Tuesday, August 28, 2007
Grand Rounds: Volume 3, Number 49
Welcome to this week's edition of Grand Rounds! I'm very excited to be hosting for the first time, and I want to thank Nick Genes, the Father of Grand Rounds, for offering me this opportunity.
I received forty-three submissions from forty bloggers. (I really hope I haven't left anyone out; it's been a very hectic week, so if I somehow deleted your submission e-mail by accident, please forgive me!) As promised, I've selected thirty posts for the body of the edition, the "first cut"; but I've also followed the lead of some recent GR hosts by including the rest of the links at the end, so that anyone who wants to can read the "second cut."
This week's theme is Narrative Medicine. Pioneered by Rita Charon, an internist and professor at Columbia's College of Physicians and Surgeons, Narrative Medicine trains doctors and other caregivers to use careful listening and reflective writing to forge deeper connections with their patients, resulting in better care.
Charon describes three essential components of narrative medicine:
Attention: Listening carefully to patients, which includes remaining sensitive to what they may not be saying, gives the caregiver potentially valuable information and also makes the patient feel more cared for.
Representation: Using writing to reflect on patient interactions helps caregivers understand both their own feelings and those of their patients more deeply.
Affiliation: The process of attending carefully to patients and reflecting on patient stories ultimately makes caregivers stronger and more passionate patient advocates, because they've become more invested in their patients' care.
In this edition of GR, we'll pay attention to Patient Narratives, enjoy the representation of practicing medicine in Provider Narratives, and see how providers use writing to enhance affiliation with patients through Reflections on Advocacy. These categories are, of course, somewhat fluid and overlapping.
Additional, off-topic treats will follow. But enough intro! On to the first cut!
THE FIRST CUT
Laurie Edwards, who is both a writer and a patient with chronic medical conditions, uses narrative as a lens to give us a fascinating meditation on how these two roles intersect.
After almost twenty-one years with type 1 diabetes, author Kerri Morrone talks wistfully about her new normal. And Amy Tenderich from Diabetes Mine asks, equally wistfully, Why Did God Make Carbs So Yummy?
Elsewhere on the spiritual front, a thought-provoking post from the blog How to Cope With Pain asks how disability affects patients' relationships with faith communities. Since spirituality and group support are both vitally important to people with chronic medical conditions, this is a topic that merits thought from medical caregivers.
Rachel, who has both SAD and diabetes, reminds herself that the coming of autumn means dusting off the light box. Rachel, I'll be digging mine out of the garage soon, too!
Ileana offers some tips on helping patients with social anxiety.
Mary, a fat-acceptance advocate, tells us about the emotional turmoil -- complicated by her mother's medical history -- that she undergoes when she has to see a doctor, even a "fat friendly" one. We've been hearing a lot about weight in the news lately, and it's important for providers to understand how overweight patients feel in the doctor's office.
Dean Moyer, who suffered for years from back pain, advises fellow back patients which doctor to see first.
Although this next post was submitted by a doctor, I've put it in this section because the main voice we hear is the patient's. Dr. Rima Bishara shares her interview with a patient diagnosed with cancer at age sixteen.
Another cross-category post comes from everyone's favorite Mexican Med Student, who offers a uniquely self-reflective case study.
And, finally, Jon Schnaars from Anxiety, Addiction and Depression Treatments reminds us of the importance of listening to patients in a post about the role of cultural factors in suicide prevention. Since I live in a state with a very high suicide rate and very poor mental-health services, I found this post particularly compelling.
Medical student Kendra Campbell muses on the irony of how her training in medicine -- a field often associated with selfless idealism -- has temporarily made her more selfish, and thanks her family and friends for their support. Good luck, Kendra, and hang in there!
Med-Source reminds future physicians of the importance of listening carefully to patients, and addressing quality-of-life issues, in a moving post about a young cancer patient and her family.
For medical students and providers new to practice, encounters with mortality can be particularly wrenching, as our next three posts illustrate. Medical Student AMiB (an American Medic in Britain) tells us about his first code blue. Dr. Val (who actually studied under Rita Charon at Columbia!), shares an entry from the journal she kept during residency, describing Night Float in the Hospice. And Nurse Jane shares a suspenseful tale, from when she was a very New Nurse, about a patient with severe cardiac decompensation.
Experience doesn't lessen the impact of some patient interactions, though. ERNursey, in a poignant post, honors the humanity of one of her former patients, a true gentleman despite initial appearances.
On a happier note, Dr. Emer brings us a heartening story from Taiwan about the survival of extremely premature babies under very challenging hospital conditions.
Challenging patients occur at every stage of life. Dr. Paul Auerbach tells us how, as an intern, he negotiated with a diabetic patient, a young woman, to stay in the hospital. Meanwhile, Jay from UroCanswer ponders the appropriate treatment for an elderly prostate-cancer patient.
If conversations with patients are difficult, witnessing the conversations of other providers can be even more so. Geena from CodeBlog describes her discomfort at witnessing a doctor's inopportune call.
Our final post in this section is a monumentally entertaining epic from Bo, the brave and intrepid Road Nurse, who shares two intertwined stories about danger on the job -- the first posed by a patient, the second by the weather -- and ruefully laments her own rashness in the latter situation. Bo, I think the moral here is to trust your instincts and follow them (and damn the peer pressure). Also, I really hope someone films the story of your life someday!
Reflections on Advocacy
The ever-thoughtful Kim tells us how blogging has made her a better nurse.
The Nurse Anesthetist, Counting Sheep, writes a letter to her patients, assuring them that the short conversations she has with them in no way lessens the quality of her care and concern.
Jeffrey, a medical student in Australia, reflects on how his military training will make him a better doctor. Jeffrey, I'm glad you're putting those old skills to life-saving use!
And, in a characteristically witty post, the blogosphere's beloved Nurse Ratched pens an only slightly tongue-in-cheek updated Nurses' Prayer.
We have a trio of posts this week about statistics and the dangers thereof. Sandy Szwarc brings us a rigorous challenge to popular interpretations of data about bariatric surgery. Christian from Med Journal Watch is similarly alarmed about the misuse of statistics to suggest links between risk reduction and weight loss. And in a slightly lighter spin on fun with statistics, Clinical Cases and Images shares the amazing phenomenon of a PubMed article with 600 coauthors.
Because I'm a science-fiction writer, I couldn't resist these two posts about the intersection between medicine and cyberspace (although I guess all medblogging really falls into that category, right?). Tony from Hospital Impact tells us what healthcare can learn from FaceBook, and medical student Bertalan Mesko reports on an intriguing virtual hospital in NHS London in Second Life.
That's it for the main body of Grand Rounds this week. Again, my thanks to everyone who submitted posts. Next week's host will be Parallel Universes.
Below are the rest of the submitted posts, for those of you with the luxury of lots of reading time!
THE SECOND CUT
JC Jones RN shares some of the health challenges facing black men.
Allergy Notes praises immunotherapy as protection against asthma for children with allergic rhinitis.
Alvaro from SharpBrains reviews recent cognitive training research, and also lists The Ten Habits of Highly Effective Brains.
Over at Diabetes Mine, diabetes patients energetically debate the merits of Merck's new drug Januvia.
Adam at NY Emergency Medicine tears into a New York Times Op-Ed piece recommending pay cuts for physicians.
Henry Stern from InsureBlog helps us wise up to Stupid Government Tricks.
Eric Turkewitz discusses the ramifications of Medicare's Medical Malpractice Fix.
Sam Solomon from Canadian Medicine brings us news of an American medical-malpractice insurance firm that promises to help doctors fight RateMDs sites.
From South Africa comes a grim little anecdote about political corruption and liver transplant.
Jolie Bookspan, the Fitness Fixer, gives us two inspirational stories of regained health, here and here.