BLOGS: Grand Rounds

Welcome to Grand Rounds on THCB, the weekly round-up of all that is good and great in medical and health care blogging. This is a special edition as it’s the last of 2005 and so I’ve asked my fellow bloggers for their best posts of 2005. For some of them, like any great soccer player whose best goal is their last, their best post is their most recent. But for many we’ve gone back into the archives. There’s some great stuff, and some great series of posts too. So let me act like the consultant I am and put it into sections, and act like the blogger that I also am, and give you some not so unbiased commentary. Oh, and it’s pretty long with some nearly 60 posts mentioned. But you weren’t doing anything else this week, were you?  So settle in and enjoy.

This was the year that the medical and health care blogosphere exploded. I now track some 25 “healthcare” blogs and over 40 “medical” blogs in my Bloglines, and there are many, many more. But of course I’m going to start with the ones I like the most. You’ll note that some of mine feature somewhere in here too, but then again what’s the season of goodwill if at least a little isn’t self-directed!

Personal favorites: Medbloggers

My two favorite medbloggers are Bob Centor at DB's MedRants and Syd Smith at Medpundit. Bob had a great series on the key to being a good doctor, not understanding the disease but “Understanding the patient”. He put it at the top of his Top 10 for the year, but they’re all worth a read. Sydney at Medpundit is someone I’ve had running battles with over the years, but she is still the doyen of MedBloggers (although she says she’s slowing down). And when she’s not driving me mad ranting about Canada or Holland, she’s either brutally honest about the process of putting an EMR into a solo physician’s office, as described in her three part series, or she’s a breath of common sense in a world filled with hype—such as her take on Herceptin being the cure for cancer. Hardly.

Personal Favorites: Health IT Guys

But I’m a business and tech guy so I like a couple of bloggers who live in that world. And they each bring attention to screamingly important issues that tech people are not paying enough attention to in these days of national infrastructure revolutions. Shahid Shah, The HealthCare IT Guy gives you the skinny on — when we are building these health care information systems — why data models matter. Complex, but trouble if it’s not understood (and it’s not). The other huge issue is whether the EMR/CPOE is usable by physicians. Mr HISTalk, the leading cult health care blogger you may never have heard of, tells you what’s behind a famous recent CPOE study where it looks like things went very wrong. There was lots and lots of discussion on a post written by Kelly Clark on THCB about whether physicians can learn to love the EMR. Of course if you want the real (and cynical) low down on RHIOs, Mr HISTalk has that too in his RHIO guide for CIOs (scroll down in the post). If you want more on health care IT, Shahid has set up an aggregator of virtually every health care IT blog at the HITSphere.

Policy wonks: Too many favorites to count

Health care is in essence about politics, but the mainstream political bloggers not only hardly mention it but betray staggering ignorance when they do. Meanwhile, the academics in Ivory Towers tend not to sully themselves explaining the problems in the health care insurance system to the masses (although Paul Krugman has been making a half-decent effort). Filling this hole is a group of valiant bloggers, divided between the old farts wise heads, and the young punks. Much of my writing on THCB mostly lives here, although I moonlight policy stuff at Spot-on.

Elisa at HealthyConcerns (despite being sponsored by an insurance broker) is a (in health care terms) young punk learning about health care and getting upset about medical underwriting that stops ordinary people getting health insurance. And she’s not alone, and by no means should she be. In fact we should all be much more outraged about uninsurance. Of course over at political blog Spot-on I explain why health care will be the domestic political issue of the next couple of decades. Back in the torpor of 2005, consumer health, CDHPs, HSAs et al are the new propaganda slogans of the health care “free-marketeers”. Tom Hilliard at Signal Health is not impressed by the Cato Institute’s approach promoting it and ended up with interesting comments from his targets at Cato and their quasi-fellow traveler Wharton professor Mark Pauly, who stepped down briefly from his ivory tower to speak to the masses. Still in the new consumer health mode, Joe Paduda at Managed Care Matters was suspicious of AOL founder Steve Case’s Revolution Health when it was announced, and didn’t really see that it had much going for it after Case chucked the first $250m into the ring.

Pay for Performance is going to be one of the screaming big deals for the future of healthcare no matter what system we end up with. At Health Voices Hippocrates (Dmitriy Kruglyak) has a three part series on the concept and complexities of P4P, suggesting that the American College of Physicians has a reasonable approach. Henry Sturn at InsureBlog thinks that P4P might work, or at least that tipping doctors is no more dumb than tipping waiters.

Talking of series, Ezra Klein had perhaps the best of the year from a health policy perspective, explaining in concise terms what goes on in the health systems of Japan, Germany, Canada, France and the UK. Really good stuff from a young punk who is helping drag health care into the mainstream policy debate. Fellow punkette Kate Steadmanhas been displaying great promise (and hopefully having a good recuperation from her own recent surgery), and her piece on the society lady in the Midwest who couldn’t understand  why her uninsured housekeeper couldn’t get access to a doctor is a classic. Don’t miss the comments which show some of the pure frustration and pain of the uninsured.

Medicare Modernization Act and its Part D (drug coverage)’s introduction passes for what counts as health “policy” in these days of ignoring the problem. Another great series at Healthy Policy from Kate Steadman, was this whole series on what’s so screwed up about Part D. (Hint—virtually all of it). Joe Paduda explains why private plans like Medicare Part D so much--they’re playing at the casino with the bank’s taxpayers money (note the comment from the true believer!). The best explanation of how to use CMS’ very user-unfriendly calculator to figure out your Part D process comes from medical student Graham Walker—so much for the great works of government, even though since 2001 it's now run by CEOs instead of those incompetent bureaucrats. Of course if you really want to understand the problems behind Medicare and the angst it causes political liberals, you could do worse that read what I wrote on THCB about separating the Medicare discussion between its individual and corporate welfare sides.

And if you really want the long term picture of the tension between social and individualistic health care in the political world, well, this old chestnut from January 2005 in THCB might amuse you. It’s called Health Care = Communism + Frappuccinos.

Physician and clinician blogs about medicine

When most people think of medical blogs, it’s usually about the experiences of clinical professionals dealing with patients and others who get in their way. In this blogging round-up, that world lives here, and it’s proof that medicine is a lot more complex than we lay people and consultants tend to make it out to be.

That complexity shows up as often as not in the emergency department. DrTony hangs out in ED’s and is troubled by suicides at what’s supposed to be the happiest time of year. Gruntdoc lives there too and is devastated by a sudden head injury and life long brain damage to a teenager. On the other hand he was aggrieved that the WSJ got it wrong on how emergency doctors should treat strokes. Doc Shazam is writing fiction about how one might end up in the ED. Kim, an emergency RN  has some amusements over what happens in patient–clinician “communication” at Emergiblog.

Meanwhile outside the ED Graham Walker at Over My Med Body knows that both patients and doctors can be the difficult ones.  Medscape’s The Differential has some blogging students and residents, whom we all know are overworked. Pin-Chieh Chiang has a cartoon which describes how they get by on no sleep! And while Kristen Heinan finds pediatrics therapeutic, Iranian med blogger Ali Tabatabaey instead uses medicine to observe a Culture of War

And if you want to see some of the gory pictures that make me glad I’m not a doctor like my old man, head to Jon Mikel Iñarritu’s post on open fractures classification and its clinical manifestations at Unbounded Medicine. Lots of fracture images with the emphasis on the word “open”. Meanwhile, troops in Iraq are picking up a yucky sounding skin infection called leishmaniasis from sand-fly bites, although Mike Pechar at Informed Participant tells us that 12 million people each year in the developing world get it. On a better known note, Paul Cheney at The Cancer Blog tells of the announcement from (the now late) Peter Jennings that he had cancer and that chemo was a bear. Barbados Butterfly gives us a harrowing tale of a patient bleeding out.

Even deeper in the science of medicine psychoanalyst blogger ShrinkWrapped is lost in the brain looking for the development of the self. To round out the topic of physician blogs, there’s an entire self selected Top 10 of the year at the Internal Medicine Doctor, the Mad House Madman, who writes the Chronicles of a Medical Madhouse.

Finally, the RedStateMoron explains why he’s in high risk obstetrics. It’s a personal and moving story.

Drugs, developed and marketed.

The pharma business is a very important part of health care. We’ll start with my favorite in the space, Derek Lowe at In The Pipeline. Derek usually lives in the R part of the R &D world, but he has lots to say about the industry’s tribulations from the inside. For instance, he thinks that the NEJM may be covering its legal ass with its repudiation of the Vioxx VIGOR study, while he considers a reader’s suggestion that Pfizer’s new clinical trial for Celebrex is a four year insurance program against more suits.

And more in your brain on drugs: Dr Crippen at NHS Blog Doctor in the UK thinks that we are over-medicating children, and that it’s mostly the fault of drug companies who, now done with the medicalization of overactive kids, are interested in doing the same to his wife’s….inadequate intimate bodily functions, as diagnosed by her hairdresser. (We blush at THCB about those topics, unless they concern horny school-teachers).

Now we’re getting a little silly, but pharma just seemed to inspite it this year. Grand Rounds originator and ring-master (all hail!) Nicholas Genes at Blogborygmi was having too much fun with those ridiculous clinical trial names, and  Ira Segal at Doc Around the Clock  was enjoying himself just a little with the concept that no-one seems to be paying for product placement in the ED. And the list of the year was the one with the real meaning of those pharma-medica(il)logical terms as explained by the cheerleaders at PharmaGossip. John Mack at the Pharma Marketing Blog can’t keep his thoughts away from those cheerleaders or ex-Mrs Rolling Stones selling impotence drugs either. And there was plenty on the most bizarre pharma PR blunder of the year — the financing of the “terrorists take over the Canadian drug import market” novel, most notably described by Roy Poses at Health Care Renewal.

Problems in the provider world

Of course there are hospitals and there are clinicians and there are problems and half in that world too.

Stuart Henochowicz at MedViews is concerned that we spend too much on buildings and not enough on nursing basics, something that meshes with the “Pimp my Ride” school of health care that Ian Morrison has been writing about (although one column a month doesn’t make Ian a real blogger!). Tony Chen at Hospital Impact thinks that perception is more important than we give it credit for being, and that things would be different if a big rodent from Los Angeles got involved in the hospital game. Tim Gee who usually writes about technology at Medical Connectivity Consulting keyed in on the problem of ensuring that only appropriate admissions end up in the ICU and CCU. AggravatedDocSurg and MSSPNexus Blog are bickering about whether JCHAO, which is the main body which inspects hospitals and is a tool of the industry/a regulatory body attacking American health care(delete where applicable to your view), is The Borg or the Death Star.

Maybe technology will come to the rescue. Clinical Cases and Images Blog wants to build a Google for all medical knowledge, or rather wants to open all medical knowledge behind closed “doors” to Google. David Williams at The Health Business Blog wonders if the way to cut radiology costs isn't to send all diagnostic reading overseas. Meanwhile The Difficult Patient thinks that physicians may be using interesting but not necessarily new decision tools at the point of care.

The two other big news stories this year were of course Katrina and the birds…

New Orleans/Katrina: Hsien-Hsien Lei at healthcare.wurk.net shows that it’ll be a long while before the healthcare system in New Orleans is back in action. Enoch Choi, a doc at Palo Alto Medical Foundation spent a lot of time down there and his blow by blow account at MedMusings is well worth reading. Sart here and move on day by day.  Finally In her own words has a nurse telling about her experiences volunteering for the Red Cross in Baton Rouge.

Avian Flu: Tara Smith at Aetiology had the best history of pandemic influenza.

Late arrivals (added 12.30 PST Dec 28)

When cleaning out the junk mail, I found Bard Parker from A Chance to Cut is a Chance to Cure about whether the CT Scanner is a match for a duff appendix, Jim Hu from Blogs for Industry about skin conditions in the cartoon world, and Parallel Universes considering that drinking is bad for humans, while dancing boys are good for girls. Sorry that the first 1200 readers missed you guys, call Bill Gates and ask for a better Outlook filter with fewer false positives in 2006.

Parting Shots and gifts for reading this far....

Now just in case you over-did the holiday cheer and good food, you may be thinking of a New Year diet. The nice people at the Discovery Channel are having a National Health Challenge coming up starting on Dec 30. Go see their site for more details, but THCB has three copies of this book on getting thin(ner) and healthier by the perky looking Pamela Peeke to give away. Let me know if you want one (and no I’m not getting a cut for advertising it…)

I will however get a menial cut if you want to get a THCB T-shirt or mug from my friend Shazza’s Vaniteez site.

Thanks for coming by. Hope you enjoyed this extended edition, and I’m looking forward to what 2006 brings us in the medical and health care blogosphere.

Next week Grand Rounds returns to its more usual weekly format at Random Acts of Reality.