Some inner truth of vast reflection

I've seen a couple of examples of this now, so I've decided it's a trend. Naturally I'm going to excerpt something from which to base this post:
This sentence claims to follow logically from the first sentence, though the connection is actually rather tenuous. This sentence claims that very few people are willing to admit the obvious inference of the last two sentences, with an implication that the reader is not one of those very few people. This sentence expresses the unwillingness of the writer to be silenced despite going against the popular wisdom. 
I've got further evidence to back this up from this humerous video (though I won't embed it for stylistic reasons).

A pithy observation is shared, and of course, a link to a prior discussion on Metafilter.

After all this deliberation, I've got to conclude this trend has pros and cons, and a lot of unappreciated nuance. I just hope it turns out alright. 

Into a void we filled

I had a bunch of difficult shifts midweek last week and a lot of charts to complete, afterward. That, plus some other obligations, and I had fallen behind on emails -- to say nothing of the news. So while I had heard a little bit about the earthquake in Haiti, I hadn't really reflected on it.

Gmail had grouped the following messages last week from CNN -- all sent within a few hours of each other -- into a thread:
  • CNN Breaking News: Hundreds of thousands of people have died in Haiti's earthquake, the prime minister told CNN today. 
  • CNN Breaking News: President Rene Preval tells CNN that Haiti lacks capacity to hospitalize quake victims, asks for medical aid. 
  • CNN Breaking News: R+B singer Teddy Pendergrass has died at age 59, CNN has confirmed. 
So forgive me, I knew something terrible had happened but I was having difficulty putting it into context.

This isn't necessarily new territory. But, much like with Katrina, the enormity really only sinks in, for me, when I read physician's accounts from the front lines. Something about comparing the challenges of working in my electronic ED with the endless supplies, state-of-the-art equipment, and an army of readily available specialists, to what these doctors are going through, conveys the horror more than a thousand breaking news updates or footage of crumpled buildings. 

Some informative, and responsible, medical accounts are available online (1,2). 

Here's a dispatch from a former colleague with ties to the area: 
My husband and I hitchhiked it to port au prince from the domincan republic; the devastation is of incredible magnitude; [X] and I both have family here; his father was pulled from the rubble alive after having been trapped for 16 hours; fractured ribs hand and leg ; his brother and stepmother killed;  we are still looking for 2 nephews; [X] and I stay on opposite sides of town since food and water are scarce; we are helping our families to ration; at night we sleep on the roads the only safe place since after shocks are still being felt daily; hospitals have turned away thousands so I care for whomever I can in the meantime; I delivered a baby on the sidewalk this morning; please send this email out to our colleagues and ask them to send whatever resources they can; the various teams deployed have still not covered a large portion of the city that is in need of assistance; I have still not been able to get in contact with my medical mission group for lack of communication.
People have been bellyaching about disaster journalism cliches for close to 40 years, but the physician-as-reporter is a new wrinkle that's coming under some scrutiny. From my perspective, I find the physician dispatches very helpful for contextualizing the disaster -- at least, until these doctors' heroics start to become the focus of the story, instead of the lens from which to view it.

Comment te dire adieu

A longtime reader wrote to ask if I had removed comments because they were a relic in this age of facey-spaces and tweety-pages.

That's when I realized my comments had disappeared. 

Haloscan, which had faithfully been providing free commenting to this site long before could,  is now under the control of another company. There was a warning sent to my email before the holidays that I promptly forgot about. And then sometime after Grand Rounds last week my comments were gone; not with a bang but a whimper.

There was a brief period of panic but fortunately, my login still worked on and they let me download the 1279 comments blogborygmi has accumulated over the past six years. Folks are working on ways to import these old comments to Blogger. In the meantime, I've enabled Blogger's new (to me, at least) comment features.

Of course I understand after a growth phase, there's a need to convert resource-intensive services into sources of profit, even if it means charging for something that used to be free. I just wonder if the new owners of Haloscan (JS-Kit? Echo?) carefully thought this through:

  1. They had a small group of early adopters who wanted comments on our blogs, long before a major platform offered them. 
  2. We were happy enough with their service to stick with it, for the better part of a decade, even after more robust (and free) versions were offered by competitors. 
  3. For various reasons, they needed to move us to a flashy new system. 

Were they really counting on us to start paying for this unnecessary new service? Or, put it this way: was there no other way to offset the cost of making a few blog veterans happy? It seems like they could upgrade us to the new platform for free and maybe get some positive, genuine word-of-mouth publicity, which I'm told is something bloggers have a knack for. Or, I don't know, maybe they could offset the cost by including advertising -- I've read there's some money in that.

Oh well. An opportunity for them has been lost, and for me, some old lessons have been reinforced. What about you? Feel free to leave a comment below.

My one lucky prize

GruntDoc's got a neat little post up how he infers his hospital's census:

My way to work goes through one of our myriad basement areas, the one where empty beds are stored.  I’ve seen literally none, and a lot.
The other night there were so many I couldn’t believe it. Our count is down. This, too, shall pass.
Follow the link for dramatic photo evidence.

These sorts of indicators are fun -- almost as elegant as the Ambient Orb sitting on the desk of Beth Israel Deaconess CEO Paul Levy, gently alerting him to the status of the emergency department waiting room.

Though I can access my emergency department's information system from home, and thus check ED crowding before my shift (if I see lots of admitted patients waiting for upstairs beds, the hospital's pretty full), I rarely do so. I'd much prefer the Orb's distilled, wordless updates to the information overload from our EDIS.

The other day, I got a new kind of indicator about the hospital's census. I had admitted a patient with a history of MRSA to an isolation bed, only to learn a short while later he was ready to go upstairs. This was surprising, as isolation beds are in short supply and patients frequently wait many hours in the ED for one (if not a day or more). In fact, the floor nurse was suspicious I had listed him incorrectly to a regular room, with a vulnerable roommate.

I called our bedboard to make sure they got the right listing. They told me the census was low enough to permit them to turn double-bed rooms into single isolation rooms (in college we called these "dingles"). I don't think I'd ever heard of that happening in our hospital, before -- though like GruntDoc I realized this, too, would pass.

Grand Rounds Volume 6, Number 15

Welcome to Grand Rounds, the weekly collection of the best in medical blogging, featuring works from physicians, nurses, researchers, students, patients and healthcare professionals.

It's a new year and I'm very happy to be involved again in organizing this "carnival of the caregivers." Many thanks to Dr. Colin Son for his role in scheduling hosts, and for writing the Pre-Rounds column for over these past 18 months. Special thanks to Dr. Val Jones of Better Health who will continue to promote and plan GR.

This is the 327th edition of Grand Rounds, and navigating web is pretty different compared to when I first hosted. I've been stubbornly resisting social media to help spread the word about each week's location for Grand Rounds, figuring quality writing will find a way to reach interested readers. But when you consider that the Grand Rounds community of patients, providers and pundits is its own kind of social network, it only makes sense to adopt these new tools.

And so, this week, in addition to the RSS feed and Google Calendar, we're rolling out the @grandrounds twitter account, and a Grand Rounds fan page on Facebook.

These (still comically underdeveloped) resources are hardly groundbreaking innovations in 2010, but then again, the blog carnival concept wasn't new when Grand Rounds started in 2004. Your suggestions to keep Grand Rounds accessible and relevant are always welcome, and your continued participation -- as readers, contributors, and hosts -- is essential. Thank you for your involvement over the years, and be assured, even with this expanded social presence, the purpose of Grand Rounds will always be to showcase excellent writing from independent voices in the medical field. 

I've loosely organized bloggers' contributions in the categories below, but first wanted to take a moment to highlight my favorite post of the week:

Editor's Choice

Medical News and Reviews
  • What killed Franklin Delano Roosevelt? Dr. Ramona Bates sifts through the photos and reviews the evidence behind "FDR's Deadly Secret" over at Suture for a Living.
  • Smile! Inside Surgery looks at tetanus, part of the continuing series of concise summaries of commonly occurring medical conditions.
  • What just happened? Doc Gurley condenses all the medical news of the past year into a hilarious recap: Top 10 Health Lessons of 2009. Read it, lest you be doomed to repeat that bizarre year. 

Healthcare Policy Views
  • In the latest from his Careful What You Wish For series at InsureBlog, Henry Stern contrasts his wife's recent mammography scare in the US to shortcomings in the UK's NHS system.
  • In the US, electronic health record adoption is getting a boost from the government -- providers will receive incentives for "meaningful use" of EHRs. David Harlow of HealthBlawg thoughtfully reviews of the new definitions for meaningful use – a must read for those of us in health care informatics. 
  • You've heard about patients in Canada or the UK who endure long waits to see specialists -- but did you know that less-educated patients wait longer? Over at Colorado Health Insurance Insider, Louise looks at why socioeconomic status influences wait times
  • Dr. Val has a call to action for preventive health, asking readers to channel their frustrations over healthcare reform into staying fit and trim for the new year. That'll show 'em!

Case Reports / Notes from the Front Lines
  • What happens when a son tries to 'drop off' his father, and treats a hospital like the adult Humane Society? The Happy Hospitalist becomes unhappy, and is forced to explain hospital admissions.
  • Emergency Medicine blogger Chris Nickson at the Life in the Fast Lane blog writes about an unexpected ending to a family meeting about a dying patient, in his post: Bad News Broken.
  • In a very personal post, Todd C. Williams reflects on his wife’s medical care and draws comparisons to his own work in project management. 
  • At a blog called Own Your Health, medical journalist Roanne Weisman reflects on lifestyle choices and a family member's death, and concludes: she didn't have to die.

Good Medicine for the New Year 
  • A blogging therapist named Will Meek (prediction: large inheritance) reflects on some common blurred thinking from a psychotherapeutic perspective, and offers some simple checks to keep folks grounded.

Thank you for checking out this first Grand Rounds of 2010. Please visit DrRich at the Covert Rationing Blog for next Tuesday's edition!

Call for submissions -- Grand Rounds @blogborygmi on Tuesday January 5

The first Grand Rounds of the year will appear here, at, on Tuesday morning. 

The deadline for submissions will be Monday 1/4/0910 at 11:59 PM EST.

Please review the ancient but still relevant submission guidelines and email a link to your best recent writing to nick -at-, with a short description.

Also, please -- if you'd like to try your hand at hosting, or know of a blogger who'd make a great Grand Rounds host, please let me know. It's a wide-open year ahead of us.

Finally, if you've got suggestions for improving Grand Rounds -- social media integration, organization, anything -- I'm happy to listen.