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

Related Posts:

• Some Notes after Grand Rounds, and Ques­tions for Medical Blogs and the Internet
• Why Should Physi­cians Blog or Use Twitter?
• A Website About Illness In Celebrities and Other Public Figures
• Wednesday Web and Shoutout: Flashfree Moves to a New Site
• Shoutout to Shrink Rap