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Grand Rounds


Grand Rounds Vol 8 No 25: Super Tuesday Edition

Welcome to grand rounds, the best around the world of medical blogging!   For those expecting a silly recitation of today's posts in rhyme, this post will let you down.  But don't be sad, as I have provided with an alternate version of grand rounds on my other blog, Llamaricks, which (if you hadn't guessed) is not quite as dedicated to the serious side of things.  

Since today is "Super Tuesday" (whoever associated the word "super" with politicians should explain this to us now), I thought I would use today's posts as a means of communicating to those who would represent us just what they are getting in to.  Unfortunately, it seems that the people in Washington and those who are trying to get there pay more attention to the polls than they do the people.  They want to get elected more than they want to solve our problems, and the problems in health care are huge.  These posts do a far better job of underlining that reality than I could do on my own.

My apologies to those living outside of the aren't really offended at not being part of our system, are you?

Thanks to all who contributed and to the fine folks who run this whole grand rounds thing!


Dear Politicians:

I have heard something startling: you want me to vote for you.  While I greatly respect people dedicated to public service, I must say that I have lost trust in you and in the political system.  I share this mistrust with the majority of Americans.

The bottom line is this: you have all lost touch.  It seems that you are more connected to the votes than to the voters, more aware of the polls than the needs of the people being polled, and more set on political battles than fixing the mess our country is in.  In no area is this more plain than our health care system.

The following articles are written by real people from all ends of the political spectrum. Some of the writers are wealthy, others are poor.  Some are doctors, some nurses, some are patients.  Some of the people are healthy, some are sick, and some are dying.  Some are thoughtful and introspective, while others are silly and sarcastic.  Some are from this country, while others are not.

What do all of these writers have in common?  They deal with health care.  They are the end-result of policy, the pawns in political battles, the "consumers" pandered to by profiteers, the sob-stories told to prove political points, and the statistics that are twisted to political ends.

They are all real.  Here are their stories:

The patients who would rather not be sick.  Walking the Walk - Life is a Many Zebra'd Thing

This article is written by a person has been through cancer, heart problems, endocrine problems, infections, and now has to face being a diabetic.  She tells of the struggle to admit the reality of the diabetes.

Yep, I'm going to have to start acting like a diabetic and carry a rescue kit of juice and candy with me. Sad to think that while I know that sugar is not my friend, from time to time I'm going to have to rely on it. Fun times ahead, I can already see.

People who get advice that is motivated by money, not what's best for them.  The Challenge of Shopping Around for Healthcare - from the Colorado Insurance Insider

This article discusses the perils of trusting advice from others without knowing their motivation.

Given the difficulty of comparing something as basic as prices for medical procedures – much less things like long-term safety and efficacy – it’s unlikely that patients can really be informed healthcare consumers unless things become a lot more transparent. 

Doctors who don't want to recklessly spend money  -  Friday Reflection: The risks of looking and doing so much – Dr. John M

Doctors are put in a difficult situation: they are handsomely paid to do things that may not help, and may even hurt patients.  This article talks about a doctor's struggle between doing the job and caring for people.

I love this doctoring thing. Using hard-won skills, smartly applied modern technology, teamwork and compassion to make sick people better feels really damn good. But with such fine sensations comes the heartbreak of failure.

And one such failure that haunts me is…

Making a well person sick.

That my friends should be a never event!


People who get drunk to avoid societal stupidity -  UCEM Position Statement On Alcohol And Idiocy - Life in the Fast Lane

This is a very clever (and fictional) post that proves that it's easier to face society's stupidity with elevated blood alcohol levels.  This is the world in which you are wanting to govern.

Upon completing measurement of baseline neuronal density, participants were exposed to three hours of conversation topics associated with neuronal death. These conversations covered the Kardashians, Jersey Shore, Lady Gaga’s newest costume monstrosity and popular culture.


Doctors who are not motivated to give good care - Swedish Meatball Surgery, Part XVI - Insureblog

This post points out that bad care is not unique to the US, raising the issue that simply paying for care won't fix it.

When Swedish health care "professionals" aren't out trying to score hot nurses, they're apparently turning away fellow citizens who've suffered broken necks:


Rich people who pay for good care they cannot get from our system - Yacht Medicine - Glasshospital

File this one under: "signs of the apocalypse."  Being rich has its rewards, the greatest of which is: avoiding our health care system.  By the way,just by running for office you are lumped in with these people (in the minds of most voters).

I’ve been having trouble finding quality medial care aboard my yacht lately.

Thank goodness Guardian 24/7 is working tirelessly to fill this vital niche.


People getting care that is not equal.  - Study Finds Wide Variation in Reoperation Rates after Lumpectomy - Medical Lessons

This post, written by a physician, details the huge variation in the quality of care for breast cancer as witnessed by re-operation rates for lump removal.  To call our health care a "system" is quite a stretch at times.

All of this meshes with my experience – knowing women who’ve had breast-conserving surgery and then got mixed infor­mation about the results and what to do next. You’d think lumpectomy would be a standard pro­cedure by now, and that deci­sions about what to do after the pro­cedure, sur­gi­cally speaking (let alone deci­sions about chemo, hor­monal treat­ments and radi­ation) would be straight­forward in most cases.


People who go to extremes to avoid care they don't want. - “Do Not Resuscitate” Orders as Body Art - ACP Internist

Some people are afraid of dying, while others are afraid of being kept alive.  These are the people who want to control their own destiny, those who don't want insurance companies, lawyers, or politicians saying when and how they should die.

Along with tattooing comes body piercing, a review article considers all the issues that surround pierced body parts that the primary care physicians should be aware of. Body piercing is on the cusp of entering mainstream acceptance, and a host of issues follow.


People who feel ignored by providers. -  Channeling Your Inner Aretha Franklin – Advoconnection Blog

Our system doesn't excel in being respectful of people, especially the elderly.  This post is advice to the care advocates for the elderly to demand respect.  It's a sad thing that getting respect often requires a demand.

I’m going to guess you have witnessed this, too. In fact, some of you have done the same thing. In particular with an elderly person, or a patient with dementia, or certainly a young child, it’s so easy to have a conversation with a spouse or adult child or some other caregiver, and discuss the patient as if he or she isn’t present. But, when it comes to any adult patient who is conscious and able to comprehend the discussion, it is highly disrespectful. These patients are not objects to be discussed. They are living, breathing, intelligent human beings. You are discussing THEIR bodies, THEIR health, THEIR diagnoses, THEIR treatment needs, THEIR lifestyle changes – and those questions and discussions need to include and embrace them as contributors to the conversation.


People who feel they are being shafted and mistreated by insurance companies -  Letter to an Uncaring Entity – Northwest Transplant

This is a letter written by a very angry patient, who happens to also be a nurse.  Regardless of the specifics of the case, this encapsulates the emotion most people feel toward those trying to "manage care:" fury.

Obviously this letter is written from an emotional and personal perspective; it's long and a bit messy and imperfect.  My dual roles as a provider and a patient in need of care has brought the issues of our for-profit (and broken) health care system right into my living room.  I fear that, with the new Affordable Care Act requirements that insurance companies cut their overhead costs and actually spend 85% of our premiums in providing care for us, that we as patients and providers alike will be hearing stories like mine more and more often.  Money has to be made somewhere otherwise the insurers (or the drug companies or us providers) would just give up entirely and then where would we be?


People who care for the dying  - Mindfulness in Palliative Care - ACP Hospitalist

What does it take to care for dying people?  What does it take to care for dying children?  It's not about politics, law, insurance, or technology; it's about being a human being.  That is the essence of health care.  It's well worth the listen.

Palliative care is an emotionally tough field for physicians and even more so for pediatricians. One coping mechanism is mindfulness, a way of remaining involved and aware of interacting with patients, yet detached just enough to allow for proper decision-making.

The goal of mindfulness is to act and be aware of acting at the same time, which creates a slight mental space that allows the physician to choose how he or she responds, instead of reacting, judging or lashing out.


People who inspire - The Soundtrack of Loss – MS Renegade

What do a British composer during WWI, a cellist in the 1960's, and a blogger disabled by MS have in common?  The ability to rise above the tragedies of life and inspire others.

There are, sadly, all sorts of tragedies in our world.  Huge, global events like wars.  Public losses of talents like Jacqueline du Pré’s.  And millions of anonymous, small (in the scheme of things) losses like that of the life I used to lead.  All cause grieving.  And now when I think of loss, in my head, I hear the eloquent, elegiac melody created by Edward Elgar out of his own pain almost one hundred years ago.   Played by Jackie in her youthful prime, conducted by Daniel Barenboim, knowing how their stories will play out, makes this performance heartbreakingly poignant.   For me, it is the soundtrack of loss.

So, my dear vote-seeker, you see that this is a very real game you are entering.  It's not about winning or losing an election.  It's not about playing the political game to defeat your rivals.  It's not about raising enough money to smear others on television.  It's about people.  It's about helping others.  It's about life.

Happy "Super" Tuesday.

Next week's host: Health in 30



Grand Rounds Deadline Looms (Thanks Jeremy)

So I was just chewing the fat with Mitt and Newt.  I made some wise-crack about how Santorum who would rob newts of their mitts.  They got a chuckle out of that one.

Then something strange happened.

"Grand Rounds is coming!" crooned a tremulous voice.  Nobody could find where it came from until Jeremy Lin pointed it out to us (thanks Jeremy).

It was the Grand Rounds Goat!

"Grand Rounds is coming!" the goat bleated again.  "Submit your best blog posts by Sunday at 6 PM (EST) and you will see dancing goats!"

Yes, the goat was right!  I don't know how he came to be so wise, but the Grand Rounds Goat  - with the help of Jeremy Lin (thanks Jeremy) -  had told the public of the upcoming deadline for submission of grand rounds.  Submit your post using the submission form with the help of Jeremy Lin (thanks Jeremy) and you will see dancing goats.

If that's not motivating, then nothing is.



Grand Rounds Submissiveness

For those confused by where to submit your Grand Rounds posts (created by one man or woman, please), I am sorry.  I was distracted by these giant spheres.  Go to the grand rounds submission page to be submissive and I will create (as one man) a grand thing that may be round.  It will at least be round-ish.



What's Grand and Round and Comes in an RSS Feed?

I will be hosting Grand Rounds next week!

I have been assured that my head won't open up in the process.  I hope not, as it would creep out my kids.

So how am I going to do grand rounds this time?  I am not going to tell, but I will promise the following:

I promise it will be more grand than a giant rubber band ball.

And more grand than a giant soccer ball crushing a car.

It will be more merry than this ball of twine (which is chained to a tree, so it must be the rabid variety anyway).

I cannot promise, however, that it will be more grand than the world's largest disco ball.  That's a very tall order.

To submit your GR post for next week's GR, fill out the attached submission form.  I must have submissions in before Sunday, March 4th at 6 PM EST.



How Much Grand Could a Grand Rounds Grind? GR Vol. 6 No. 19

It happens every year. I try to get a little shut-eye, but then these guys in hats come around and yank me out of bed.  They proceed to parade me around a huge throng of people (most of whom are not wearing hats), obsessing about the presence or absence of stratus clouds.

What a strange group of people.  I seem to be the center of attention for the day, though, and that's not all bad.  It's my day on February 2nd, and nobody has ever taken that from me.

Until this year.

Let me back up a little.  My name is Phil, and I am a woodchuck who lives in western Pennsylvania.  Yeah, I know I was supposed to say "groundhog," but I like throwing people off.  I am also called a whistle pig and a ground beaver, so it could be worse.  I personally prefer the woodchuck thing because I like the "how much wood could a wood chuck chuck..." poem.  Shouldn't I be able to decide what I am called?  What's wrong with "Woodchuck Day?"  It beats "Whistle Pig Day," doesn't it?

Sorry, that subject gets me emotional.  I live in a town known as Punxsutawney, which is an Delaware Indian (or Native American - see, it's not so bad to have more than one name!) word meaning "town of sandflies."  I can vouch for the appropriateness of that name.  It's not much of a town otherwise; which is why I suppose they go around in hats and pester me each year.  What else is there to do?

There are a lot of llamas in our town too.  I think that's why Dr. Rob came in the 1st place.

But this year we've been invaded!  Turns out that there is a whole other group of strange people who get all excited on a regular basis, and this year they invaded Punxsutawney!  They are lead by a guy named Steve, and for all the doting they do on him you'd think that this was "Whistle Steve Day!"  He took the much-anticipated day of my emerging and turned it into a way to show off a new thing he made; I forget what it's called...something beginning with an "i," I think.

So you see, I have be relegated to second-fiddle, which doesn't suit me well.  That's why I took Dr. Rob up on the offer to give my particular woodchuckian perspective on medical blog posts.  Plus, I thought he said "Ground Rounds," and it seemed up my alley.  Ah well, you can't blame me for wanting to get out of Punxsutawney as quickly as I could.  I'll show you other pics of the day in Pennsylvania to prove it.  This guy is crazy!

Everyone thought last year's stunt by the llama was crazy, but that was nothing compared to this year!

Since Dr. Rob inexplicably got a gazillion submissions, I am grouping them.  It makes things easier to digest.

Group 1: My Faves

Some of the posts stood out from the rest.  This is not to say the rest weren't great, but certain posts just resonate with a large North American rodent.  I'm not sure if that's good or bad.

The first on the list of Faves is a Post from the blog named Nourish: Living, Laughing, Whining (great name) which tells about Jacqueline du Pre', a woman who played the cello but lost her ability due to Multiple Sclerosis.  Marie Cooper, the author of the post identifies with her in the pain of facing a horrible illness. Like the pain I feel facing Steve.

The next is from Dr. Charles, who writes about being a doctor and going to a patient's funeral. Dr. Rob says Charles expressed the emotion perfectly.  Dr. Charles is a good writer.

The third of my faves is from Dr. Robert Centor, who's a smart dude (so I am told).  He discusses the reason nobody is choosing primary care: it's not because of what people say about it, it's the job itself.  I think he is basically saying that primary care should suck less.  Dr. Rob agrees.

My final fave is from a psychologist named Will Meek.  He explains the difference between remembering and reliving hard things. Why do I like this so much?  First off, I have a lot of trauma to deal with, getting lifted out of bed every year (the whistle-pig side of me is quite sentimental, you know).  Second, there was a guy once who relived Groundhog's day a bunch of times.  He should have read this post.

See!  He took over!  At least he wore a hat, though.  Even the llama wore a hat.

Group 2: What Docs Do

I get a skewed view of doctoring by just talking to Dr. Rob (he's a skewed kind of guy), so reading posts about docs being docs was quite enlightening.

The Happy Hospitalist taught me what the difference between a hospitalist and an intensivist.  If there's a Happy Hospitalist, is there an Idiosyncratic Intensivist?  I am sure there are lots of them.

Dr. D taught me how doctors diagnose the weird stuff.  It turns out you don't have to be mean and abrasive (like that doc on TV) to be able to make "good catches"!  Who'd have thought?

Lockup Doc talked about how some doctors make you feel at ease, while others make you feel like you are a nuisance put on their schedule to give them justification to abuse illegal drugs (kind of like that mean and abrasive doc on TV).  The interesting thing here is that Lockup Doc takes care of prisoners!

Why do people need a thorough physical exam before getting surgery?  Dr. DJ (sounds like a rapper) talks about how people hide stuff that can hurt them later, necessitating a thorough physical exam.  He wonders if that is unique to India.  Dr. Rob says that it's definitely not.

Kent, that's his name...I am not saying he bottles things.  He might bottle things, but that is not relevant.  Dr. B talks about how some smarty-pants surgeon is telling everyone to use checklists all the time. Dr. B thinks that this guy may be right, but there needs to be room for imagination and deviating from the checklists.  I find that it's very important to have creativity as a woodchuck.

Group 3: Yowza!

Some posts made me say "yowza!"  That's woodchuck for "wow, what a controversial topic covered in the blog post."

Dr. Wes talks about the healthcare legislation that has stalled in congress.  The amazing thing about this post is that the comments section is about 5 times as long as the post itself.  Great discussion, but Dr. Rob confessed that his Adderal ran out before he got to the end of the comments.

A blogger named Phil (good name!) on the Behaviorism and Mental Health Blog says that Schizophrenia is not a disease!  Dr. Rob was impressed by his bold stance that is definitely against the mainstream, and the way Phil put forth some solid points.  I was impressed by his name.

Mary Clark has a chip on her shoulder.  I think it's a Pringles, but I can't tell for sure.  LOL ROFL - That was a bit of woodchuck humor.  Anyway, Mary is very frustrated about two people who got surgery who clearly would have chosen otherwise.  Not all docs (or woodchucks) disagree with Mary.

Toni Brayer wonders about how doctors and hospitals get rated.  How can this information be useful to patients?  She says it can't.  Of course, she's from California, so you have to expect that kind of thing.  She probably got sick on some tofu or sushi.  (More woodchuck humor)

I have to admit, I was a little star-struck when I saw the iPad for the first time.

Group 4: Taking Care

What's the best way to take care of people's health?  There were some good posts on that topic.  If only they'd cover the best way to avoid guys named Steve.

Metformin for Type 1 Diabetics?  Amy Tenderich at Diabetes Mine once thought the idea ridiculous.  But then after looking into it more, there are definitely times it's a good idea.  Who'd have thought of such a thing?  I am probably the only woodchuck with that knowledge.  Thanks, Amy!

What's best, low carb or low fat diets?  The blog On The Wards discusses the research on the subject.  It turns out that they are the same.  I am glad about that.  Some woodchucks eat bugs and other yucky stuff, but I stick to the veggies to maintain my chuckish figure.

Bruce Siegel, who writes at the Robert Wood Johnson blog talks about some people from Minnesota who are working together to improve the quality of care.  He has the quote of the day:

You could dismiss this as another example of “Minnesota care”—where all the clinics are strong, the doctors are good-looking and the scores are above average. But Minnesota is only a harbinger of things to come in other parts of the country as the movement for high-value health care continues to pick up steam—with an extra boost coming soon (we hope) from the quality-related provisions of the national health care reform bill.

Group 5: Hah!

Some posts were either funny, or they were unexpected.  I usually like unexpected things, but Steve and his disciples are making me rethink this whole issue.

My first "hah" came when I read the post by Dear Dr. Ramona Bates on her blog, Suture for a Living. It turns out that there's a surgery to make a navel!  I guess people would look funny without one.  Rumor has it that Dr. Bates learned the procedure at the Navel Academy.

Step aside Scoobie and Astro, the new dog darling is Ruppy - a genetically-engineered dog that fluoresces!  Jamie Newman at the ACP Hospitalist blog uses Ruppy, who's a combination of beagle and sea anemone genes, as evidence that very different things can work together.  Pretty clever!

The spoof article in BMJ about evidence based medicine and parachutes made a lot of people (and woodchucks) say "hah!"  Not so for Jacqueline at Laika's Medlib Blog.  She thinks that rejecting EBM is equivalent to rejecting science as a basis to medicine.  She's right about that; I just hope she doesn't bash the article on Ruppy.  She does have a picture of a dog using a parachute, so I'm optimistic for Ruppy.

From "Down Under" comes a post by Chris Nickson in the blog Life in the Fast Lane. He talks about a real mean dude who comes into the ER, goes to the ICU, and gets a rude surprise.  It's not a funny "hah" at the end, but perhaps there's a bit of justice in it.

Steve looked pretty smug when he found out I already own an iPhone.  I swear, I was borrowing it from the llama!

Group 6: Huh?

Understand this: I am a rodent.  My brain is not real large.  So there were some posts that made my brain complain to me.  Dr. Rob assured me that they were great posts, and that the smart people will get a lot out of them.  I wonder how Dr. Rob knows about smart people.

The first one is from David Williams on the Health Business Blog.  He interviews two real smart dudes who made software that improves the process of case-reviews. It seems like they are on to something good, because you can't fix something if you don't know where it's broken.

The second "Huh?" was an article on the Health Care Law Blog by Robert Coffield, who is a Lawyer!  Does that surprise you?  Dr. Rob thinks some lawyers specialize in "huh?".  But Mr. Coffield isn't one of them, and he actually points to some really good resources for getting an idea about IT laws for different states.

Group 7: Feeling Better

Whew!  There are lots of submissions to cover!  My paws are starting to ache.  If only I had a tablet with a touch screen....  Well, the point of medicine is generally to make people feel better.  Here are some good posts on that subject.

The first one comes from the blog How to Cope with Pain.  I was interested in this because Steve is being a real pain to me.  Anyway, the article is about how values affect how people deal with pain.  Good stuff.  Useful.

Steve (no, not that Steve) over at the Funky Heart blog talks about being an adult survivor of childhood heart disease.  He sees how just his existence is an encouragement to parents of kids with heart disease.  Very true stuff.

Being sick is lousy, but a lot of times it's harder on the people taking care of the sick person.  Barbara at In Sickness and in Health asks the question: Caregivers, do you tell your ill partners about your stress? Tough question.  I've already told you all about my stress (named Steve).

Group 8: Dumb Stuff

I was surprised to find out that Dr. Rob doesn't have the corner on the "Dumb Stuff" market.  There's enough dumb stuff to go around, and bloggers like to tell about it.

Dr. Val (who gets my vote for empress) writes on the Better Health blog about her experience getting licensed in Maryland and California.  Maryland took no time flat, while California is still working on it over 500 days later!  Perhaps they are all sick on tofu or sushi.  For a state that needs doctors, making it hard for Val is very dumb.

The ACP Internist blog brings up a very surprising fact: many medical students don't have a clue when it comes to electronic medical records. Considering how hard they are being pushed, that's a dumb thing to be happening.  Just ask Steve, a computer is your friend!

Scott Marshall is a Chaplain who has a bone to pick with Sanjay Gupta.  It's not that Sanjay has fancy gig at CNN, and not that he has a cool sounding name.  It's that in his book he compromises as a doctor for the sake of being a journalist. Scott says the book is a good read, but it could lead people to make dumb conclusions.  Scott's no dummy.

I finally got my paws on the iPad, and what does Steve do?  Whoa, don't drop the goods, buddy!

Group 9: Following Rules

Rules are there for a reason.  There is often a good way to do things that should be followed.  Other times there are just dumb rules that should be changed.  Steve certainly ignored all the rules in my fair town today.

Fee for service medicine is just the way we do things.  Is that right or wrong?  Lots of people want to change it.  Michael Kirsch at the MD Whistleblower blog muses about the pros and cons of FFS.  Interesting stuff, and he has a new spin on the idea of  "putting an end to tonsillectomies." Read it; it's more woodchuck humor.

Dr. Ed Pullen's blog has an article about taking medication correctly.  It's not therapeutic to just want to take your medication, you have to actually take it.  He gives some good rules patients can follow to do it better.  It's hard for me to remember to take medications during hibernation.

If you are in the hospital, the last thing you want is to go right back.  It's kind of like Punxsutawney.  Amy over at the Health AGEnda blog writes a post with a link to a guide to prevent readmission.

Group 10: Reader Beware

Some posts are for mature audiences only.  No, they don't have any gratuitous sex like they do on Animal Planet; they are just...well...I guess you should read them yourself to understand.  Maybe you should ask your mom first.

Elizabeth over at Life. Not Terribly Ordinary justifies the name of her blog, giving a recount of a very busy day.  It's a great view into the very busy life of an academic doctor.  It also uses some words that would have had my mother washing my mouth out with dirt.

The Inside Surgery blog takes on a big controversy: the use of acupuncture for battlefield medicine.  It's not a real graphic article (aside from gratuitously poking people with needles) and it uses no cuss words, but I suspect there will be some fonts a flying in the comment section.

Nobody ever accused Patient Anonymous for being subtle and reserved.  That's pretty obvious when you read her post So, Is This What Medical School feels Like? Brace yourself for some strong words and stronger emotion.  I hope she doesn't ever run into my mother.

Group 11: That iThing

OK, I confess: I am turning into a fan-hog of the new iPad.  Steve has this magnetic appeal that makes me want to go out and buy something I never thought I needed.  Even Dr. Rob uses a Mac!  I don't really know what I'd use it for, but I still want to buy 50 of them.  Predictably, the Medical blogs had things to say on the matter.

Dr. Anonymous (who is, ironically, well-known) is the first to jump on the iPad bandwagon.  But wait!  He takes issue with the assertion that it's a perfect device for healthcare.  Couldn't cool aps be written for it?  Sure, but it's not about the aps, its about the hardware.  Dr. A doesn't think the iPad has what it takes for medicine.  Say it ain't so, Steve!

Finally, Peggy over at The Blog That Ate Manhattan chimes in about the iPad.  Being an OB/GYN she first scolds everyone for snickering at the name.  I know for a fact that Dr. Rob snickered a lot - saying that the virus scan should be called the iPap.  Shame on Dr. Rob!  Anyway, the post analyzes the claim that the iPad is perfect for healthcare.  She too is mystified at where exactly it would be used.  But she should give up on trying to get Dr. Rob to grow up.  It will never happen.


It's been a pleasure to get out of my hole and away from the hullabaloo in Punxsutawney.  You medical bloggers are bright folks and the world should pay more attention to you.  I read more common sense this week than I have heard in my entire life from Washington DC.

Pathetic Dr. Rob is now a fan-boy.  HE TOOK MY IPAD!! I'm going to have to bite him (if the llama doesn't get to him first).


After the deadline, I got an email from Paul Auerbach From Healthline.  I add this on because of the importance of the topic:

I just returned late last night from two weeks of medical relief work in Haiti, so apologize for the late submission. Please consider the following posts, which are a series of what we experienced, for submission for this week's Grand Rounds. I realize that it would be highly unusual to list so many posts, but I offer it nonetheless. If you read them, you will understand.


Thanks for the opportunity!  Next week GR is hosted by Edwin Leap.



Grand Round: Everyone Will Be There

Grand Rounds is a big event, and I have gathered together a star-studded line-up.  Do not submit any more posts, however, or you will be forced to go onto Dr. Phil to explain why you are such a dead-beat.  You don't want that.

Obviously, with such a gathering, you don't want to miss it.


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Steve Wants You to Submit

The deadline for grand rounds submissions is on Sunday at Noon EST.  EST stands for "Eastern Standard Time," not "Estimated" or "Extra Submission Time" or "Even Steve Trounces."

iSuggest you get things in as quickly as possible.

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Llary the Llama Announces: Grandhog's Rounds

Emerging on February 2.

Llary says that you should submit your blog posts to grand rounds.  Llary also says that Dr. Rob really stinks at photoshop.  It's a good thing you don't need to photoshop to be a doctor or all of his patients would be in extreme danger.

Llary thinks they might be in danger anyway.

Obey Llary.  The email address is

Deadline is January 31 at noon EST. ------------------------ Addendum: Several people have sent me the full articles. Grand Rounds is a summary of the best of the medical blogosphere. I read and link to your posts, giving summaries. Following those links gives traffic to your site (which is another big advantage). Submitting to GR is one of the ways this blog became widely known.

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Old School

Grand Rounds is up at The Examining Room of Dr. Charles.

For those who don't know him, Dr. Charles was in the blogging world before I was.  He has always been regarded as a thoughtful blogger and a terrific writer.

He also once wrote about peeing in the shower.   That alone makes him a force to be reckoned with (although it gives me the heebie-jeebies to think about it).  I am not sure where to find that post - it's probably locked away in some vault.  Perhaps he can tell us.

Anyhow, he did a great job on GR this week - going "old school" in his theme.  That does remind me of the Steely Dan song "My Old School," which was one of my favorite dance songs parties when I was younger.  I am including this song in this post so that you can see why I so enjoyed it.  Pay special attention to the saxophone riff after the line "California tumbles into the sea."  It's classic.



Wherefore art thou Grand Rounds?


If you want grand rounds as you like it, then head on over to Rural DoctoringMeasure for Measure it is definitely well done; not a comedy of errors.  Believe me, this is not much ado about nothing, it is truly an epic tale.  It may seem like a lot to read, but when you finish you will agree that all's well that ends well.

This grand rounds, by the way, is co-authored by none other than Zippy the Lobster, who is raising money for brain cancer research.  If you have not given to Zippy's cause yet, please click on the Firstgiving icon on my sidebar.