic learns from a patient that really, some wounds never heal.

Neuroanthropology writes about
Our Blessed Lady of the Cerebellum, a compelling story of personal, medical, and political drama.

Dethmama Chronicles offers the story of a daughter’s last act of love and respect for her mother in “Joie de Vivre et Madame M.”

Leslie at Getting Closer to Myself explores the emotional impact of chronic illness and questions the concept of “First Do No Harm.”

Lyrehca at Managing the Sweetness Within deals with the best way to treat insulin reactions. She’s a diabetes veteran, so she would know.

Aequanimitas discusses the unique qualities of elite alpinists in “Achieving Impossible Heights.” Check out what it takes for yourself.

ACP Internist tells us that alternative medicine use holds steady at more than 1 in 3 Americans. This post follows up a topic that is occurring more and more frequently in the communication from patient to doctor.

Laika’s MedLibLog describes the difficult concept of randomized controlled trials in an easy to understand manner.

The Fitness Fixer offers innovation in abdominal muscles, saying this post was one that directly quickly stopped the source of chronic back pain for many people who wrongly thought they had to tighten or strengthen abs to stop back pain.

Best of Health Policy
As you know, 2008 was a busy year in the world of health care policy—the recent presidential campaign certainly added more urgency to important conversations about health care reform, health insurance, and other issues surrounding health care delivery.

*Mind, Soul, and Body writes an impassioned response to where the path of blaming patients for their illness will always lead in “Those People.”

*Mike Feehan at InsureBlog thinks many people mix up health care and health insurance—and he’s here to set the record straight. (I love a good semantics discussion…)

David Harlow of HealthBlawg tells us that
ambulance diversions will soon be banned in MA and explains how overcrowding factors into this decision. Be sure to read miss his interesting interview with Alasdair Conn, MD, Chief of Emergency Services at Massachusetts General Hospital.

David E. Williams of Health Business Blog asks an important question to think about as we move forward: Generic Biologics –or Me Too Drugs 2.0?

Duncan Cross has a decisive answer for why health insurance is tied to jobs.

Survive the Journey shares some good ideas on how to address the primary care physician shortage in “Dear Doctor, I Can Help.”

Louise at Colorado Health Insurance Insider stirs up some dialogue when writing about the affordability of health insurance.

Best of Health Humor
Even weighty topics warrant a good dose of humor, and I’m pleased to see a little snark, some (not so) subtle sarcasm, and the occasional silly story come through in 2008.

*Barbara K at In Sickness and In Health likes the idea of starting the year with a laugh and offers “A Conversation Overheard in a Waiting Room.” Since I live in the Boston area, I could really relate.

How To Cope With Pain takes a break from more serious topics in chronic management and gives us a
humorous look at invisible illness
courtesy of “I Can Haz Cheezburger” photos.

*The Week is used to medical school rejections, but one in particular came from Drexel many weeks into the academic school year: “As if I was on the edge of my seat thinking they would accept me after classes began!”

At Sutures for a Living we hear what it’s like to have “one of those days” in the post “Mama said there’d be days like this.”

Dr. Val offers some Christmas humor in “The Christmas Miracle.”

Shrink Rap keeps up with the holiday theme, offering an edgy piece about gifts.

Dean Moyer of The Back Pain Blog offers some tips for avoiding injury in
Back Pain and Anger
. And for what it’s worth, kicking a fire hydrant isn’t one of them.

Covert Rationing Blog sends along
“How To Think About the Obesity Dividend,” saying that “my usual ironic voice was misinterpreted here by more than a few. While it is probably a sign of my own pathology, I always enjoy it when that happens.”

Best of Health Inspiration
Attitude is an important part of living with medical conditions, and the following posts offer insights and experiences that uplift, entertain, or motivate.

*Rosalind Joffe at Working With Chronic Illness thinks fighting illness is the wrong approach. Check out her reasons why.

*Kerri at Six Until Me writes about her wedding day, the best thing that happened to her in 2008. It’s written “with love in mind and with diabetes in mind.”

Jenni at ChronicBabe says she wants to be a turtle, which she calls “the concept of carrying your positive self everywhere with you; the times when things are hardest and you just want to pull your head inside your shell; and the benefit of going slow and steady – pacing yourself.”

Adventures of a Funky Heart! says you can’t help but getting “fired up” about all the things that are coming in the Congenital Heart Health field when you sit down and talk with Amy Verstappen, President of the Adult Congenital Heart Association.

Rachel at Rachel’s Diabetes Tales is getting back into the exercise groove a few weeks early. Who needs to wait for New Year’s resolutions?

Chocolate, Music and Hope offers “Hair Today, Gone Tomorrow: Learning to Accept Disability,” saying it is “the most meaningful post I have written to me because it really marks how far I have come in learning to accept my disability…”

In “All Souls,” Writing and Healing responds to a patient’s death and learns firsthand how reflective writing can bring clarity, release and a profound gratitude for simply knowing the patient.

Day of the Doc remembers all the veterans in our country and poses a heartfelt and educational discussion of PTSD.

Lastly, Emerald Arts gives us inspiration of the visual persuasion. Check out her post in photos chronicling a day at the beach.

Best of Health Debut
Since 2008 was my debut year as well, I can relate to what it feels like to put yourself out there for the first time. The bloggers who sent the following posts have never submitted to Grand Rounds before, but took the plunge and shared their estimation of 2008’s best posts. Welcome!

Genevieve at Spit Happens has a rare form of cystic fibrosis coupled with bronchiectasis (a girl after my own heart with those diagnoses). In this post on chronic illness and relationships, she discusses the downside of being a passionate fighter—and no, she’s not crazy.

Living in the Midwest knows the low point chronic illnesses can bring a patient to—and wants to confront it directly and honestly.

My Journey from Nurse to Doctorshares what happens when a mentor is anything but in “How Things Change.”

Thank you to everyone who submitted posts and made the Best of 2008 possible. Highlight Health will host next week’s edition.

Grand Rounds Vol. 5 No. 13: Call for Submissions

It seems fitting that I started out the semester hosting Grand Rounds and am finishing out the semester with another edition at A Chronic Dose on Tuesday, December 16th.

It’s hard not to get thematic during the holiday season, and at first I thought about using “Gifts” as the common thread for submissions. But I’m knee-deep in “Best of 2008” book lists, and it occurred to me that for writers and readers, quality writing truly is a gift. So, please send along what you think is your “best” post of the year…and why. Whether it’s your funniest post, the one that was the hardest to write or stirred up the most dialogue, or touched on a topic that really matters to you, etc, I want to see it.

Please send them to laurieDOTedwardsATgmail.com by 11 pm on Sunday, Dec. 14th and put “Grand Rounds” in the subject line.

Thanks, and I look forward to reading your entries!

Narrative Medicine: Better Doctors, Better Patients?

One of the best classes I’ve ever taught—and by “best” I mean the most interesting, engaging, and rewarding, the class I learned the most from as an instructor—was a writing course for pre-med and health sciences students. It was called “Constructions of Health in Contemporary Literature” and it contained various essays from physicians, writers, and patients about illness, healing, social justice, etc. I was so fortunate to have the chance to read these types of works with a class of future health professionals and see the way they responded to these personal stories and how their readings might inform their identities as they develop their careers.

Of course, physician-writers are hugely popular outside the classroom; the best-selling work of authors like Atul Gawande and Jerome Groopman are probably the most well known examples of this. Narrative medicine is an important topic (now more than ever, I would argue), which is why I was so pleased to come across Dr. Pauline Chen’s article on combining literature and medicine on Tara Parker-Pope’s Well blog in the New York Times.

Among other things, the article discussed how incorporating literature and writing workshops during residency can help doctors view patients with more empathy and compassion—and by extension, it can help them provide better care. It is no easy thing for the well to be able to understand what it feels like to be sick, and no insignificant thing when doctors can do this. As a patient, I am encouraged by programs that incorporate literature and medicine and as a writer I am appreciative of the value others see in studying these works.

Perhaps it is from the dual point of view that I see another strong benefit to narrative medicine beyond fostering more empathy and compassion in doctors: I think it makes us better patients, too. It is useful for me to see the other perspectives, the thoughts and fears and reflections of the people charged with healing (not curing) me. I hope it makes me more understanding and more open-minded, too.

Between writing about illness, living with it, and teaching it for a living, I’ve done my fair share of reading. Here’s a short list of some of the best examples of both narrative medicine and all-around riveting health writing I’ve found:

A Life in Medicine: A Literary Anthology, edited by Dr. Robert Coles and Randy Testa. I’ve used this book as a basis for undergrad and grad classes and have even given it as a gift. It’s a great mix of classic and contemporary pieces.

The Tyranny of the Normal: An Anthology (Literature and Medicine, Vol 2), edited by Carol C. Donley and Sheryl Buckley. An interesting combination of scholarly and personal essays and poetry on illness and disability.

Complications: A Surgeon’s Notes on an Imperfect Science, by Dr. Atul Gawande.

How Doctors Think, by Dr. Jerome Groopman. I loved this book so much and it made me think about so many things that I quoted it in my own book when discussing the doctor-patient relationship.

Mountains Beyond Mountains: The Quest of Paul Farmer, a Man Who Would Cure the World, by Tracy Kidder. I was originally assigned this book in graduate school, where the obsession began. It is one of my favorite books of all time, and one I recommend to students, family, and friends every chance I get.

The Spirit Catches You and You Fall Down, by Anne Fadiman. An utterly engrossing and emotional narrative about one family’s quest to cure their daughter and what happens when Western medicine and other cultural ideals and norms clash. I’ve used excerpts of this in classes and recommend it to everyone.

Illness as Metaphor and AIDS and Its Metaphors, by Susan Sontag. Every time I read it and teach it I come away with something new.

Have you enjoyed any of these titles? Have any more to suggest? I am always on the lookout for new material!

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Speaking of writing about medicine, another fantastic edition of Grand Rounds is up today at Emergiblog. Check it out!

Politics, Sports…and Chronic Illness?

I try to stay on point in my writing on this blog, exploring universal issues of living with chronic illness and discussing new research, policy, or insights from other writers and bloggers. But sometimes, personal interests and public issues intersect, and there’s been a lot of that happening lately.

I don’t usually stray into political leanings, but when it’s an election year and presidential health care policies have the potential to impact so many lives, how can I not write about the importance of the female vote when it comes to health care?

Similarly, I don’t usually write about sports. Now, I’m by no means an athlete—remember, I’ve broken fingers typing before, so you can imagine what an awesome combination me and a basketball court made—but I grew up with two older brothers so sports have been part of my life for as long as I can remember. I mean, I went to hockey, baseball, and football games before I was old enough for nursery school.

Plus, when you live in Boston, you can’t escape fan fever. Clearly Sunday’s game was a tough one for Red Sox nation, (though the Monday night football with the Patriots cheered us up somewhat) and the series with the Tampa Bay Rays was an emotional rollercoaster.

Why bring up a painful loss? Because while rooting for my team, I had the chance to watch Rocco Baldelli hit for the Rays. This spring, after a lot of tests and some tough symptoms to piece together, Baldelli was diagnosed with mitochondrial disease, which makes it harder for his cells to recover from even minimal exertion and can cause excessive fatigue.

Since Life Disrupted published this summer, I’ve heard from many patients and learned about many conditions I didn’t know much about, including mitochondrial disease. Despite our vast differences in symptoms and body systems affected, I could relate to a lot of what I learned, especially regarding the difficulty in diagnosing it and the fact that since it often manifests in children, it’s even harder to identify in adults.

(I had immediate flashbacks to doing homework for grad school while waiting in my pediatric specialist’s office, flanked by toddlers with croupy coughs and stacks of Highlights magazine.)

So at first, I was interested to see Baldelli because anytime a rare disease can get national exposure and awareness like that, it’s wonderful—good for general knowledge and education and hopefully, it’s also good for fundraising and research goals too.

But on a deeper level, watching Rocco’s at-bats reminded me of so many things I normally talk about on this blog: adjusting to new symptoms, negotiating setbacks, and balancing professional ambition with personal health needs. So many of us have had to be creative about our employment situation, from finding ways to work from home to switching jobs so we’re in a more flexible corporate culture. We seek ways to be successful and to contribute even when our bodies don’t work the way we want or need them to work.

Now think about Rocco’s situation, and just how much success and positive contribution depends on athleticism and peak physical condition. And think about trying to compete at his level when his body can’t do the things it used to do, the things he needs it to do. Talk about an adjustment.

In what I am sure will be an ongoing process with many revisions, Baldelli and the Rays are figuring out how to keep him in the game without exacerbating his condition. He doesn’t play in every game, and the time to rest and recover appears to be working since he had no problem knocking out some hits in a clutch position.

I’m glad to see that his diagnosis didn’t automatically mean retirement for Baldelli, and glad to see the Rays are working with him. After all, if there’s room for chronic illness in professional baseball, there’s some hope for everyone else trying to balance work and illness too.

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In other news, a new edition of Grand Rounds is up at Pallimed—check it out!

Tuesday Reading

Need a distraction from the financial chaos? Grand Rounds is up at Monash Medical Student. This week’s theme is “Medicine and War.”

In other places around the Internet…

Finding the right doctor. Believing knowledge is power. Do these and similar topics, like what it means to be “healthy,” sound familiar? I talk a lot about them here, so I was thrilled to see today’s NYT’s Well Blog and the Science Times, where “Decoding Your Health” compiles a series of articles and essays on these very issues. Definitely worth a read!

More on language, medicine, and the words we choose to follow…

Call for Submissions: Grand Rounds Vol. 4 No. 50

I’m looking forward to hosting next week’s Grand Rounds here on A Chronic Dose. Since it comes on the heels of Labor Day and my colleagues and I will soon head back to our writing classrooms, I have decided on a (loose) theme:

Education. I’m interested in hearing about moments where you’ve really learned a lesson and who you learned it from, whether it took place in a traditional classroom, in a hospital, with a friend or loved one, a patient, etc. (Or, if you were the one imparting knowledge or experience.) Education can take so many forms and have so many “instructors,” if you will, that it’s pretty open-ended, and I’ll consider all submissions.

The deadline is 11 pm Sunday night, August 31st. Please send the post URL, blog URL, and a short summary of the post to laurieDOTedwardsATgmail.com. Thanks so much!

And don’t forget to check out this week’s Rounds over at Rural Doctoring-it’s an English major’s delight!