Grand Rounds Volume 4 No. 27
25 03 2008Welcome to the 183rd edition, or No. 27 of Volume 4 of Grand Rounds. This week, I am honoured to present you the best posts from the medical blogosphere. All submissions have been included.
I am a surgically-inclined medical student who someday hopes to a missionary surgeon. As such, i have interspersed amongst the posts some pictures from medical mission field around the world. Below are 2 tracks by Enya I thought might suit the black & white pictures.
The first is entitled “Only Time”.
The second is entitled “Storms in Africa”.

A mother keeps vigil at bedside, hoping medicine can save her infant from a merciless death. Malnutrition hovers over Camp-I-Sakhi, Tajikistan, during the hottest months. (image credit)
Picks of the week
Submitting well ahead of time, Dr Rob at Musings of a Distractible Mind writes a beautiful account of a recent patient encounter.
“It is nice to feel liked and important, but you always need to remember that the edge of the cliff may await you in the next exam room.”
Dr. T. chronicles in Notes of An Anesthesioboist a “deeply painful message” she had to deliver to a patient. Moving story.
Every patient encounter, every death, every mistake, contributes to a healthcare professional’s continuing medical education, which is challenging but not without immense satisfaction.

A patient is treated amidst the Israeli-Palestinian conflict. © Valerie Babize/MSF
Medical education
In 2004, Grand Rounds creator Dr Nicholas Genes challenged medical students to blog more often. Today, we have our very own Medical Students Blog Carnival, and many, many more blogs by medical students.
Surgical intern Dr Alice from Cut on the Dotted Line shares some tips for medical interns, paying tribute to the Butterfly. Those who have been around long enough know who she is referring to. Barbardos Butterfly’s “tips for surgical interns” may be re-published in due time on the surgical blog carnival, SurgeXperiences. Please hop on over to its catalogue of the past 17 editions.

In the Ivory Coast’s Bouake Hospital, MSF staff train a local surgical team to perform caesarean sections. MSF has been working in the hospital, located in the north, since a civil war erupted in the country in 2002. 2005 © Carl De Keyzer/Magnum Photos
Another regular contributor of surgical-related posts, S. African surgeon Dr Bongi from Other Things Amanzi, presents “Cuban Resus“, amongst an entertaining series on resuscitation.
A/Prof Westby G. Fisher, an internist/cardiologist/cardiac electrophysiologist, presents “How to piss off an attending“, highlighting how unacceptable it is for residents to prioritize their interactions with drug reps over an attending’s lecture at ‘noon conference’. Some sympathizers, however, present the residents’ side of the story.
Medical errors have been in the media spotlight in recent times. As fallible beings, health professionals are bound to make some along the way. We learn, take heart, and treat it as part and parcel of one’s professional education. A veteran ER nurse gives her take at her blog “madeness:tales of an emergency room nurse”. Most share their experiences, like ImpactEDnurse, who dispenses some pearls of wisdom as to how to avoid medication errors.
Nancy Brown, an adolescent health expert at Teens Health 411 brings us a warning about some products sold on the Internet that claim to prevent AIDS and herpes and prevent STDs.

A doctor in action
The practice of medicine
Dr John Crippen at NHS Blog Doctor tells us about a UK General Practitioner accused of “inappropriate, improper behaviour” in pre-signing blank prescriptions and blank medical certificates and provided them for use by a Nurse Practitioner.
Veteran surgeon blogger Dr Sidney Schwab from Surgeonsblog educates us on heat therapy in “Hot stuff“.
The responsibility of medical professionals when it comes to polypharmacy and drug overdoses is highlighted by Dr Ijeoma Eleazu, especially when it comes to the overwhelming list of celebrities’ deaths.

An MSF physician listens to the breathing of a patient receiving treatment for the disease kala azar at an MSF clinic in the village of Walgak in Sudan’s Upper Nile region. 2004 © Tomas Van Houtryve
Just another day as a doctor
Dr Whoo over at Ob/Gyn Kenobi is “just about all out of doctorly concern” after a hectic and challenging week at work and at home. Who could blame her?
With the impending tax day coming, Jenni Prokopy at Chronic Babe gives us some tips to make tax time easier.
Dr Sidney Schwab at Surgeonsblog reflects about how the new generation of doctors are different, and Dr James Gaulte, a retired internist, shares his thoughts on the matter as well.
Professor Kenneth F. Trofatter, Jr., at Fruit of the Womb, answers a patient’s question with regards to findings of chromosomal mosaicism at the time of chorionic villus sampling in first trimester.
ERDOC at M.D.O.D shares a funny story about a patient with bloody urine and a tea strainer and the ‘joys’ HIPAA has brought.

MSF-run clinics in four camps for internally displaced people provides basic health care and malaria treatment in the Kokrajhar district of northeastern India’s Assam state. ©Tom Craig
Medicine beyond our own boundaries
Dr Chris at Made A Difference for That One shares with us an excerpt from the International Committee of Red Cross report on living conditions in Iraq. We truly appreciate your work in a war-torn zone.
Another military surgeon Dr Josh points out the importance of victories in medicine, big or small, as he recounts his day on call as the SOD (surgeon of the day) at Baghdad.
Dr Aaron Buzzard, a military ER doctor, updates us on his weeks 17 and 18 in Iraq. Fascinating read, and it shows us how important it is to be thankful of a relatively peaceful work environment as compared to a war-torn zone.
Dr Paul Auerbach at Medicine for the Outdoors presents a notification post regarding the annual Wilderness Medical Society Annual Meeting this July - a big milestone (25th anniversary) for the organization. Combining one’s profession with passion; ingenious! Now, if only I were a doctor in the States.

An MSF outreach team visits families in the shantytowns of Quibdo, Colombia, helping people to register with local authorities for free health care. 2004 © Pieter ten Hoopen/MOMENT
The system
JC Jones from Healthline Connects exposes some “racial disparities in US Healthcare“, highlighting a well-known fact that health care spending does not always translate into health care outcomes.
InsureBlog’s Bob Vineyard has an intriguing look at the battle brewing between insurers and a new wave of “concierge” medical practices.
David E. Williams from Health Business Blog suggests a software licensing model for chronic medications that will drop costs and help patients.
Attorney Eric Turkewitz shares on his blog “New York Personal Injury Law Blog” his opinion on counterfeit heparin and the liability repercussions for Baxter.
Patient updates
Louise from Colorado Health Insurance Insider discusses the good experiences her parents have had with daily dialysis.
Susan Palwick from Rickety Contrivances of Doing Good, a depression patient, discovers a new test based upon a biomarker for depression, and wonders what others will feel about this.
Amy Tenderich at Diabetes Mine is holding a “Seven Words of Wisdom Contest for Diabetes“. Link on to comment and submit your best 7.
Just on quizzes, the board-certified psychiatrist blogger behind “How to cope with pain” interviews a certain Dr. Taylor who has come up with an interesting quiz site that helps evaluate how well kids are coping with any physical or emotional challenge and suggests ways to cope better.

A MSF doctor examines a tuberculosis (TB) patient in Thailand. (image credit)
Alternative medicine
Recently, the Ministry of Health (MOH) of Singapore has decided to put a stop to doctors offering patients a range of controversial, unproven beauty treatments: “Without having proper scientific evidence, it is not known whether these practices can cause harm in the medium or long term.” Aliendoc muses about the double standards the MOH seems to portraying with regards to Traditional Chinese Medicine.

At any given moment, more than 60 million young children in the world have signs of acute malnutrition and are at serious risk of death unless they receive specialized care. But ready-to-use therapeutic foods and outpatient treatment strategies now allow many more acutely malnourished children to be treated than ever before. Chad, 2006 © Philip Horak
Thank you for participating in Grand Rounds. The next edition will be hosted by GruntDoc. It’s been my pleasure to host.




Well done. I have lots to read still, but appreciate the care you obviously took. It is a whole lot of work (as I well know). Thanks too for putting a highlight on my post. I am very honored.
Excellent Edition. Thanks a lot for the mention and the great job you have done.
Very nice, Jeffrey!
[...] Grand Rounds is up at Monash Medical Student. I am very grateful for Jeffery highlighting my post The [...]
well done. it was as good as i was expecting from you.
Thank you for your kind comments. Hope you are enjoying the well-written posts.
[...] out the latest edition of Grand Rounds at Monash Medical Student. +del.icio.us +Digg [...]
Outstanding job, Jeffrey!
Thank you for hosting, and for including our post.
Grand Rounds is up!
Monash Medical Student Jeffrey Leow presents a stark but compelling edition of Grand Rounds. His own interest in surgery is evident in the haunting photos interspersed throughout. And, with over 2 dozen intriguing posts, it’s hard to choose a favorit…
I just found your blog and I’m very inspired! I have been trying to decide between medical school and nursing school with Midwifery certificate to follow. I haven’t made my choice yet, but I am truly fascinated by medicine. I have just started my general ed at community college and hope to transfer to University when I begin my pre-med classes. I am a reformed Christian, by the way
Thanks for a thought-provoking and inspiring blog!
[...] Grand Rounds Volume 4 No. 27 « monash medical student Welcome to the 183rd edition, or No. 27 of Volume 4 of Grand Rounds. This week, I am honoured to present you the best posts from the medical blogosphere. All submissions have been included.I am a surgically-inclined medical student who someday hopes to a missionary surgeon. As such, i have interspersed amongst the posts some pictures from medical mission field around the world. [...]
Thank you for the inclusion!
[...] Mind, polymedicine, polypharmacology, Surgeonsblog | Grand Rounds Vol. 4 No. 27 is up at Monash Medical Student. Grand Rounds is a blog carnival showcasing the best of the week’s posts from the medical [...]
Fabulous job, fellow Monash person.
Heaps of interesting reading. It’ll take some time to get through.
[...] Grand Rounds Volume 4 No. 27 [...]