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Grand Rounds: Vol. 6, No. 14: New Years Resolutions

December 29, 2009

Welcome to Grand Rounds, Volume 6: Number 14 – the last one of 2009!

The end of the year is a time of reflection. We look forward to the years to come and look backwards, pondering our triumphs and tragedies. And, if you are anything like me, you might also look behind the dryer for that missing sock.

In late December, the tradition is also to formalize our best intentions for the future, even if we know the process is futile. Though considered nearly a pointless exercise, with failure resulting in an even worse state than before we started, we make these resolutions annually. So, onto the blogs, grouped according to some of the classic New Year’s resolution themes.

1. Be self-aware; reflect; pick out the colour of your parachute before your jump!

In The Examining Room, Dr. Charles invites you to cast your vote for the Medical Advance of the Decade. We make leaps and bounds, sometimes with the subtlest change. Smoking bans? Hypothermia protocol? HPV vaccination? I might vote for ‘better resident/intern working hours’ if it were on the list, but my new found penchant for self-analysis informs me it would be egocentric to do so.

This just in! Our sources at ACP Internist point out the latest development in Medical News of the Obvious. Shockingly, women tend to opt for careers in less slovenly, less nerded-out environs when given the choice. So for those of you who have “Find New Job” scrawled on your To Do list for 2010, uh, I’m not sure how this affects you. You’ll have to work wherever the job is! Back to you, Kent.

2. Enjoy the little things (#32 on Zombieland’s list of rules)

My wise patients tell me how important it is to stop taking things for granted on a temporary (but frequent) basis. On this note, The Happy Hospitalist pledges to Eat Well Before it’s Too Late; be careful though, if you are wondering about the real explanation for the universal RN shortage, Happy reports that  Chocolate Covered Potato Chips Knocked off [the] Nurses.

Maybe the number of nurses doesn’t correlate with clinical outcomes. Did you know that, according to the Colorado Health Insurance Insider, by percent of population, there are half as many nurses in Taiwan compared with the US? Despite this, the life expectancy of a Taiwanese person is only 8 weeks shorter than that of an American! Lessons From The Taiwanese Health Insurance System could help shake the way we look at our essential services. And if not, at least we might learn to cherish those 8 weeks!

Many would say that “when life gives you lemons, make lemonade!” but you’d also be smart to listen to an experienced healthcare safety blogger and not get your lemons mixed up with your oranges. In efforts to save us from confusion, Barbara Olson shares some Helpful Hints for Home (and for the New Year) on her Medscape blog (login required; accounts are free) called On your Meds: Straight Talk about Medication Safety.

3. Take care of yourself, health and mind

Living healthily is probably the most essential and least attainable of our vows; Doctor D (Ask an MD) helps us understand: Why Is It Hard To Live Healthy? An oldie but a goodie, this post looks at the biological routes of failure to eat right. The basics? Salty and sweet taste good! In a time of feast-or-famine, high calorie meals were equated with survival. Looks like after my family’s three Christmas dinners, I could last through to next winter! Evolution informs us further: if you’ve lost your posture, Dr. Jolie Bookspan, the Fitness Fixer, will help you overcome your Cro Magnon-like state. Maybe we wouldn’t be such slouches if we just would follow her advice and learn How to Sit Up Straight!

Deeming the holidays absurdly unsafe, the Utopian College for Emergency Medicine (UCEM) Cancels Christmas! During Life in the Fast Lane, Chris Nickson took the time to explain that gift-, food-, alcohol-, and Christmas-tree related incidents make the holiday season a time of horrific injury; we might as well call the whole thing off. This might be a move toward the objectives of utopian care, but back in the real world, the Emergency Room docs I know would disappointed if their department’s traffic slowed any. Sewing on snowblower-severed fingers and reassuring snooty alcoholics – depressed that Santa didn’t bring them a new vomitorium* for Christmas – is sometimes the only consolation for working when the rest of the world is having fun. And keeping happy is keeping sane, right?

Counseling psychologist Will Meek holds The Secrets of Changing. Aware of our tendency to make resolutions and swiftly revert, he emphasizes making routine, well-timed, and small changes; of course, there’s always bouncing back when things fall through! That’s why they invented moonshoes, afterall.

It can take a person anywhere between one to infinity attempts to quit smoking, making it not surprising that this is one of the frequent flyers atop resolution lists every year. Bouncing back after failing at smoking cessation is probably a lot easier than recovering from surgery, but as Plastic Surgeon Dr. R. L. Bates writes, smokers have an even tougher time with the post-op period. Smoking in Facial Aesthetic Surgery Patients results in higher risks of some pretty horrible outcomes, like a 12.5 TIMES increase in the risk of facelift skin flap necrosis. Ewww. How about “Never Smoke/Quit Smoking” and “Never Have Cosmetic Surgery” as rules to live by in 2010?

4. Face reality / Do something different

We can learn a lot about practical resolution making from Rachel’s Wide World of Lunacy; her status as an insightful patient is reinforced in The One where. . . [she] figures out what Next Year will hold. Her implied advice? Set attainable goals, do things gradually, and maintain hope!

Many of those principles (patience and hope in particular) could also apply to physicians aiming to employ Electronic Health/Medical Records (EHRs or EMRs) in their offices for 2010. Healthcare IT Project Management guru Elyse Nielsen writes at Tangible steps to help capture current workflow are outlined within Getting Ready for the Meaningful Use EHR – Capture Current Workflow and Baselines.

Dr. Eric Widera of GeriPal in his critique of Dr. Sanjay Gupta’s book, Cheating Death, implores that we do just the opposite of the title. The post, Cheating Death: A Book Lost in Definitions, explains that ambiguity around the term “death” invites us at times to think of death as a discrete, finite moment and at others, to think of it as a reversible or transient state. Gupta’s thriller maintains the status quo, pronouncing that with enough intervention, we can and should beat Death, our ultimate adversary. I get the impression that Gupta forgets all the progress in palliative medicine we’ve made; death is not the enemy. So, starting on January 1st, let’s stop cheating death (unless, like, uhm, you aren’t supposed to be dead and your post-resuscitative quality-of-life is estimated to be decent and stuff). (Oh, and let’s have a jolly good time while we are still alive).

5. Find faith, keep it

Henry Stern at InsureBlog wonders if there is Not a Prayer? for folks, like Christian Scientists, who don’t view healthcare as the government does. The Individual Mandate would force even those who don’t subscribe to Western medicine practices to pay for the provision of such services. A solution? Include coverage for prayer as a medical treatment. Hmm. I think I’d like hugs with my plan, too.

With healthcare reform happening, it’s time to put up or shut up. HealthBlawg takes a stance with Health Reform: What’s a Provider to Do?, encouraging US providers to roll with the new bill. As Atul Gawande suggests in his latest New Yorker piece, we should shake our ways up like the farmers of 1903!

Despite the need for fresh ideas, some things we’ve been doing forever still have value. Have faith in vaccines. And if you don’t, then at least, don’t get the Mumps! InsideSurgery, in a characteristically clear and brief technical post, reminds us of the swollen necks, embarrassing orchitis, and other key features associated with this viral infection.

6. Be a good person (role model/parent/sibling/spouse)

Nancy Brown, who expertly hosted last week’s Grand Rounds at Teen Health 411 searches for a way to allow parents to model and talk about healthy body image with their teenagers. She’s found it, or a start anyway. As she reviews the How I Look journal, she develops a wise resolution for everyone with (or without?) teenagers: “be conscious of the comments and judgments you make about bodies – your own and other people’s . . . “ I think it’s possible to create a dialogue of body-image acceptance with your kids while still being allowed to strong-arm encourage them to eat their veggies. Yes, even the broccoli.

In Sickness and In Health, former psychotherapist Barbara Kivowitz, debunks some More Myths About Illnesses and Couples. If we try too hard to be conscientious and protect others, we may forget common sense. It can happen in any of our relationships if we aren’t careful and open communicators.

7. Achieve World Peace; make the world a better place

In Miss Congeniality, a hate-to-admit-I’ve-seen-that movie, Sandra Bullock’s undercover FBI character laughs at the Miss America contestants that ditzily list “world peace” as the one most important thing our society needs. But, they could be onto something . . .

Dr. Paul Auerbach of Medicine for the Outdoors humbly describes what it was like to walk around the ruins of Hiroshima with his son. The profoundness of his message – A Holiday Hope –  cannot be ignored; healthcare providers can be, outside the hospital, instrumental in making the world a better place. Our hearts, hands, and minds have the power of destruction, but our capacity for good is even greater. My own parents were also recently in Japan; they remembered how particularly vigorously I folded paper cranes with my grade 5 class, after we read the story of Sadako and the Thousand Paper Cranes. It’s the only origami I still remember how to fold. I made one for you. –>

Be kind to yourself this year. Maybe nothing will be resolved, but that’s a-okay.

(the Grand Rounds host for next week has not been announced as far as I can tell)

* mistaken belief

19 Comments leave one →
  1. December 29, 2009 6:45 am

    A seriously cool round up of the week in the medical blogosphere. Stupendous effort!

  2. December 29, 2009 7:57 am

    Thanks for including me Jess – and extra points for the simpsons reference!
    (I was looking for a ralph wiggum quote for you… and couldn’t find a good one. oh well)

    happy new year 🙂

  3. December 29, 2009 7:59 am

    Happy New Year to you! Great edition of Grand Rounds.

  4. December 29, 2009 8:51 am

    Well done – Thanks for including our post.

    And a very Happy New Year!

  5. December 29, 2009 12:37 pm

    Wow awesome job! Also, where is the Grand Rounds brain trust located? I would love to host it but don’t really know how that happens.

    • December 29, 2009 4:22 pm

      Thanks, Dr. Meek, it was a pleasure.

      I was invited by Colin Son after I sent in a Grand Rounds submission to him. I think all the info you need is at or try him on twitter @txmed. I think he must be a wee bit swamped right now because I haven’t heard from him in a few weeks. Dr. Val is the other one to seek out if Colin is up to his elbows in the OR.

      Good luck!

  6. Mike permalink
    December 30, 2009 12:06 am

    “Gupta’s thriller maintains the status quo, pronouncing that with enough intervention, we can and should beat Death, our ultimate adversary.”

    The only status quo he’s maintaining is confusion about what brain death is, and what it signifies.

    • December 30, 2009 1:55 am

      thanks Mike
      I haven’t read Gupta’s book, so the clarification is appreciated. I (erroneously?) had the impression from the review that in Gupta’s book, death is the enemy and it must be fought at all costs – a popular, though diminishing, notion in Western culture.

  7. December 30, 2009 4:01 pm

    Great job. Happy New Year!

  8. Mike Cadogan permalink
    December 30, 2009 11:15 pm

    Brilliant Rounds!
    Love the way you pulled this post together.
    Have a prosperous New Year

  9. January 4, 2010 10:11 pm

    Fabulous, lovely, terrific way to ring in the New Year! Great job.

  10. February 6, 2010 11:02 pm

    I guess I must have missed this grand rounds back when it was published. Thanks for mentioning GeriPal and the post on Cheating Death. You got a great blog here too!


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