Medical Blog Grand Rounds – June 29, 2010 Edition

(Vol. 6, No. 40)

Learn­ing about med­i­cine is a life­long endeavor whether you’re a patient, a doc­tor, a care­giver, a hos­pi­tal admin­is­tra­tor or, per­haps, even an insur­ance com­pany exec­u­tive. In today’s Grand Rounds, we’ve an array of eleven per­spec­tives that, directly or indi­rectly, bear on the sug­gested theme of education.

If there’s a motif that emerged unso­licited this week, it’s empa­thy, a term high­lighted in the titles of two sub­mit­ted posts:

In Glass Hos­pi­tal, Dr. John Schu­mann con­sid­ers what moti­vates health care work­ers in a thought­ful post, Find­ing Empa­thy. Schu­mann, an internist and med­ical edu­ca­tor at the Uni­ver­sity of Chicago, sug­gests that doc­tors and nurses need to re-encounter and re-engage with empa­thy to con­tin­u­ally find mean­ing in their work.

Bed­side Man­ner, a blog out of Boston’s Ken­neth B. Schwartz Cen­ter, offers an arti­cle on ‘Boost­ing’ Empa­thy through Con­tin­u­ing Med­ical Edu­ca­tion. Here, direc­tor Julie Rosen writes on newly-published data on the value of post-graduate, inter­dis­ci­pli­nary ses­sions where clin­i­cians dis­cuss psy­choso­cial and emo­tional aspects of patient care.

Near empa­thy lies the con­cept of inter­per­sonal con­nect­ed­ness. In that vein, sev­eral of this week’s essays con­sider the essen­tial and some­times close (or not-so-close) rela­tion­ships that form between patients and their doc­tors, between physician-educators and doctors-in-training, and between sci­en­tists who study par­tic­u­lar dis­or­ders and the pub­lic that depends on their work:

In How Can I Explain it to You? The Life of a Grad Stu­dent With Lupus, a young woman (20-something, as self-described) blogs anony­mously about her expe­ri­ences as a per­son with sys­temic lupus ery­the­mato­sus. Her lat­est post, it’s sup­posed to be a ‘doctor-patient’ not ‘doctor-disease’ rela­tion­ship bemoans the lack of atten­tion given to empa­thy (yes, it’s here too!) and patients’ lives in med­ical edu­ca­tion. “Don’t test only the sci­ence,” she recommends.

Dr. Kim­berly Man­ning is a med­ical edu­ca­tor at Atlanta’s Grady Memo­r­ial Hos­pi­tal. In the ACP Hos­pi­tal­ist she con­sid­ers the tran­sience of some rela­tion­ships, and per­ma­nence of oth­ers, formed between fac­ulty and junior doc­tors pass­ing through that pub­lic hospital’s res­i­dency train­ing pro­gram. Her post, “Life at Grady: A clinician-educator reflects” included some lovely verse. After read­ing those lines, I couldn’t resist try­ing to find out more on Alek­san­dra Lachut, a poet pre­vi­ously unfa­mil­iar to me.

A recent Health Busi­ness Blog offer­ing weighs in on the emo­tional and heal­ing value of con­nect­ed­ness among patients. In a tran­script of his Pod­cast inter­view with LaChance Pub­lish­ing Pres­i­dent Vic­tor Star­sia, HBB author David E. Williams reveals why Debra LaChance founded the Heal­ing Project. This non-profit orga­ni­za­tion pro­vides sup­port and edu­ca­tion for peo­ple with breast can­cer and other chronic or life-threatening dis­eases. It encour­ages patients’ shar­ing of sto­ries through a book series, Voices Of.

In his wrench­ing Med­i­cine vs. Reli­gion: My Brother’s Keeper Revis­ited, Dr. Alan Dap­pen con­sid­ers the predica­ment of a severely ane­mic woman who refused treat­ment for many years based on her firmly-held reli­gious views. Draw­ing on his own, per­sonal expe­ri­ences with a brother whose faith-based ideals led him to decline care, Dr. Dap­pen per­suaded the patient to accept med­ical help. This and related posts by can be found on Bet­ter Health.

A sci­en­tific sort of con­nec­tion is espoused by Wal­ter Jessen, Ph.D., who edits and writes at High­light Health. In his early-June post on The 2010 NF Con­fer­ence – Con­nect­ing the Pub­lic with the Research, he antic­i­pated the research pre­sen­ta­tions at a meet­ing on neu­rofi­bro­mato­sis (NF) spon­sored by the Children’s Tumor Foun­da­tion. Although con­fer­ence atten­dance was restricted to researchers, the foun­da­tion decided to pro­vide infor­ma­tion and updates to the pub­lic through a video and blog. What I liked best was the video, in which Dr. Kim Hunter-Schaedle explains the sig­nif­i­cance of the NF con­fer­ence theme: “Back to the Future.”

Mov­ing on, toward a most prac­ti­cal aspect of med­ical edu­ca­tion, the ever-anonymous and Happy Hos­pi­tal­ist tells us in Dif­fi­cult Foley Catheter Inser­tion. I Got To Watch The Cath Man In Action how glad he was to absorb, first-hand, details on the intri­ca­cies of plac­ing a Foley the right way. (As some­one who’s, um, had quite a few surg­eries and sub­se­quent catheters, I can­not exag­ger­ate the sig­nif­i­cance I assign to this type of spe­cial­ized knowledge.)

Going fur­ther in a prag­matic direc­tion, Louise Nor­ris advises patients and doc­tors to “think twice” before CT scans in her post Radi­a­tion Expo­sure from Med­ical Test­ing. She and her hus­band own Insur­ance Shop­pers Inc., provider of the Col­orado Health Insur­ance Insider blog. Of inter­est, Nor­ris advo­cates a radi­a­tion med­ical record that would track a patient’s total expo­sure to imag­ing radi­a­tion over a life­time. Health insur­ance com­pa­nies could help patients, she sug­gests, by reduc­ing their risk through the approval review process for imag­ing stud­ies. “If an ultra­sound could be used instead of an x-ray, or an x-ray instead of a CT scan, we could be sav­ing money as well as pre­vent­ing future can­cers,” she writes.

My favorite title of the week comes from Insure­Blog’s Bob Vine­yard, CLU (that’s Char­tered Life Under­writer, just in case you’re won­der­ing as I was). In his Mis­sion Accom­plished! post, Vine­yard rails on the con­se­quences of Rom­n­ey­care includ­ing a pri­mary care physi­cian short­age. One les­son from the Mass­a­chu­setts expe­ri­ence is that there will be an even greater demand for pri­mary care physi­cians under Oba­macare. As he sees it, the ques­tion for today’s aspir­ing physi­cians is whether or not to take advan­tage of that opportunity.

Finally, and com­ing full cir­cle, the ACP Internist sub­mit­ted a post authored by none other than Glass Hospital’s Dr. Schu­mann. This one’s called Cho­les­terol: val­i­da­tion of the self. Here, he ques­tions the merit of an estab­lished and per­haps over-valued con­cept in med­i­cine, that of low­er­ing cholesterol.

It seems to me, the notion of chal­leng­ing old assump­tions is a ter­rific les­son with which to end any cat­a­log of essays on education.

Lots to think about –

Many thanks to all who con­tributed to this week’s Grand Rounds!

ES