Now that I'm well into medical school... well, who am I kidding, this happened back in pre-med too... family or friends or even strangers are willing to tell me the most gruesome details of their personal medical lives.
It's partly a testament to the amount of respect doctors have. They know that I should be able to understand that part of their lives a bit differently than some of their other friends. They know that I won't go broadcasting their story to the rest of the family.
It's also partly a testament to apathy. Why book an appointment when Vitum is here and I can just ask him? I'm not mocking them... just saying, there are plenty of things I've not bothered to see a doctor about that maybe I should have (like how it always burns when I use the toilet).
They way I respond to these varies on the situation. Sometimes it's about old aunt Helga who is having trouble getting up off the couch these days, and I smile and nod. Sometimes it's about Jimmy's dad who now has a tumour, and I ask if they have biopsied it yet and how the treatment is coming along. Sometimes its about the fungating, smelly growth on their foot, which they insist on showing me, wafting its visible fumes vigorously towards me ("Does that smell like anything bad?") - for those people, I try to encourage them to see a doctor and explain I haven't had a lecture on that yet so please take it away from my face...politely.
I don't usually provide an opinion as we've been warned to not provide advice to people outside the office setting (or at all, really, right now, since we're still students) - we've been told enough horror stories of lawsuits from such situations - so I usually simply tell them that's something they should discuss with a doctor. I don't want to be telling somebody that a mole is nothing of concern and have it turn out to grow into a massive tumour.
However, a couple times I've grown quite concerned after I asked a few questions and end up being a bit more insistent that they go see their doctor. In fact, for a couple of my friends, I asked them to go the hospital right away. One of those people ended up needing surgery.
I appreciate being the person that people feel they can approach with questions, and being able to apply my interest in science to the answers. That's undoubtedly one of the many things that attracted me to medicine as a career. We'll see if I can put up with it happening more than once or twice every few weeks.
A story on this topic: Blinded by the Silver Lining
Monday, July 07, 2008
Oh, you're a medical student?
Saturday, August 18, 2007
Top 10 List: Terrific Tips for Stupendous Suturing
Today, while shadowing in the ER, I sutured real people for the first time. Twice.
Clearly, this makes me one of the world's leading expert on skin sewing. Ask any doctor.
This, and watching dozens of lacerations put together, and taking part in a suturing workshop with very realistic artificial materials designed to perfectly simulate human skin (those materials being made of box cardboard).
Fortunately, it was the second patient - not the first - who asked, "Have you done this before?"
I answered him truthfully. "Yes," I said.
So, having learned so much from my great wealth of experience, I have decided to benefit you, the reader, with ten terrific tips for stupendous suturing of lacerations. 
If you're a medical student, like myself, use these ten tips and you will blow away your classmates.
If you are a nurse or patient, read this list then verbally chastise any physician you see who does not follow these ten tips.
If you are a doctor, verbally chastise yourself right now, out loud, under the assumption that you do not know all of these ten tips.
I request no repayment for this tremendously valuable guide, other than the act of "suturing" be re-named "Vituming." With a capital V.
10. Don't have your stethoscope draped around your neck while you suture. Place it in a pocket or on a desk.
It will get in the way and ruin your sterile field (not good) - very important for emergency department laceration suturing.
(Actually, research has shown that sterile gloves and sterile saline are not needed for ER suturing, as they don't significantly reduce the rate of infection.)
9. Don't have your ID badge on a lanyard. Use a clip instead.
It will get in the way and ruin your sterile field. So not good.
8. Don't have your lab coat on. Roll up the sleeves or remove it.
The sleeves will get in the way of your sterile field. Like, totally, so not good.
7. If the patient is getting woozy, tell them not to look at the wound.
The patient I saw was very pale. Research shows that by telling them not to look at the wound, they will not get woozy (research pending). Research also shows verbally demeaning or physically assaulting the patient will help with compliance on this point.
6. Don't bend the needle.
This will make it a pain to get through the wound. This is partially accomplished by grasping the suture needle at the right point with the needledriver - close to the end.
5. DON'T POKE YOURSELF.
Generally, getting patient blood inside you is something you should try to avoid. Mostly for the pain, I think that's what I was told once, but there are supposedly some blood-borne illnesses that are nasty.
4. Poke the patient.
You can't suture a patient if you don't puncture their skin with the suture needle. Trust me on this one. This is more important than #5; as well, the comedic value is decreased if it is ranked higher than #5.
3. Ignore the fact that the image associated with this post shows suture removal, not suture administration.
Allowing little errors like this to cloud your mind while you suture will distract you from doing a good job. Your patient will complain, and likely sue you.
2. Efface the edges.
For improved wound healing. Or something like that.
1.
Sorry I couldn't come up with a #1. What did you think I was, an expert on the topic? I've only done this twice.
By the way, before you follow any of these, make sure you read the disclaimer below. Especially the part about not listening to any advice on this blog.
(If you actually are an expert, by all means, post your tips.)
Sunday, August 12, 2007
New to medical blogs? Vitum's Beginner's Guide to Reading Medical Blogs
Over a year ago, I discovered the medical blogging community, and the amount I've learned from it has been incredible. I linked to my first blog through an online medical forum, found a series I enjoyed (the Don't Become a Doctor series on Incidental Finding's blog), and started reading every post in that series. I was captivated. I loved the humour, the point-blank honesty, and the impact the blog made on me.
I wanted more. But I didn't really have a clue about where to begin reading more medical blogs. I somewhat stumbled through blogs for a while, here and there learning neat things about being a blog reader that I wish I'd known sooner. It would have been nice to know them right from the start - to read them in some sort of concise, brief overview guide. So, after a year of being involved in the medblog community and somewhat 'knowing the ropes' by now, I've decided to put a guide together myself. Here it is.
WHAT IS THE MEDICAL BLOGGING COMMUNITY?
If you're reading this, you've obviously had some experience with the medical blogging community - this is, after all, a medical blog.
You may not be aware, however, how broad the scope of the medical blog community really is - it took me a while to figure it out. Medical bloggers include, to name a few:
There is so much content in the medical blog community that it might seem overwhelming at the start. So, where should you begin?
FINDING INTERESTING POSTS
There are many genres of medical blog posts - humour, drama, law / politics / policy, research - and any one of these genres can contain any type of content - stories, instructions, commentary, helpful advice, or interesting links.
Just Browsing?
If you're just browsing, and you are interested in a recent digest of the best posts of the medical blogosphere regardless of the topic, you should definitely check out a blog carnival. The authoritative medical blog carnival is Grand Rounds (hosted here in July 2007) - here's a list of past and upcoming Grand Rounds hosts. Other medical blog carnivals include Change of Shift, which has a focus on nursing blogs, and Medicine 2.0 which focuses on the combination of Web 2.0 and medicine.
Looking for Specific Topics?
You may already have an idea of the genres you enjoy, or, more specifically, individual topics within those genres. If that's the case, here's how I recommend finding great posts: Good ol' Google.
Two Ways to use Google
Google is a great way to find individual posts on specific topics that are of interest to you, but you might not have known there are two ways to find great posts on Google.
The first way is using the regular old Google.com, but including the keyword "blog" (for example, searching 'medical student blog') - this will sort blog posts by relevance, listing the most linked-to and relevant posts. However, this will show websites that aren't necessarily blogs - news stories, forums, etc.
The second way is to use Google BlogSearch. It works just like Google - the difference is, it only searches blogs, and the results you get tend to be very recent (usually posted that day or week), rather than sorted by the number of links to each post.
FINDING INTERESTING BLOGS
You'll find that as you read interesting posts, you'll really like the author's sense of humour or perspective, and you'll look up more posts on that blog. Like me, you might find that you'll read all the archives of a few blogs you really enjoy - every post that blogger has written.
Blogrolls
So how can you find new blogs by blogger, rather than each individual post? Again, blog carnivals are a great way to do this, but another great way to discover new blogs is to check out the blogroll on the blogs you enjoy. Most bloggers have a blogroll - a list of links to other blogs. You'll notice my blogroll in the right-hand column, under "Vitum bloggicus" - it's a list of bloggers that I have been influenced by, and enjoy reading on a regular basis, to the extent that I thought my readers would enjoy them as well - so I figured I would post the links.
Blog Ranking Directories
There are directories that rank blogs by topic - the Healthcare 100 from eDrugSearch and the Medgadget.nl ranking are lists of blogs ranked according to a number of different criteria, which will let you find popular medblogs. These will also help you get an idea of the who's who of medical bloggers, the more famous ones such as Kevin MD and Over My Med Body.
KEEPING UP ON ALL THE BLOGGY GOODNESS
The Amateur Blog Reader
An amateur blog reader finds a blog or two they enjoy, and then they'll bookmark them or try to remember the title. Every so often, they'll use their bookmarks or Google to find those blogs again, head to the sites, and catch up on the latest reading.
If they're lucky, the blog user has posted something interesting since the reader last checked. Otherwise, there might not be anything new. But the downside is, if you go to a blog that hasn't been updated the last few times you checked, you'll get frustrated and could even throw a tantrum, and you might not be inclined to visit it as often.
The Intermediate Blog Reader
That's how I read blogs for almost a year. Then something amazing happened. After countless tantrums, I realized that more advanced - or perhaps just smarter - blog readers make the blogs do the work: instead of you going to a blog to find out if it's been updated, let the blog come to you.
One way to do this is to sign up for an e-mail subscription to a blog that you like. Some bloggers are considerate enough to offer the ability to have new posts e-mailed to you (clearly if I put it like that, I offer this option to my readers). This is good for people who only want to keep track of a couple of blogs.
The Advanced Blog Reader
If you're interested in more blogs than just a few, you might want to consider signing up for an RSS Feed Reader such as Google Reader - almost every blog offers their posts in regular updates through a feed you can subscribe to. I took a long time before I started using a feed reader... and every time I look back I wonder why I waited so long. This way, I can keep track of a few dozen blogs without having to check them so often - I just go to my feed reader and new posts show up whenever they've been written.
SUPERCHARGE YOUR MEDBLOG EXPERIENCE
Perhaps the best thing about medical blogs is you can play a huge role in the content you're reading. Almost every blog contains the capacity to accept and display reader comments, and most bloggers have contact information available so you can contact the bloggers directly - use these! Contribute to the discussion and increase the quality of the blogs, and you'll improve medical blogs for yourself - and everyone else.
THE LATEST MEDBLOG GOSSIP - CONFIDENTIALITY AND ETHICS
If you're going to hang out in the medblog community, you might as well know about the latest gossip. A major event that had repercussions throughout the medblog community recently has been the disappearance of a couple of bloggers due to patient confidentiality issues. Both The Flea (former Best Medical Weblog winner) and Barbados Butterfly ended up getting attention in the mainstream media (such as ABC News) after they found that medical blogging is hard to mix with getting sued or working in certain hospitals - both of them suffered consequences such as being forced to settle their lawsuit or being suspended from work.
The events sparked lively discussion, and some medical bloggers posted reactions lamenting the loss of the bloggers, and were reminded to be more cautious to keep patient confidentiality an extremely high priority.
Rob from medbloggercode.com was kind enough to comment on this post and point out the Healthcare Blogger Code of Ethics, a development in the healthcare blogging community that deserve mention in any med blogging guide. The Code is designed to hold medical blogs to a high standard when it comes to the nature of medical blogging, and its goal is to provide benefit for readers and bloggers alike.
THE NEXT STEP - START YOUR OWN MEDICAL BLOG?
Soon you might find that you've got so many things to say in the comment sections of other blogs, that you realize you should start your own blog. Blogger and Wordpress are two awesome, free sites that will get you started on your blog.
THE END
That's all I've got for now. Maybe over the next year I'll find just as many tips about medical blogs. Feel free to ask questions about medblogs, or post your own tips for new medical bloggers in the comments below.
Monday, July 30, 2007
Top 10 List: Pieces of advice for pre-med students
Overheard during the interviewer lunch break at my med school's interview weekend: one old doctor to another - "The very first student we interviewed blew us away. She'd summited Mt. Kilimanjaro, competed in the Olympics, and was an honours student with incredible research experience and publications. You know, if applying to medical school was like this back when I applied, I don't think I'd be admitted."
Getting in to medical school is tough. In Canada, less than 30% of students who apply each year are admitted to a school, and on an individual basis Canadian schools accept as little as 3% of the people who apply (that's more competitive than some Ivy League schools in the USA!) (source). That's not counting the thousands of students who wanted to be doctors when they started their undergrad degree, and had to face the realization that thanks to things like the MCAT and the competitiveness of the pre-med world, and perhaps the odd slack semester or difficult year, they would never even make it to the point of applying for medical school.
Here's some advice I would give to any pre-med student applying to medical school, though non-pre-meds might find it interesting as well as it might give you a unique perspective into the mind of a pre-med student. I wrote this list assuming you know all the basic info - what the MCAT stands for, what an application involves, and the like, though keeners at any level of their training - high school, college, or university - might find this useful as well. Given that, what I've written below something I hope every pre-med could have the chance to read before they apply to med school.
10. Have a backup plan...
This is one of the hardest thing for pre-meds to do: plan what you'll do with your life should you not 'get in' this year (or ever). Why's it so hard? It just sucks to think about the fact that you might not be accepted. But, you can't put your eggs all in one basket... you need to be realistic and know that even some applicants with the highest marks aren't accepted anywhere. Nothing is for certain. So, have a backup plan if you don't get in this year... and also consider what you could do with your life should you not get in at all. This might even mean considering taking a 'pre-med' degreee other than biology, since you don't need a biology degree to apply; if the only job you'd be interested in doing that you can get with a biology degree is medicine, you might want to do something else.
9. ...but don't give up if you don't get in your first time.
It's turning out more and more now that getting into medical school is more about learning how to "play the game;" because it's such a crap shoot, anybody who doesn't get in their first time applying would be stupid to throw in the towel right away. Even if you didn't get an interview, go to an advising session if any of the schools you applied to offer one, and give it another go.
8. If you do get in, don't do anything the summer before you start classes.
Seriously - don't work. Travel, but only for part of your summer, since travelling around can be stressful and you want to have time to veg. Give yourself at least a few weeks to sit around like a bum and do nothing, maybe see some friends that you won't be able to hang out with when things get busy. Let me put it this way: you now only have a couple of summers left (unless you chose to apply to a 3-year program!).
7. Know what doctors do before you decide you want to be one.
It would be devestating sacrifice so much energy, effort and free time just to keep up in the pre-med rat race and realize later on that medicine isn't for you, so learn what a doctor does - not just daily, but learn what the lifestyle is like, the stress level, the impact on family life. How? A few ways: you can read books and biographies about physicians, you can shadow physicians where you live, or you can go to a developing nation and volunteer your services at a medical clinic or hospital. The third one shows commitment and could have much better opportunity for clinical exposure, thanks to different policies on liability; though if you do that, please make sure you're going to a place where you can actually contribute and not just be watching or being a pain, and remember that some med schools actually use the length of time you spend away as a 'filter' for resume padding; a former dean of admissions in Canada, as quoted in a newspaper article: "only the affluent can spend six months in Africa volunteering at an AIDS clinic. ... it's become sexy to put stuff like that on an application.... but they're not necessarily going to get extra points for it."
6. Know what other health care professionals do before you decide on medicine.
What does a perfusionist do? What's within a Respiratory Therapist's scope of patient care? Did you know that there are nurse anesthetists? How do you know that you want to be a doctor, not a nurse? As well, getting to know other health professions will help you respect other health care professionals once you start working with them. Finally, it will add depth to your understanding of your own motivations if you can be positive that you want to be a doctor, and not some other type of health care provider. Following #4 (below) can play a huge role in satisfying this, but make sure you still get the chance to see what these people do in real life as well. From my experience, anyone in these professions is more than happy to tell a future doctor what their job involves, if they're approached with interest and respect.
5. Don't kid yourself: Training to become a doctor is one of the most difficult things you can do.
Even though it may appear easy at first, when finals come around (even in first year) you will realize that you've never done anything more difficult, more demanding mentally, intellectually, and emotionally. It will take over every minute of your free time and you will have to set aside time usually devoted to family, friends, and yourself; literally my entire days the month before finals was wake/study/sleep, even though in undergrad I never had to study very much for most courses. The only people who don't feel this way around finals are the ones who have spent their entire semester studying, literally every day and weekend, or are exceptionally brilliant - and there will only be 1 person of the latter kind in your class so chances are it won't be you. And that's just first year. For third year, add all that stress to being on call, having to deal with patients, nurses and doctors daily, having a pager go off while you're sleeping, and having to study for finals in the midst of all that. In all honesty, I've always said that the only thing I can think of that is more demanding and draining than becoming a doctor is boot camp, and boot camp only lasts 12 weeks. However, that was until I read about a U.S. Marine turned doctor, who discusses "How Residency is Different from the Marines" (scroll down to find it). Even though he says the Marines was harder, training to be a doctor must be pretty hard in order to even deserve the comparison.
4. There is much value in reading the online medical blogosphere.
See my posts titled 'why pre-meds should read medical blogs' (which I'll write someday) or 'a guide to medical blogs for beginners' . Here, though, I'll just list a couple of the several reasons. You'll see from jaded residents and medical students just how hard med school can be (try reading the Don't Become a Doctor series on iFindings' blog, as an example). You'll learn what being pimped means and how med students react to it and the subtle, unspoken rules involved. You'll hear about the most exciting moments in the OR, what it's like to be sued and sued again, learn from the mistakes of medical students and read what residents wish they had done differently. As well, you'll learn more about different health care professions if you take the time to read their blogs, fulfilling piece of advice #6. Beyond that, medblogs can give you a perspective on how these different professions work together in the same problem - see, for example, the story Perspectives, written in three parts: part I by a cop, II by a paramedic, and III by a nurse. And, you'll get involved with the profession in a unique way - by engaging in discussion, leaving comments and e-mailing blogging doctors, you can get 'face time' and advice from physicians that you might not get elsewhere.
3. Make sure that going into medicine is your own decision.
Are you doing this because an expectation has been imposed on you by your friends or family? Is this a dream you once had that has now faded, but it's just too hard to tell everyone that you are switching career plans? If you do go into medicine just to satisfy someone else's plan for your life, you are going to hate yourself, and you'll have nothing to keep you going when you have to give up everything for medicine.
2. Marks come first. You can always add volunteer activities after you graduate; you can't go back and increase your undergraduate GPA.
You don't want to look back on a year or a degree and say, "Those marks don't reflect my true potential...I wish I would have worked harder." My dad has told me over and over again of a man he knows who wanted to get into medicine, but when it came down to applying, his GPA was too low because he'd had more fun than study time in his first year of university. More than a few times I've been having conversations with people who say "My brother / cousin / friend tried to get into medical school, but couldn't..." and often it ends up being a GPA issue. Some people end up having to take a master's degree just so that their undergrad marks aren't considered... they have to work extra hard to make up a first semester where they played more billiards and pranks than studied, or a year when they didn't figure out that they understand organic chemistry until the last week.
1. Be 1000% sure that medicine is what you want to do.
...and make sure that you've completed #7 so that you are making an informed decision. Please do not go into this profession if you aren't completely and utterly sure that this is what you want to do. You'll only end up hating yourself for it, and if you stay in the profession, everyone around you will hate you, too.
Monday, July 16, 2007
The Official Grand Rounds, Volume 3, Number 43
Welcome to Grand Rounds, Volume 3.43, hosted for the first time ever at VitumMedicinus.com.
Having used Grand Rounds as a springboard into the world of medical blogging when I first started reading medblogs, it is truly an honour to be hosting Grand Rounds.
The template for this Grand Rounds is as follows:
Description: In his quest to bring you Grand Rounds, Vitum Medicinus went from excitement to panic to enjoyment. Excitement = signing up for Grand Rounds months ago. Panic = when 22 submissions had arrived in my inbox by Friday morning. Enjoyment = putting GR together. Once I got started, it was actually nothing to be panicked about.
Why you should read it: There are some stellar posts in this edition, and for every post I’ve spelled out why it’s worth your time. As well, for the bloggers observant enough to notice that I requested they submit their favourite food along with their blog post, you’ll notice their dish of choice represented pictorially beside their entry. Just one more way Vitum Medicinus is going above and beyond in an utterly pointless and time-ineffective manner.
Award: Grand Rounds 3.43 gets the Vitum Inclusivus award, for subscribing to the age-old (and very childish) “Everybody Wins” concept. This has been manifested in the following manner: Each of the 35 blog posts that were submitted and received a confirmation e-mail have been included, and every one has also received a cryptic Latin-ish award of some sort. (If you need a certificate of your award for your office or bedroom, for reasons of ego-bolstering or personal gratification, you are welcome to print one for yourself.)
Please enjoy Grand Rounds volume 3.43. Feedback, discussion, and criticism of this edition of Grand Rounds are requested and are very much welcome.
It’s pretty annoying to have to deal with a spoiled kid who says “I’m telling my dad!” when they don’t get what they want. Val Jones, MD at RevolutionHealth.com writes about a young man with VIP syndrome, who does just that, and complains to his dad that he wasn’t admitted when there was no medical indication that he should have been. This guy treats the hospital like it’s a casino – at the end, he expects that his care should be comped because his dad threw a lot of money into it. (This would rarely happen in Canada, by the way.)
Why you should read it: You’ll be disappointed to read how elaborate this becomes, involving the CEO of the hospital and the patient’s insurance company… especially when you find out who gets the shaft at the end. As well, you might be interested reading or contributing to the discussion generated by this post.
Award: The Geographicus relocaticis award, for rightly putting this arrogant, snotty, spoiled brat in his place; as well, placement in Vitum’s Top V.
If somebody tells you that after this year’s Running of the Bulls, they have “reviewed with interest the reports and video clips of the bulls goring the runners,” they are either a) a bit out to lunch or b) a surgeon. Having not done clerkship, I have no bitterness towards surgeons (yet?) so I will not take the well-set-up opportunity to say something like “you have to be ‘a’ to be ‘b’.” Won’t go there.
Instead, I will simply say that the editors at Inside Surgery have put together a unique post they call “Possible Types of Injury after being Gored by a Bull.” I don’t think any more explanation is necessary. Strangely enough, this submission is eerily similar to my medschool friend’s desire today to discuss “Possible Types of Injury after being Beaten with a Hammer” (he came up with two thanks to his ER shadowing shift last night).
Why you should read it: Because you don’t want to be in the situation, inevitably someday, when you wish you did. Read it, and then you’ll be the hero who knows what to do when you’ll have to provide first aid to / assess / refer a patient who has been gored by a bull. Subsequently, eligible members of the opposite gender will flock towards you. (Not guaranteed.)
Award: The Practicalus improbabalus award, for being practical advice for an unlikely situation; as well, placement in Vitum’s Top V. Maria at Intueri.org hosts a Literary Medblogging Project called A Picture is Worth A Thousand Words. The writing in this little project is so good that I can’t even top the description that Maria submitted: “Five medbloggers of the more literary persuasion collaborated on what has become an (at least) annual event--you know, to take a break from the usual randomized, double-blind, placebo-controlled rants that usually occupy our blogs.”
Why you should read it: Stunning writing. Times five.
Award: Serialus excellencissimus award, for high-quality writing over and over; as well, placement in Vitum’s Top V.
In an old man’s final hours, a nurse came into his room with a syringe and hooked it up to his IV. When the patient’s son asked what she was administering, she said, “Oh, just some morphine. Just to make him comfortable. We don’t want him in any pain.” It wasn’t long after that my grandfather breathed his last.
Geena at Code Blog submitted a story that reminded me a lot about this incident with my grandfather, and her and I actually got into a little bit of a discussion about this practice that happens in real life but isn’t taught in nursing school. In her post “On the verge of what society finds acceptable,” she reacts to a physician in the UK who took this one step further, administering not a sedative but a paralytic to an infant with agonal respirations.
Why you should read it: You should know where you stand on topics like this one. If it happened to my grandfather, it could happen to yours, or to your child, or to you. And if doctors are apparently taking this one step further, you might want to know about it.
Award: The Contemplatus arresticus award, for discussing something that goes on in the hospital that makes you really stop and think for a minute; as well, placement in Vitum’s Top V.Over my med body!'s Graham Walker gets top points for putting together ... get this ... The Clerkship Video Workout Guide, specifically targeted at preclinical students who are about to enter the world of the wards. This video answers a lot of my questions about clerkship, especially the burning one, "What physical manoeuvers can I practice to prepare for my clerkship?" My favourite exercise: "Surgery Exercise Number 1: I like to call it... Just stand there." It's almost as good as the final surgery exercise. Anyone who will one day hold (or has held) a retractor at an uncomfortable and awkward angle will identify quite well with this video.
Why you should read it: Because it’s not even a blog post that you have to read; it’s one you watch. And laugh at.
Award: The Goldenglobus Oscarifficus award, for putting his dashing likeness on camera; as well, placement in Vitum’s Top V. "A patient refuses a life-saving treatment. What do you do?" Virtually every medical student has looked over ethical cases in an effort to prepare for their medical school interviews. This is all well and good, until you realize that an ethical situation takes on a whole different meaning from reading about it in a book, to when you're on the wards and it's a patient staring you in the face. Sid Schwab writes a post at Surgeonsblog called "Blood Oath" on one of the classic med school interview ethical cases... and talks about how in real life, finding the edges of the often blurry ethical 'line' can be a lot harder than citing a textbook on ethics - or simply falling back on legal precedent.
Why you should read it: Instead of reading about an ethical dilemma discussed by a philosopher sitting in an office, try reading about an ethical dilemma by a physician who has had to put ethics into action in a life-or-death situation. Trust me, it's much more compelling.
Award: Honorarius medicinus, for having the honour to respect patient's wishes, even when some ethicists would say he's wrong, and when colleagues have said they won't do it. As well, a placement in Vitum's Top V (which I suppose is now the top VI) as a way to apologize for my oversight in not including his post in Grand Rounds from the start.
Bongi, the surgeon who writes at Other Things Amanzi, submitted two equally disgusting stories of experiences in the operating room. If you think the job of Grand Rounds editor is easy, it is making decisions like this which choosing between these two posts that would convince you otherwise. I went with the one that doesn’t have the high likelihood of ruining a popular food for you…(medicine tends to do that with food…check back here soon for a post on that, in the works) though I’m sure you’ll easily be able to find the post I chose not to include, if you look for it.
Why you should read it: To prove to yourself that you have a strong stomach, and to catch a glimpse of just how big that mythical creature known as the Ego of Surgeons actually is.
Award: The Incitus Vomitus award for the most disgusting post to Grand Rounds this week. (I won’t translate the name of this award into English. If you really want to know, look it up in any reputable Latin textbook).
It’s a medical student’s greatest dream come true. They are standing in the wards, when, all of a sudden, “CODE BLUE” comes squaking out of the intercom. All of a sudden, the student gets to witness one of medicine’s greatest orchestrated lifesaving ballets in action: running a code. After reading about CODE RED at Rickety Contrivances of Doing Good, I found out that a CODE RED is just like a CODE BLUE - the only difference is, in a code red, nobody knows what to do. Random fact: “Paging Dr. Pyro” is used by some hospitals to mean “Code Red,” according to the infallible Wikipedia. As a patient, I’m not sure which would be more unsettling to hear over the intercom.
Why you should read it: Because experiencing a real live Code Red, albeit vicariously, is pretty exciting (at first).
Award: The Combusticus avoidicus award, for averting certain disaster by fire.
From Counting Sheep, Tales from the Nurse Anaesthesia Front comes a story of a combative nurse who wrestles a patient into TKO, despite the patient being the greatest heavyweight boxing champion of all time. Pretty macho for someone who claims that their favourite food is “any kind of chocolate cake with a warm molten center.”
Why you should read it: This story has to be read to be believed.
Award: The World Heavyweight Boxing Championship Trophy. For obvious reasons. 
A post from Musings of a Distractible Mind called “Joi de vivre” talks about how life and work can really get to you. “Life often seems like a hamster wheel - the harder you run, the more tired you get, but you never get ahead,” writes Dr. Rob – sound familiar?Why you should read it: Because that’s not the end of the story; Dr. Rob has found “a ray of sunshine” to light up the dreary days, and you should read to find out what it is.
Award: Employerus exemplari, for making “Equal Opportunity Employer” more than just an empty statement stamped on his office’s want ads.
In a post titled simply “Loss,” Neonatal Doc writes an incredibly touching story that outlines one of the most tragic moments in any parent’s life – the loss of a child. It’s a moment that admittedly neither a fresh medical student like myself, nor a seasoned physician like neonatologist looks forward to.Why you should read it: Because it is better to be in a situation of consoling grief once you have read a post like this, which (along with its reader comments) tells you what you should and should not do in that situation.
Award: Lacrimarum nostrum, the tear-jerker award, for making us cry. Have a tissue handy.
Just as in the previous post, the McCanns are suffering from a lost child, but in another, entirely different and equally devastating, manner – their daughter simply disappeared, victim to abduction. Dr. Rima Bishara at The Doctor Blogger has passed on what was originally an e-mail the family hopes will be forwarded extensively so that this four-year-old girl can be found. (Of course, should you choose to donate money to any cause online, make sure that you are looking at a legitimate website - some pathetic criminals have tried to profit from this family’s loss, defrauding people into giving to fake funds by setting up fake websites).Why you should read it: Because Madeline has such a unique birthmark that unlike many other missing children’s photos, you won’t forget her’s.
Award: Compassionatus empathaticus, for showing the compassion and empathy characteristic of an excellent physician by petitioning for this child’s speedy return to her family.
Bruce Campbell, MD writes a reflection on the difference between “knowing” and “understanding,” as he was taught by a five-year-old boy. Let’s just say that it happened on the 5th of July, many years ago, and like a good dramatic story, this one contains a good dose of suspense.Why you should read it: Generally, any time a story starts with “This is something I have never forgotten,” it’s usually a pretty good story. As well, this post was designated by a reader as a piece of wisdom worth saving for her unborn grandchild.
Award: The Paternalis aureus award, for providing golden, fatherly medical advice in the form of high-quality writing.
Dean Moyer describes himself as “a guy who discovered one day that he had a bad back and then spent 10 years ignorantly seeking chiropractic treatment for it.” And yet, for an anti-chiropractic blog, it’s actually really well put together and respectable – arguments are objective, the website takes a tone of contemplative disappointment rather than ignorant rage, and he’s not trying to sell quack creams or potions. As you might expect, there are people who take offence to his website, particularly people who stand something to lose should the chiropractic profession be challenged. The post “Dumb Day and Disk Decompression of Delaware” talks about the unusual response of one of these people to Dean’s website. Make sure you click through the “Continuing Saga” links at the end of the post to get the full story.Why you should read it: A few reasons: 1. The alliteration in the title of his post. It’s incredibly impressive, in its intelligent idiosyncrasies (I spent more time on that sentence than I did on all of Grand Rounds). 2. Hillbilly humour. Always gets a laugh (what I like to call a ‘universal punchline,’ kindof like Chuck Norris jokes). 3. In all seriousness - you might be surprised at the way these “professionals” have responded to Dean’s website when you get to Part 3.
Award: A Bloggisimus novicus award, for being a First-time submitter to Grand Rounds! Welcome Dean!
ERnursey at, uh, ERNursey writes a post just like the ones that got me hooked on medical blogging, called “Dumb reasons to come to the ER.” I don’t know why I get such a kick out of patients demonstrating lapse in judgement, when they’ll inevitably be a source of major frustration to me once I actually become a doctor.Why you should read it: Because you won’t believe how dumb some of these people are, and because you should leave a comment encouraging ERnursey to provide more stories like this.
Award: Toothicus clenchicus award. For being able to clench her teeth and get through having to deal with these stupid, stupid patients.
“Suffer the children who don’t fit the mould,” by nurse Sandy Szwarc at Junk Food Science, is another one of those posts best described by the author. It begins: “Imagine having a daughter with a rare condition that is poorly understood and health authorities seem disinterested in helping to diagnose. It’s not that girls and boys just like your daughter haven’t been seen throughout history, but today she’s mocked and viewed as a freak and everyone is pointing the blame at you — so much so, that government officials have taken your daughter away and made her a ward of the state.”Why you should read it: Because you’ll be shocked to read the ridiculous reason this girl was taken away from her family. And, Sandy uses rational discussion to propose that a dramatic blanket crackdown on childhood obesity may NOT be that well thought out.
Award: The Advocatius familii award, for using her background in clinical medicine and scientific education to advocate for the unfortunate parents.
Dr. Linda Regan, a contributor for the NY Emergency Medicine blog, discusses some of her experiences as a female physician ranging from breast feeding to ordering morphine that suggest gender disparities still exist in the world of medicine.Why you should read it: Because when you read the first story of how she was treated by a chief, you’ll be shocked that things like this actually happen in real life.
Award: The Feminatus commendibus award, for being a female having to put up with what is, in many ways, a male-dominated profession.
Dr. Paul Auerbach talks about a trap that caught his friend during a camping trip. You will be surprised to see how dangerous such simple consumer products can be.Why you should read it: Because pictures tell a thousand words, and you should click the link lest ye end up in the same trap.
Award: Solutionatus ingenious award, for coming up with more than one possible solution for an unexpected problem. . . and choosing the better one.
When I put out a call for posts containing drama, action, OR humour, I never expected to get a post that tried so hard to fit all three (and did so successfully). Interestingly enough, it doesn’t seem like Kim at Emergiblog had to try so hard – she was treated to all three elements during a shift on her 50th birthday.
Why you should read it: Because a) you need to click on the link so that you can comment and wish Kim a happy 50th birthday, and b) because once you read this you will be convinced to take off work any birthday of yours that ends with a zero (or two).
Award: Kim basically begged for an award, so she gets the Desperatus inclusivus award, for working hardest to fit the theme of this week’s Grand Rounds. You’re one in a million, Kim. (well, one in 35.) Look, you even got your own category!
At first I misread the e-mail and thought that a ham and cheese sandwich was Anonymous Therapist's (Keep Breathing) favourite food, but later realized that a ham and cheese sandwich is instead an integral part of the plot for The Tale of Mr. Bignose, one of AT’s favourite patients.
Why you should read it: Uses a ham and cheese sandwich as a plot device, as well as the word “curmudgeon.” And stories about favourite patients are always worth reading.
Award: The Keenerificus maximus award, for being the first blogger to submit a post to Grand Rounds v3.43.
Written from a patient’s perspective, Ileana’s blog Beating Social Anxiety holds more than one post about feeling like a medical condition rather than a person. In this particular post, “Are you ready to use props,” Ileana tells about a medical student who leaves a much better impression than either the doctor or a resident. (If this ever happens to you, make sure you encourage the medical student. They can always use some positive reinforcement.)
Why you should read it: Anyone in the health care profession should always jump on any chance to see how things are viewed from the patient’s perspective, especially when we need to learn from another health care provider’s screwup. This post is also a solid reminder that you never know if something deeper is going on.
Award: The Bloggisimus novicus award, for being a First-time submitter to Grand Rounds! Welcome Ileana!
Kristie McNealy, MD of NICU 101 tells the story that explains why she would put a residency on hold, and instead focus on family-centered care to advocate for families of premature and critically ill newborns. Unfortunately, it’s another rude healthcare provider story. Fortunately, Dr. McNealy chooses the positive way out, instead of brooding in anger and resentment, she actually uses it to motivate her into making a difference.
Why you should read it: Because this post uses a touching story to show that in the same way that it is important to see things from a patient’s perspective, healthcare providers need to learn to see things from the family’s perspective as well.
Award: Transformus Obstacalis Opportunisticus, the Transforming Obstacles into Opportunities award, for being treated rudely by a doctor . . . and working hard towards making something positive come out of it.
Type I diabetic Kerri Morrone at Six Until Me reviews a highly technical product that promises to revolutionize the medical industry. The only dilemma it presents is whether to use the product when your blood sugar is low, or not.
Why you should read it: Because this product could change your life, and I’m not going to tell you what it is. It even lights up. Personally, I can’t wait to get my hands on one.
Award: Jealousum incitum, for inciting jealousy in me. Yes. This product is that good.
The FDA issued a warning in 2004, stating that antidepressant use in patients less 25 years old can increase suicide rates, after hearing anecdotal evidence from mothers who had lost their children to suicide and implicated their children’s medication. Jake Young at Pure Pedantry lashes out against the FDA for this “black box” warning, citing a recent publication in the American Journal of Psychiatry which wields evidence to contradict the FDA’s anecdotal conclusion.
Why you should read it: Because this issue is a hot topic, and you should get involved in – or at least take a look at – the already hot discussion going on in the comments section under Jake’s post.
Award: Thermophilus symposius, for inciting the most heated discussion topic of any post in this issue of Grand Rounds.
Dr. Jolie Bookspan, also known as The Fitness Fixer, talks a bit about her past research with the Navy. Apparently, Viagra has been tested for use against altitude sickness. Grand Rounds was almost left incomplete as I spent most of the weekend trying to find out how to apply to the navy.
Why you should read it: Because you want to know, just like I did, what role Viagra could play in air travel. (Get your mind out of the gutter.)
Award: The Aviatus Erectus award, for encouraging flight medicine researchers who walk uprightly in both posture and morality. (You! Mind…gutter…out….now.)
Amy at Diabetes Mine has submitted a post called “Help Cure MI,” in which she reviews MI – a condition described as invisible, chronic, and suffered in silence by millions. You might even have it and not know it yet.
Why you should read it: Because you don’t know what either MI or the award below mean, and reading this post will let you find out both.
Award: Paedis ravinus honourificus, or the Crow’s Foot Badge of Honour.
Alvaro at The Sharp Brains blog presents an interview with a paediatrician, discussing a cognitive skill called Working Memory. There are some good examples that help explain what Working Memory is, and how it has helped patients with seemingly insurmountable challenges due to ADD / ADHD.Why you should read it: Brains are fascinating, and everyone wants a sharp brain. Where better to start than reading a website called Sharp Brains. And it’s exciting to learn of a technique to help children who suffer from ADHD.
Award: The Intellectus stimulatus award, for provision of brain teasers elsewhere on the website. I’ll admit, I got sidetracked.
Mousetrapper at Med Journal Watch describes the latest in Type II Diabetes research: The practice of taking selenium to prevent diabetes has been disputed, with reports in the mass media that it actually can cause a 50% increase in diabetes risk.Why you should read it: So you can see Mousetrapper’s level-headed recommendation on how to handle this latest perspective.
Award: Cuttimus edgimus award, for staying on the cutting edge of medical research.
Your mother had breast cancer. So did her sister, and your two sisters have both been diagnosed in the last year. What’s the reasonable thing to do? Get genetically tested for breast cancer. Or is it? Dr. Lei writes at eyeondna.com about public perception of genetic testing, and – get this – a recent article published in NEJM suggesting that BRCA mutation carriers with breast cancer actually don’t have a worse prognosis.
Why you should read it: Because Dr. Lei addresses the question, “Given the above, should you still undergo genetic testing?”
Award: Advicum practicalus, for providing practical advice on a topic that can be pretty confusing for medical students, let alone patients.
My mother taught me not to sign my organ donor card. “You never know,” she said, “maybe if they need the organs they’ll let you die, then scoop them up.” TC, an organ procurement transplant coordinator who writes at Donorcycle, tells why this kind of view is more of a myth than anything.In case you’re wondering, I did sign my donor card. This, by the way, was one of the first times I went against my mother’s wishes, and it has become progressively easier since then – I have now come so far as owning my own motorcycle (okay, just kidding. I’m only at about staying awake past 8:00 pm) .
Why you should read it: Because it’s up to you to decide if TC’s argument should be believed…especially with a title like “Organ procurement transplant coordinator.” (Just kidding. I believe it.) It might also help answer that question which is undoubtedly in your mind, “When I am around an organ procurement transplant coordinator, should I keep a careful hold on my organs?”
Award: The Scooper Dooper award, for being an organ procurement transplant coordinator.
Do doctors owe anything to their patients if they write a book? Even if the book doesn’t include that patient? Or if it does include the patient but alters all details? What about the above scenarios in relation to blogging? LMF, the author at Ad Libitum, tackles these questions in a post entitled “From Hippocrates to HIPAA” in which the subject of blogging about patients comes up yet again. Included is a helpful list of recommendations for medbloggers.Why you should read it: Because if you are a patient, or a blogger, it is in your best interest to be fully aware of the privacy issues that are paramount to blogging health care providers, and it’s hard to get to the point where you’ve read too many reminders about HIPAA.
Award: The Checkissimus realitus award, for providing a reality check for anyone who runs a blog and reminding us all that we must be accountable for what ends up being published.
Bob Vineyard publishes a post at Insureblog akin to playing “taps” in memory of Dekalb General Hospital’s emergency room. This shutdown is putting the residents in its area an additional 20 minutes away from the nearest trauma centre
Why you should read it: So you can find out why it closed; and, so you can read if an ER near you could be next on the chopping block – Bob lists some other ERs that are within reach of the axe.
Award: Elevatus routus (the High Road award), for taking the effort to actually propose a solution to a healthcare crisis, rather than simply complain about it.