November, 2010 Archive

November 15, 2010, 11:24 pm

Grand Rounds Visits Doctor Who

Welcome to the Doctor Who edition of Grand Rounds!

We’ll travel through the medical blogosphere of 21st century Earth, where we will find that Grand Rounds can be found on Twitter (@grandrounds) and on a website known as Facebook (Grand Rounds).

Our spaceship/time-machine, the TARDIS (Time And Relative Dimensions in Space), is standing by.

“All of time and space; everywhere and anywhere; every star that ever was. Where do you want to start?” – the Eleventh Doctor

The adventure begins…


My favorite Doctor, is Matt Smith, the 11th actor to play the role. These two posts were my favorites of the week, my “Editor’s Picks”.

Jordan Grumet notes the expertise the primary care physician brings to a patient’s last days in? More on Old Fashioned Internal Medicine – Discussing End of Life Care, found at In My Humble Opinion.

Nurse Me wonders what you would choose to do If You Knew….? She also submits her intense (and oh-so-needed smack down) of Gray’s Anatomy’s creator Shonda Rhimes.


The Doctor always travels with a companion, or two.

It takes a village…Amy Sellers at Nursing Influence shares how one blood pressure measurement at a dentist’s office led to two life-threatening diagnoses. See How Dentists Are Saving Lives.

Jamie Davis heads up a prestigious panel of podcasting nursing colleagues in Something Borrowed, Something Blue on Insights in Nursing.

In honor of Veteran’s Day, Ed Pullen of looks back on his fellow family medicine residents at Madigan Army Medical Center. Thanks to these Physician Veterans for their service.

In Swanson: Physicians Have An Ethical Duty To Participate in Social Media, Dr. Val at Better Health references physicians, but the points she makes are relevant to all health care providers.

Hall of Fame baseball manager Sparky Anderson died quickly after entering hospice. Dr. John Schumann at GlassHospital puts this into perspective in Rapid Demise.


This is a Dalek. The Doctor is their nemesis. Don’t let the toilet plunger arm fool you, they want to “EXTERMINATE!” the Earth!

Jacqueline at Laika’s MedLibLog sheds some light on Expert Curators, WisdomCards & the True Wisdom of @organizedwisdom.

A recent meta-analysis in the British Journal of Medicine (BMJ) concludes that chondroitin, glucosamine and their combination do not reduce joint pain or have an impact on narrowing of joint space. Highlight Health‘s Diana Gitig reviews the analysis in Glucosamine and Chondroitin Found to be Ineffective for Relief of Arthritis Pain.

Medicare drops consultation codes, and The Happy Hospitalist notes that physicians could manipulate these new rules to cash in, if they were so inclined. Find out how in Physician Consulting Opportunities in the New Medicare Era: It’s a Gold Mine Out There!

Jay at the Colorado Long Term Care Insider notes that “From 1991 to 2007, bankruptcy filings by people age 65 to 74 rose by 178%…Health care expenses are definitely contributing to the number of seniors who are facing financial difficulties or filing for bankruptcy”. Read more in Health Care Expenses an Increasing Burden for Elder Americans.

Physicians have a duty and a right to voice concerns over questionable medical claims, don’t they? As rlbates posts at Suture for a Living, this very situation has led to a Physician Threatened by Libel Action.


Looks like the Doctor has some interesting news on his iPhone….

The ramifications of dropping out of Medicaid could have severe financial repercussions. Find out who would be affected? in Dumping Medicaid as Displaced Anger, by James Baker at Mental Notes.

Rich Elmore at Healthcare Technology News reports that while healthcare reform came under fire in many parts of the country, a single payer system is very much on the horizon in Vermont. The nation will be watching as Single Payer System Takes Center Stage in Vermont.

Flavio from Pharmacy Corner submits a thorough overview of Beta Adrenergic Receptors.

Chris Langston puts forth a new look at care coordination at the John A. Hartford Foundation blog, health AGEnda. See Care Coordination Is Not a Noun.

On this, the month of the 115th anniversary of the discovery of the x-ray, Michelle Wood of the Occam Practice Management Blog looks at studies involving X-ray and CT Scans.


The Doctor does his best to understand what makes humans tick…

Say good-bye to thin, lousy hospital gowns. Dr. Elaine Schattner gives the details at Medical Lessons. See Hospital Fashion News from A.A.R.P. and the Cleveland Clinic. And just for fun, I’ve added a link to a photo of the gown.

Rachel Baumgartel not only beguiles us at Tales of Rachel, she is also the writer of Rachel’s Diabetes Tales at Diabetes Daily. This week, she submits a post about the “Double D” (and we aren’t talking Victoria’s Secret here). Check out D-Blog Day: Six Things About the Double D’s.

It’s embarrassing to admit, but I was once convinced I had cancer after doing exactly what Evan Falchuk advises not to do in 5 Tips for Diagnosing Yourself on the Web at the See First blog.

A recent contest at How to Cope With Pain, netted this gem of a post about a road trip that led to a breakthrough. Author “MizJess” realizes her strength in It’s My Life So I’ll Do What I Want.

Once in a great while, a research study reveals a truth that can change the course of life itself. InsureBlog shares one such study in Outstanding Food Pyramid News. I, for one, wept with joy at the discovery.


Thanks for reading! It’s been a blast hosting Grand Rounds for a sixth time!

Next week, Grand Rounds will be hosted by Amanda Brown, DVM on her Facebook blog! It’s the first time a veterinarian has hosted Grand Rounds and the first time GR has been hosted on Facebook!

See you then!

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November 13, 2010, 3:16 pm

A Peek at My NaNoWriMo Novel

Deep in the quiet depths of a night shift on the ward, an RN…

Sits writing a novel!

Not that I’ve ever done that <cough>.

I’m am writing my 50,000 word novel for National Novel Writing Month. I wasn’t going to show it to anyone, but then Doctor Rob went and shared the first part of his NaNoWriMo novel and I can’t let him show me up!

So here’s the first few words of mine.

It’s about a woman experiencing life changes in the world of the 21st century. Or, more prosaically, you could call it “Menopause is Hell, Where is my Handbasket?”

Remember, this excerpt is merely a draft.

But sharing it makes me accountable for finishing.

Ladies and gentlemen, the world premier of the very first part of “Whatever I Finally Decide to Call It”:


“Why the hell did I walk into the kitchen?

“I swear I have Alzheimer’s,” Kathy thought as she stood with bare feet on the cold linoleum, frustration mounting.

It was happening more often: forgetting why she entered a room, losing her train of thought mid-sentence, and a she had a very disconcerting inability to concentrate.

“It’s not Alzheimer’s, it’s this f****** menopause,” Karen decided. All you hear growing up is how wonderful your body changes will be when you “become a woman”, but no one bothers to tell you what happens when it all goes south. Literally, Everything droops. Your body begins masquerading as a dessicated sea sponge by day that floats off the bed at night in a sweat tsunami. Okay, that they tell you.

But no one tells you your mind goes to hell in a hand basket.

No one talks about your overwhelming urge to jettison your husband, quit your job and move to the coast to sell jewelry at craft fairs after you get your PhD, write a book, learn Spanish, lose 50 pounds and begin the seven-day-a-week work out program you’ve been meaning to develop. How ironic, Kathy thought, to have the urge to do so many things all at once when you don’t have the motivation to even get up and wash your hair.

Shampoo! That was what she had come to the kitchen for!

She’d have to talk to her Steven about remembering to return it to the bathroom the next time he decided to use her designer salon hair products to wash the dog. At least she didn’t have to worry about doggy odor. BigDog smelled like coconuts. Very expensive coconuts. She grabbed the bottle quickly, so she wouldn’t forget again and dragged herself upstairs to wash her hair. Motivated or not, she didn’t have a choice, she was going to work that night.

Can’t be going into work looking scuzzy, she told herself.

Even if it is the night shift.


Of course any resemblance to any person, living or dead is purely coincidental….

Of course.

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November 11, 2010, 7:07 pm

Guest Post: Working Overtime – Are the Benefits Worth the Risks?

She’s got mail!

Or maybe she’s looking over her pay stub.

Nah, can’t be that. She’s smiling!

The size of our paychecks (and what we go through to increase it) is the subject of this guest post by Julie, a registered nurse with an interest in finance who is a staff writer/blogger at The Millionaire Nurse Blog.

Welcome, Julie and thanks for guest posting at Emergiblog!

Take it away…….


Working Overtime? Are the Benefits Worth the Risks?

We go to work week after week, trudge through shift after shift aiming for that one special day…payday!

There never seems to be enough to meet our financial demands of mortgages, car payments, insurance, child care, fuel, and other day-to-day expenses that keep our wallets and bank accounts drained.

In short, we all just need more money. As nurses, our easiest resource is working overtime.

But after working a long, exhausting week:

  • caring for needy patients and families,
  • running down physicians for orders they failed to give you (not you, Dr. Dean!)
  • dealing with the demands of managers and administrators who are out of touch with the real world

I would be insane to go back for another shift!

But nurses are compassionate creatures. We care about our patients and each other. We can’t just sit at home while our co-workers are struggling, short staffed as usual!

(And that extra $300-$500 sure would be nice!)

So what do we do? We agree to work another shift. It may be simply to pay that overdue bill or maybe those Lucky Brand jeans or the latest techno gadget such as the iPad or Nook reader we’ve had our eyes on. Christmas shopping is the biggie…how can I afford that iPhone my hubby is dying for?

But are the financial benefits worth the risks?

Nurses are extremely concerned about the care their patients receive, yet don’t realize the risks of harm to their patients through increased errors by working extra shifts. Most hospitals have changed nurses’ schedules in recent years from 8-hour shifts to 12-hour shifts, lowering staffing requirements for the hospital.

However, studies show that fatigue increases and mental alertness decreases with the extended 12-hour workday even though nurses may not be aware.

Medication errors are the number one area affected by fatigue!


  • Do errors occur during a regular work shift? Sure, they can! But it is more likely to occur when you?ve worked longer hours, are physically tired, and not as mentally sharp.
  • Your family…whether you have children or not, the strain your work places on you mentally and physically not only affects you, it also affects your spouse and children.

Nurses who work extra hours seem to burn out quicker and tend to become chronic complainers.

Who wants to live and work with a grouch?

It’s a matter of establishing priorities. Is the financial benefit of that extra shift worth the lack of time spent with your family?

(During the time of our economic crash, I was guilty of working every extra shift I could get. While the extra money was great, I was totally unaware, until my husband finally communicated with me, that my extra time and focus spent at work made him feel lonely, and unappreciated! Wake up call!)

So, where does that leave us in regards to needing extra income or wanting to help our co-workers when staffing is short?

  • Don’t give in to working that extra shift if you’ve been short on sleep or have already had a very busy, exhausting week.
  • Make sure working the extra hours doesn’t jeopardize your family
  • Don’t forget about taxes-that extra income will be reported to Uncle Sam! Been there, done that!
  • Remember, trimming expenses first is always an option

Think about the safety of the patients you care for, the strain on your family, and the added stress on yourself and choose your extra hours wisely! When it comes to making mistakes, administration may forget they begged you to take that extra shift.

The risks could very easily cost you your license or family!

Reader Questions:

Have you ever worked when you knew you weren’t safe?

Have you ever been pressured into working shifts, and then wound up regretting it because you knew you were not at your best?

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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