Grand Rounds 4:34 at the Health Business Blog

Welcome to the latest edition of Grand Rounds at the Health Business Blog. This is my fourth time hosting (fifth if you include the April Fool's edition).We'll start things out with a little fun before getting serious

Who says radiologists don't have a sense of humor? Not Totally Rad's iPhluoroscope is the latest antidote to the cocktail party consult syndrome.Clinical Cases and Images advises that starting to drink in middle age may reduce cardiovascular events as much as statins do. If the effect is synergistic, expect to see combination products enter clinical trials soon. Liquitor anyone?And if you want to play games while drinking, Vitum Medicinus likes to pour hot water in one ear and cold in the other to make your eyes quiver.

Medical manners, miscues and menschenI was struck by the number and depth of posts discussing the complexity of relationships among doctors, administrators, patients, nurses, and chaplains.

Other Things Amanzi offers a story from his surgical training. A senior physician had essentially left a patient to die --pronouncing his diagnosis of a fatal condition by phone and refusing to come in to help out-- but our blogger and a colleague saved that patient's life. The next day another senior doc took the two trainees to task (in public) for not performing the surgery exactly the way he would have, while the doc who'd given up on the patient and abandoned the trainees sat by silently.Dr. Anonymous interviewed Beth Israel Deaconess president Paul Levy. The Blog That Ate Manhattan was eating it up at least for a while. Here's an administrator who gets it, who's empathetic toward docs and generally a good guy. But then she reacts (or possibly overreacts, as she admits) to a comment Levy made about dealing with a difficult doc in a negotiation. In the comments section Levy explains himself further: Doctors should be expected to communicate and negotiate well as part of their jobs, and not just in dealing with administrators. Meanwhile GruntDoc was listening to the podcast, too. He didn't take umbrage at Levy's comment. In fact he's a bit embarrassed that doctors display such "horrible" negotiation skills.In case you think you can't teach an old doc new tricks, The Entrepreneurial MD presents Secrets of developing new habits. Physicians fall into certain patterns of thinking, but they can become creative and innovative again by pushing themselves out of their comfort zone (and perhaps learning to negotiate and communicate). For the RoboDocs who aren't quite ready to leave their comfort zone, the NEJM ran an article entitled Etiquette Based Medicine. In Sickness and In Health is saddened by NEJM's cookie cutter approach to etiquette in the doctor/patient relationship, e.g., "Sit down. Smile if appropriate." She considers it a poor substitute for real empathy and connection.I'm more sanguine on the concept --courtesy and manners can go a long way for patients, even when it's not heartfelt. Over time, following such mechanical steps may actually lead to a change of heart. But if your doctor isn't the compassionate (or polite) type, you could do a lot worse than to receive a visit from Rickety Contrivances of Doing Good, a volunteer chaplain. What she calls Two Moments of Grace I would call, A Touch of Class. Her offer to get a glass of water for a fatigued family is greatly appreciated, and her "few trite, awkward sentences" for another patient help that person turn the corner.Medical Pastiche offers up commentary on 7 famous medical TV shows. Some are more realistic portrayals than others, but as a whole they offer insights into doctoring and the nature of medical relationships. In any event they do have an impact on real-life patients and medical professionals --current and potential. Meanwhile, Mind, Soul, and Body was introspective and insightful in his choice of pediatrics over adult medicine. My favorite reason: "Kids don't have that unmistakable adult hospital smell."Own Your Health provides advice on creating a "meaningful, healing partnership with a physician." Old fashioned talking plays a big role.Emergiblog offers words of wisdom to graduating nurses. Among them: "Please, please remember that you practice nursing and not medicine... Act like the consummate professional, and you will find that the doctors will treat you accordingly. Those who don't have a problem. You do not."Suture for a Living offers aspirational words for physicians to live by, circa 1871 but still relevant today.

Patient tales

HealthBlawg went to Israel and had a pretty good experience at the emergency room. For one thing, no one asked about payment. Delayed arrival at Shakespeare's Falafel Stand was the only real downside.Chris is going to be quite a good husband if Six Until Me's story of nighttime low blood sugar woes is any indication. At a minimum he'll get used to hearing the term "honey" thrown around.

Decreased amniotic fluid? Not good, says Fruit of the Womb, and here's why.

Well, Well, WellnessThe biggest change since I last hosted GR is the plethora of submissions on wellness.

The Fitness Fixer shows us how to stretch mindfully so we don't just cause new problems. Wellness tips advises: "pretend that your pelvis is a bucket," to avoid hip pain.SharpBrains (surprise!) is into brain fitness.Teen Health 411 recommends healthy eating for teens. The Diet Dish lets us on to the fact that a dietitian is a professional while a nutritionist is a nobody. Dr. Penna reminds us that breast is best.Medicine for the Outdoors suggests avoiding ground-level ozone.In case you're still having trouble sleeping after all that wholesome advice, How to Cope with Pain has tips on getting better sleep and so does Highlight Health. How to Cope recommends using the bed only for sleep and sex. Apparently insomniacs had been giving the kitchen a bad name.

Health Wonk Review it ain't, but we've got a few policy posts

Dr. Rich of The Covert Rationing Blog establishes that he is no friend of lawyers but then explains that medical malpractice insurance reform is a bad idea for everyone, at least at this stage.FDA is dissing insulin pumps. If they'd read Diabetes Mine they'd know better than to say such things.Are doctors overmedicating kids? Dr. Anonymous raises the issue but keeps his own verdict close to the vest.Freedom from Smoking worries that tobacco control money is being cut in tough economic times. He may not realize that we need smokers to pay cigarette taxes for all the new domestic initiatives --like universal health insurance.Taking Accutane for acne? when you try to get insurance, says InsureBlog.

Technology's turn

From Healthline Connects: Cochlear implants may be the number one medical advance of this century, but adjunctive therapy is a must.ASTHMA IQ helps physicians implement clinical guidelines, says Allergy Notes.Wait Time & Delayed Care applies the Boston Consulting Group's richness vs. reach framework to explain the tradeoff between quality service and wait times in health care. (I wish he'd continued in the same vein as the BCG authors, who used the construct to explain how the Internet breaks the compromise between richness and reach. Workflow innovations and health care IT display some of the same potential in health care.)Efficient MD is launching a new wiki for health care professionals. "Clinical pearls" and "life hacks" are among the rewards to be found there, we are told. Perhaps they can resolve Wait Time's issues.

Thanks for reading Grand Rounds. You can read my previous Grand Rounds editions here, here, here and here.Next week's host is Musings of a Dinosaur.