Medical Grand Rounds – January 10th, 2012


Welcome to this edition of Medical Grand Rounds.  I scoured the web and pulled together what I think are some of the more interesting posts and news items of the past couple of weeks.  I’ve tried to explore some voices that perhaps haven’t crossed your radar.  We’ve got sociologists, medical students, IT gurus, medical futurists and even a couple of doctors.  Some of the discussions have related posts that you might find interesting.  Posts are not listed in any particular order.

Patients as Consumers – The Milkshake Mistake

Aaron Stupple, The Adjacent Possible

This post by medical student Aaron Stupple approaches the delicate issue of viewing patients as consumers.   Aaron offers “one example where viewing patients as consumers stands not only to improve their care, but to actually deepen the humanist goals of those who are otherwise afraid of commoditizing a covenant.”   His example comes from a Clayton Christiansen article in the Harvard Business Review, The Milkshake Mistake.  The example challenges us to see the value of our service, not as what we think the consumer should desire but as what they truly seek.  This post is important because it demonstrates how we can draw concepts from other verticals to create solutions in medicine.  This is original thinking.

6 Big Health Tech Ideas That Will Change Medicine in 2012

Josh Constine, TechCrunch

While most year end predictions aren’t worth a damn, this tidy compilation of medtech prognostication from Dan Kraft is worth a read.  Mostly because it’s from Dan Kraft.  This guy has the reach and judgment to boldly see what the rest of us can’t.  In fact, I have to I squint and cock my head to see things as he does (so far it hasn’t worked).  Of his 6, I’m bullish on big data and AI.  And speaking of the future, I’m just finishing up what will be one of the most important books of 2012, The Creative Destruction of Medicine, by Eric Topol.  I’ll have a review up in the next several days.  But if you want to know where we’re headed, read and pay close attention to Topol….and Kraft.

Disabled Bodies and the Parable of the Good Robot

Sara Wanenchak, Cyborgology

Perhaps all this talk of the future will have us looking at the physically disabled in a new way.  Sociologist Sara Wanenchak at Cyborgology put together an interesting post on rethinking how we see the disabled.  It’s a beautifully written power piece that forces some interesting questions about what defines us as human.  Where is the line between organic human and machine? Wanenchak reminds us that we’re all cyborgs, “by virtue of the inconspicuous nature of much of our technology.”  If nothing else click through for the beautiful images of the amputee athletes.

Medicine – The Pot at Rainbow’s End

The Arts, Sciences and Medicine

This post from @JediPD on cholycystectomy and a conversation with the cell phone guy really stuck with me.  Perhaps I was haunted by the idea that the idea that the surgeon removing my gallbladder would potentially only see $350 for his effort.  It should be required reading for non-physicians engaged in the debate over health/insurance reform.  The  post comes in the wake of one of the most trafficked news pieces of the week from CNN, Doctors Going Broke.  KevinMD has a worthwhile commentary.  John Mandrola made a statement.  Jordan Grumet took a defiant stand for the freestanding medical practice suggesting that the doctors aren’t quite dead yet.  Click through, read and comment at will.

The Bee Dance

other things amanzi

Consistently unique in his voice and perspective is Bongi.  Of the dozens, if not hundreds, of pieces of copy that I scoured this week, this one pulled me in.  If not for the frightening analogy between a worker bee and an attending surgeon, the use of language that’s minimalistic and raw kept makes this worth a look.  I had to wonder how many U.S. surgical residents have considered beekeeping as a way to supplement their meager salaries.  And I suspect that even fewer have ever seen a salt mine.

Are EHRs Safe?

Fred Trotter, O’Reilly Radar

If you don’t know Fred Trotter, you should.  He’s smart as a whip and represents the latest addition to the O’Reilly Radar blog lineup.  With respect to EHR there aren’t many with his depth of insight.  This post opens up with the provocative suggestion that EHRs have been killing people for years and follows with some critical points to understanding healthcare computer systems.  “Are EHRs safe? Not in the least. But they’re safer than doing nothing.”  Love it.

His new book, Meaningful Use and Beyond, is a must read for anyone trying to understand this territory.

Drawing mental illness – Bobby Baker’s 11-Year Visual Diary

Maria Popova, The Atlantic Health Channel

In case you missed it The Atlantic just launched a health channel under the watchful eye of Nicholas Jackson.  Maria Papova introduces us to the visual experience of performing artist Bobby Baker after a diagnosis with borderline personality disorder and breast cancer.  Her book, Diary Drawings, is “at once a personal journal and a tenacious thesaurus that helps translate the misunderstood realities of mental illness into an expressive and intuitive visual language the rest of the world can understand…”  It’s worth a peek.

Maria curates a site called Brain Pickings which is one of my favorite destinations for amazing stuff.

Trap Door Days

Claire McCarthy, Thriving

If you don’t think that a doctor can be a patient (or parent) you might consider takin’ a walk in Claire McCarthy’s shoes.  Understanding the pain and perspective of a parent who has lost a chronically ill child is something that few understand.  And post offers an important look inside the mind of a mother who happens to be a pediatrician living each holiday with the memory of her greatest loss.  Claire lives and writes at Thriving, Boston Children’s Hospital’s blog.

I think that it’s this type of narrative that helps the world understand truly the mind of a physician.

The Weather, Arthritis and Woody Allen’s Orgasmatron

Ronan Kavanagh, Ronan Kavanagh’s Blog

Any post that invokes Woody Allen’s orgasmatron in furthering our understanding of rheumatology has my attention.  Galway rheumatologist Ronan Kavanaugh offers some interesting history and touches on the debate surrounding the weather and our joints.  I think that the history and debate surrounding this phenomenon could be fashioned as a compelling long-form article or book.

Richard Lehman‘s Journal Review

Richard Lehman, BMJ Blog

I wouldn’t have found this had 3 separate individuals not shared it with me.   BMJ physician blogger Richard Lehman posted The Ten Commandments of Medicine.  It was apparently done on behalf of John Yudkin who avoided the matter over “American religious sensitivities.”  I’m actually sensitive that he wouldn’t publish it.  The linked editorial on surrogate endpoints makes for a really interesting read but requires access to BMJ.  The commandments are a few swipes down at the bottom of the post.  I’ve referenced them here.

  • Thou shalt treat according to level of risk rather than level of risk factor.
  • Thou shalt exercise caution when adding drugs to existing polypharmacy.
  • Thou shalt consider benefits of drugs as proven only by hard endpoint studies.
  • Thou shalt not bow down to surrogate endpoints, for these are but graven images.
  • Thou shalt not worship Treatment Targets, for these are but the creations of Committees.
  • Thou shalt apply a pinch of salt to Relative Risk Reductions, regardless of P values, for the population of their provenance may bear little relationship to thy daily clientele.
  • Thou shalt honour the Numbers Needed to Treat, for therein rest the clues to patient-relevant information and to treatment costs.
  • Thou shalt not see detailmen, nor covet an Educational Symposium in a luxury setting.
  • Thou shalt share decisions on treatment options with the patient in the light of estimates of the individual’s likely risks and benefits.
  • Honour the elderly patient, for although this is where the greatest levels of risk reside, so do the greatest hazards of many treatments.

It seems most were drawn to number 10.

And in 60 seconds, a few other finds

Some goings on about the medical infosphere: Val Jones shutters Better Health Blogging Network.  Dan Palestrant, founder of Sermo launched Par80.  Nature carried an interesting piece on why physician researchers may want to be part of the Twitter conversation.  And coming to a deposition near you is distracted doctoring (I saw this coming).  In a world big data and evidence based medicince, Matt Ridley’s column on The Hunch has special relevance to physicians.  This collection Life magazine photos, What Health Care Looked Like, is interesting.  And a word for the wise: be careful what you read on those polished health infographics. Prayers for John Halamka’s family as he has been narrating pieces of his wife’s early journey with breast cancer.  I suspect personal insight from the experience one of the world’s leading CIOs might prove helpful for all of us.

Hopefully you found this compilation interesting and concise.  The nice thing about curation is that it reflects unique character and eye of the host.  A doctor’s interest and eye is clearly different from that of an e-patient or an allied health professional.  Hopefully subsequent hosts will bring their own perspectives to the table.

Next week’s Grand Rounds host is Codeblog.

Links to books are Amazon Affiliate links.