How To Tell Your Boss You’re Overworked

Does just walking into your office in the morning cause anxiety?  

Paperwork Despite your best efforts, are you greeted by stacks of paper, an over-flowing in-box, dozens of unread emails, a blinking phone message light, and reminder sticky-notes plastered everywhere?  Did you carry work home last night in an over-stuffed briefcase, or respond to emails and phone calls on your ever-present Blackberry?   

Do you feel overwhelmed by constantly increasing job demands?  

If so you’re not alone; there are some very capable, hard-working people facing that challenge right along with you.  

First, let’s talk about what not to do.  

DO NOT  

1.  Blame your supervisor for not rescuing you.  

  • Decide that you really shouldn’t have to explain the obvious to your boss, he knows you need help and just doesn’t care.
  • Complain at every opportunity about having too much to do, and wonder why you are apparently the only person in the place who cares at all about doing a good job.

2.  Keep quiet and take on every new task you’re given  

  • Believe that if you say yes to every project someone will eventually realize you’re over-burdened and offer to help.
  • Refuse to admit that you can’t get everything done and accept that you’ll just have to work harder and longer to keep your job.

3.  Hide what’s not getting done in the hope that no one will figure it out.  

  • I once took over a position where my predecessor had left suddenly without giving notice. On my first day I had to call Maintenance to open the locked desk drawers. You guessed it – piles of unfinished work had been carefully locked away. Not a pleasant way to start a new job, or finish an old one for that matter.
  • A colleague once told me that after an employee left her company, Maintenance discovered unfinished work hidden in the ceiling tiles above his desk.  At least he gets points for creative hiding.

Now let’s give some thought to strategies that may actually help.  

DO

1.  Communicate with your supervisor – frequently and respectfully  

  • Even if you have great rapport with your boss, it’s best not to bring up the subject of being overworked and overwhelmed out of the blue.  Respectful discussions need to occur on a regularly scheduled basis regarding priorities, goals, job performance and workload. 
  • Develop a brief reporting tool to share with your supervisor that shows your progress on current assignments, pending work, etc.  If a goal isn’t being met, offer a brief explanation as to why.

2.  Learn to negotiate  

  • Sometimes the best answer isn’t yes or no.
  • Explain how a new request impacts current assignments and suggest strategies for prioritizing your most import goals. 
  • Be prepared to offer suggestions as to what tasks might be eliminated or transferred.
  • Make it a point to bring up, not just problems, but potential solutions as well.

3.  Consider ways that you may be sabotaging your own success    

  • Are you a perfectionist, working and reworking even low-level tasks until they meet a perfect standard?   If so, think return on investment.  Some projects may justify that level of scrutiny, but for those that don’t you’re simply wasting your time, and we’ve already decided that you don’t have enough of that to squander.
  • Are you a socializer?  I’m a believer in the power of networking and connections, but it’s another area where return on investment must be considered. Can you limit the time you spend visiting with co-workers?
  • Do you spend so much time and energy on crisis-management that you never have time to organize and plan?  Break that cycle or you’re doomed to the life of a “headless chicken.”

 4.  Understand that sometimes, it is what it is  

  • As an employee you have certain expectations; your supervisor and organization also have expectations.  You may find yourself in a situation where the two simply don’t mesh. Only you can decide whether it’s one you can (mostly) happily live with every day.
  • As long as you hold the job and accept the pay check, do your best work; but don’t be afraid to look around and see what other opportunities are available. 
  • If you do decide to move on, don’t jump right back into the same situation.  Look for an organization culture that aligns with your own.  We spend way too much time at work to do it in an environment that makes us miserable.

    

Related reading:  

http://www.cio.com.au/article/204793/
how_talk_your_boss_about_being_overworked
  

http://careerplanning.about.com/od/workrelated/a/overwork.htm  

 

Back By Popular Demand – The Ugly Truth

The Ugly Truth About Credentialing and Privileging was recently featured in the May/June 2009 issue of Synergy, the journal of the National Association Medical Staff Services (NAMSS).  Since many people have asked about it, here it is again – enjoy!

—————————————- 

The Ugly Truth About Credentialing & Privileging - Part I

Dear Doctor:

If you’ve been a practicing physician for more than about an hour, chances are you already know the ugly truth. If you’re in medical school or a residency program, odds are good that you don’t have a clue. Not to worry, as a fourteen-year veteran of the credentialing wars, I’m about to enlighten you.

(I feel I must preface this ominous tale with a disclaimer that I am a firm believer in the need for effective, thorough credentialing and privileging – more about that later.)

At last, you’ve completed your training and can begin to practice in your chosen field. You look forward to curing illness, cutting away disease, and finally earning some money so you can start paying back those lovely student loans you’ve accumulated.

Whether you join a large multi-specialty group or bravely hang a solo-practice shingle, you will no doubt need to apply for privileges at one or more hospitals, and perhaps a few ambulatory surgery or urgent care centers as well. If you hope to make even a small dent in those outstanding loans, you’ll also need to join various managed care panels.

How bad can it be, right?

You’re about to find out just how many ways you can be asked to document every place you’ve been, every job, license, certification or board you’ve ever held, whether or not you have any disabilities for which you’ll need accommodation, whether any professional privilege has ever been denied, revoked, limited or suspended, and whether to the best of your knowledge anyone is even thinking about denying, revoking, limiting or suspending anything of yours.

You’ll also need to produce the names, addresses, phone, and fax numbers of various individuals who will serve as your references. Some you’ll get to select, others may be prescribed. If you apply to a number of organizations all at once the people you name will get the joy of responding to multiple requests. If they don’t answer in a timely fashion you’ll be given the opportunity to prod them along. You may want to practice groveling, as nothing delays privilege approval quite as effectively as references who fail to respond.

Getting the picture? Verification of credentials is a huge, time-consuming, pain in the neck. Establishing that you’re currently competent to request and perform a vast array of delineated privileges only adds to the discomfort.

Unlike fine wine, the process does not become more palatable with age. The longer you’ve been in practice the more years of experience there are to verify, and the more proof you’ll need to produce to show that you’re still proficient at the ‘otomy, ‘ectomy and ‘ostomy that you learned way back in training.

There’s more, but I don’t want to discourage you overmuch with too many dark, dire warnings of a future decorated in red tape and dominated by writer’s cramp. (And we haven’t even touched on medical records documentation!)

Take heart – I have some tips to share on ways to make the credentialing process a slightly less bitter pill to swallow, so continue reading “The Ugly Truth – Part II to get your next dose of “Realdox.”

 

The Ugly Truth About Credentialing & Privileging - Part II

Continue reading

Restraint and Seclusion – A Hot Topic for Hospitals

CMS and Joint Commission are taking the issue of patient restraint and seclusion seriously.  Hospitals and individual care givers must do the same,  Not just because of the regulatory agencies, but because patients deserve to feel safe, and to be treated with dignity. 

That having been said, some patients need to be restrained, for their own safety and for the safety of staff.  In my years working in an emergency department I saw more than a few abusive, dangerous, out-of-control patients.  Interestingly, I also noted that every one of those patients seemed to share the same basic four-letter-word vocabulary; there is a cultural phenomenon in there somewhere.

There are also patients who may need to be restrained to prevent them from unintentionally harming themselves by pulling out tubes, IV’s etc.

Hospitals are, however, seeking ways to reduce or eliminate the use of patient restraints, or to at least make their use safer when they are determined to be necessary.

On April 11, 2008 CMS issued updated Restraint and Seclusion Interpretive Guidelines for hospitals. Joint Commission standards have recently been updated to more closely align with CMS regulations.

Here are just a few points from the CMS Interpretive Guidelines.  A link to the full text can be found at the bottom of this post.  There are approximately 50 pages devoted to the topic of restraint and seclusion. 

==============================================

From the April, 2008 CMS Interpretive Guidelines for Hospitals:

All patients have the right to be free from physical or mental abuse, and corporal punishment.  All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff.

Hospital leadership is responsible for creating a culture that supports a patient’s right to be free from restraint or seclusion.

The use of restraints for the prevention of falls should not be considered a routine part of a falls prevention program.

Restraint use is separated in the guidelines into two primary categories:

  • Non-violent, non-self-destructive behavior
  • Violent, self-destructive behavior

CMS Surveyors are instructed to review medical record documentation to determine whether the number of patients who are placed in restraints increases on the weekends, on holidays, at night, or on certain shifts or units.  If patterns are noted, surveyors are to obtain nursing staffing schedules to determine if staffing levels are adequate or if particular nurses are more prone to use restraints.

In addition to the more obvious types of restraints, the guidelines also identify:

  • Medications used to manage behavior or restrict freedom of movement that are not standard to the patient’s treatment plan 
  • Physically holding a patient to administer medications against their wishes, unless the medication is court-ordered.
  • Four side-rails up in order to prevent a patient from getting out of bed

There are extensive ordering, monitoring, and documentation requirements, and surveyors will look for 100% compliance. 

============================

Becoming a patient is often a scary business.  Limited use of restraint and seclusion can help make the experience a bit less frightening.
 

4/11/2008 CMS Hospital Interpretive Guidelines, Restraint/Seclusion  (beginning on page #83)
http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter08-18.pdf

MSSP’s – A Vital Part of Your Healthcare Team

 

It happens so fast. A sudden squeal of tires, an explosion of glass fragments, and you find yourself visiting an Emergency Department, perhaps far from home. 

As you lay on the narrow gurney observing various strangers hurry past, a woman in a white lab coat approaches, smiles reassuringly and says, “Hello, I’m Dr. Smith, how are you feeling?” 

If you’re like most patients, it never occurs to you to wonder whether the individual introducing herself to you is a licensed, well-trained, physician. You willingly place your trust, perhaps even your very life, into the hands of that smiling stranger. Should you? 

Generally speaking, the answer is yes. In hospitals all around the country there are professionals who work to assure that Dr. Smith is a licensed, credentialed, competent, physician, whether Dr. Smith works in the Emergency Department, the Neonatal ICU, or anyplace else in the hospital setting. 

Medical Staff Services Professionals are a vital part of your healthcare team, but you won’t receive a bill from us, and in most cases, you’ll never know our names. We work, along with Medical and Administrative leadership, to protect patients from unskilled, impaired, or in the worst case, fraudulent physicians. We verify the licenses, education, training, and skills of physicians and other independent providers of care. In addition to hospitals, we work in managed care organizations, ambulatory surgery centers, long-term care facilities, and many other locations. Many of us have achieved and maintain professional certification. 

We help to protect the public from people like Dennis Roark, an individual who practiced medicine in the State of Michigan for ten years before his fraudulent credentials were discovered by some of our professional colleagues when he applied for hospital privileges. Dennis Roark never went to medical school. In 1998 he was sentenced to 14 years in prison. 

We help to protect the public from people like David Tremoglie, who assumed the identity of a psychiatrist and practiced in various outpatient settings, including Bustleton Guidance Center near Philadelphia. He treated hundreds of individuals before a suspicious patient placed a phone call to the state licensing board in 1996 and discovered that Mr. Tremoglie did not have a medical license. 

In 1992, President George Bush proclaimed the first week of November as National Medical Staff Services Awareness Week. House Joint Resolution 399 read in part: “The professionals who direct or manage medical staff services, from hospital communications to the accreditation of physicians and nurses, play an important role in our Nation’s health care system. This week, we acknowledge the value of such efforts.” 

So lay back, relax, and let Dr. Smith take care of you. She’s got the credentials. 
For more information about Medical Staff Services Professionals, please visit the National Association web site at www.namss.org 

Rita Schwab, CPCS, CPMSM

Learning from Aviation – Lessons from Flight 1549

Many comparisons have been drawn in recent years between healthcare and aviation.  Crew Resource Management training sessions are held in hospitals around the country with the intent of improving team communication and decision making.  Critics argue that standardizations possible in aviation are not possible in healthcare.  Proponents counter that many healthcare errors could be prevented through improved communication, which CRM training addresses.

   
This week’s remarkable and inspiring story of US Airways Flight 1549 gives reason to again consider what healthcare can learn from aviation.   

News reports abound with details about the dedication and training of the flight crew, in particular Pilot Chesley B. “Sully” Sullenberger.  In addition to extensive flight experience, he has an avid interest in safety, having served as the Air Line Pilots Association (ALPA) safety chairman, and as an accident investigator.  He is also the owner of Safety Reliability Methods, Inc., a consulting company focused on safety, performance and reliability.  All of those factors helped prepare him to handle the extraordinary crisis of flight 1549. 

  
It is however, important to remember that even the masterful work of Captain Sullenberger and his crew wasn’t enough to avert disaster.  The ferry boats, water taxis, Coast Guard, New York Fire Department, and others all played a part in bringing 155 passengers and crew to safety.  
 

So what are the take-aways for physicians and other healthcare “pilots”?    

  • Know that experience counts, but it doesn’t stand alone
  • Nurture an ongoing passion for learning
  • Remain open to innovative ways to improve safety
  • Work willingly on quality improvement and patient safety initiatives
  • Assist in “accident investigation” and share the results
  • Understand that you don’t do it alone; honor the work of others

 
Captain Sullenberger is being hailed as a hero, and few would dispute the accolade. Physicians and their extended teams quietly save lives every day, and few will find themselves publicly lauded for their efforts.  But those of us who work in medicine know who our extraordinary leaders are. You are not just technically proficient in your chosen fields, but also steadfastly dedicated to providing safe and compassionate care.  You are the doctors, nurses, administrators and others who respectfully and tirelessly work for ongoing improvement even when the tide moves against you.  
  
You make a difference every day.

How Does The Office of Risk Management Help Your Hospital?

What does Hospital Risk Management do?  Well, that depends on who you ask.

Every organization assigns different responsibilities to Risk Management.  Much like Medical/Professional Staff Offices, the roles can vary considerably from organization to organization.

The Yale School of Medicine / Yale New Haven Hospital posts the following about the goals of its Office of Risk Management:

Offices of Risk Management are concerned with a wide range of issues, however the overall goal is improvement of the quality of care and to eliminate or minimize the number of accidents with an eye towards claims prevention.

Goals of the Yale New Haven Hospital Office of Risk Management: 

1. Decrease severity and number of patient and visitor injuries by:

  • receiving and reviewing incident and occurrence reports, as well as patient/visitor complaints.
  • working closely with quality assurance/improvement committees.
  • periodically reviewing credentialing procedures.
  • being involved in the education of medical staff and employees via grand rounds, inservices and other venues.

2. Assure that documentation of care is adequate by:

  • working closely with medical record committee.
  • educating medical staff and employees.

3. Limit financial loss related to clinical care and provide a mechanism to deal fairly with issues related to claims from adverse outcomes in clinical care. The office: 

  • investigates professional liability claims (i.e., malpractice) and negotiates fair resolution.
  • manages certain insurance policies which have been secured by the hospital and its employees.

Whether or not you have an interest in the field, most would agree that these goals provide value, both to the organization and to it’s patients.

I personally liked the YNH statement because limiting financial loss was included last.  Not because it isn’t important, but because taking care of items one and two will help item number three take care of itself, and help keep patients safer in the process.

Barbados Butterfly author faces problems at work over her blog

I miss the Barbados Butterfly Blog; like many of you I was a regular reader.  As I perused her insightful, educational, and frequently witty posts, I found myself hoping that if I needed emergency surgery at 3:00 a.m. someone like “Barb” would be on call.  Skilled, tough, and wildly passionate about her work. 

Her posts gave us an insider’s view into the challenging, exhausting, and often exhilarating world of the surgical trainee.  Her home is Melbourne Australia, but she spoke eloquently for surgical registrars, residents and fellows everywhere.  Many of them were her most devoted readers.

Not long before her blog closed, she wrote about her sadness at leaving her old colleagues behind, and her excitement at taking the next step in her career at a new hospital. She wrote about learning to find her way around at a new place, the difficult schedule, and being too tired to eat.  We worried about her.  Her readers left words of encouragement in the comments, reminding her of the need to take care of herself.  She is part of our “family” here in the medical blogosphere.

Now a Melbourne newspaper reveals more of the story of what happened to “Barb” and her blog, and it’s not a happy one.  Surgeon’s Blog Vents Her Guts and Spleens in TheAge.com.au reports that Barb (Jillian Tomlinson) was temporarily suspended by the Alfred Hospital Board for one week because of concerns over her blog. The hospital declined to comment.

Over the years I have participated in various investigations, peer review committees, etc. involving hospitals and medical staff members.  Most of the decisions have been carefully crafted and thoroughly considered.  A few have been emotional and ill-advised. 

Of course, I have no idea what went into the Alfred Hospital Board’s decision to suspend Dr. Tomlinson, but I find myself wondering if they took time to read her blog and to appreciate the intelligence, dedication, and perseverance of its author.  I can’t help but wonder if she was given the opportunity to make any edits that the hospital board might have wanted, or if she simply found herself suddenly embroiled in a disciplinary action fueled by emotion.

Not a positive way to start a new job, that’s for sure.  Let’s hope it gets better for her quickly.  But in the meantime, we know that you’re resilient and strong Barb. Rest assured that the blogosphere is rooting for you!

“We could never learn to be brave and patient if there were only joy in the world.” – Helen Keller

_____________________________________________________________

Recent blogosphere posts regarding BB:
http://dinosaurmusings.blogspot.com/2007/03/thinking-blogger-award.html
http://drdork.blogspot.com/2007/03/chrysalis.html

http://nhsblogdoc.blogspot.com/2007/03/who-breaks-butterfly-upon-wheel.html

http://mdmaking.blogspot.com/2007/03/searching-for-butterflies.html
http://dustitwind.blogspot.com/2007/03/bye-bye-butterfly.html
http://tea-at-ten.blogspot.com/2007/03/barbados-butterfly.html
http://tea-at-ten.blogspot.com/2007/04/im-sorry-could-you-say-that-again-part.html
http://thegirlwiththebluesteth.blogspot.com/2007/03/godspeed-barbados-butterfly.html

http://ourdiagnosis.com/the_britmeds_2007_11

http://msspnexus.blogs.com/mspblog/2007/03/doctors_day_is_.html

http://mdmaking.blogspot.com/2007/03/searching-for-butterflies.html
http://tea-at-ten.blogspot.com/2007/03/dear-barb-butterfly.html

My Best Boss

If you’re a supervisor or manager, you know how challenging it can be to handle your responsibilities well.  Being bossy is easy; being a good boss is hard work. Being a great boss takes a combination of talent, emotional intelligence, and wisdom.

In Good Boss, Bad Boss, Psychology Today writer Willow Lawson states, “a worker’s relationship with his boss is nearly equal in importance to his relationship with his spouse when it comes to overall well-being. Even friendly coworkers or a rewarding occupation cannot compensate for a negative relationship with the boss.”

A few weeks ago I had the pleasure of having lunch with one of my former supervisors.  Patty lives in another state now, but when she comes back to Ohio for a visit we always try to get together.  She was probably the best boss I’ve ever had.  I’ve thought about her style over the years and tried to figure out where I could emulate her and where I needed to find my own voice. 

What made her a good boss?  The first thing that comes to mind is that she had a sense of humor.  She hadn’t been in our department very long and I was still trying to decide what I thought about her, when someone brought a singing holiday welcome mat into the office.  I can still picture her jumping on and off that silly door mat singing along loudly (and quite off-key) and grinning at me.

She didn’t take herself too seriously.

Patty knew her stuff and kept up to date with industry trends. She was involved in her profession on a national level and was always looking for ways to expand and share her knowledge.

She was a student, as well as a teacher.

She knew I was looking for more challenging work, so when the opportunity presented itself she introduced me to the world of medical staff administration.  She stood up to TPTB to send me to conferences and get the training I needed to not just do the job, but to understand the underpinnings and know why it was important.

She wasn’t afraid to “give away” some of her authority.

Patty was manager over several different hospital departments.  Prior to her joining our staff we all knew one another in that “greeting in the hallway” kind of way.  She instituted staff meetings that brought us all into the same room at the same time.  Lunch was included.  Before long, we all had a part in providing that lunch and arranging those meetings.  Sometimes it involved a trip to the deli to help her pick things up, or a trip to the party store for some inexpensive fun decorations.  The lunch meetings developed themes, and the agendas became artwork. 

I suspect that her boss thought there was a bit too much party and not enough work getting done at those meetings.  But if he did, he was wrong.  We hammered out problems, jumped in to help one another, and became a team.

One of our projects was revising a large filing system.  (Oh yeah, big fun.)  It was important, it needed to be done, but, yuk.  A group of us came in on a Saturday.  We sat around a large table like an old-fashioned quilting bee, laughed, talked, (ate of course) and got to work.  The only down side that I remember was the music we listed to on the radio.  Did I mention that Patty has terrible taste in music?  Some funky rock and roll station.  Didn’t matter though, we got through that ugly job and had fun in the process.  We even felt kind of special that we’d been invited to help.

She knew how to bring people together.

Being a boss isn’t easy, and it can be a thankless job.  If you’re fortunate enough to work for a talented leader, make sure you let them know they’re appreciated. 

Thanks Patty.

Grand Rounds 3.07

 It’s a week for celebration! It is National Medical Staff Services Awareness Week, and the second anniversary of the MSSPNexus Blog. What better way to celebrate than by hosting edition 3.07 of Grand Rounds. Welcome!

Some of you may remember that last year about this time Leonard McCoy, M.D., “Bones” from the original 1960′s Star Trek was accidentally beamed into my office. So this year I figured I’d better keep my wits about me and my eyes open for any fluctuation in the time-space continuum…

Deciding that the rumblings in my stomach required attention, I headed for the hospital cafeteria, dreaming of something green and leafy of course.

On the way I noticed a man who appeared to be a bit dazed. A stethoscope dangled haphazardly from the pocket of his lab coat. “May I help point you in the right direction?” I asked cheerfully as I approached.

“I’m not sure” he replied as he turned toward me with a bemused smile and a hint of New England in his tone. “I can’t quite figure out where I am.”

Instantly my Credentialer Senses went on high alert. (Similar to Spidey Senses, but in this case they sniff out doctors who may not be ‘as advertised’.) In all my years working in medical staff administration, never have I personally uncovered a total fraud, one of those Dennis Roark types who just decides one day that being called doctor might be kind of cool. But something about this “doc” seems a bit off, and I begin to wonder who this slightly confused soul standing before me might prove to be.

“Where is it you want to go?” I asked, noting that the photo ID badge he is wearing is not standard issue.

“The Emergency Department” he responded with a touch of arrogance, “I have a patient waiting.”

I grew even more suspicious in view of his inability to locate his own patients, and began to wonder whether I might have just met my first physician impostor.

“Okay, who are you, and what are you doing wandering the hallways of the Cleveland Clinic?” I asked.

“Cleveland? That’s quite impossible! I can’t be in Cleveland, I am Charles Emerson Winchester, III, Chief of Thoracic Surgery at Boston Mercy Hospital!

Uh-oh, it’s that time-space continuum thing again. Something about combining Medical Staff Services Week and Grand Rounds seems to cause a disruption in the classic television force field. Dr. McCoy would sympathize.

“Sorry Dr. Winchester, Cleveland it is; but take heart, since you’re an aficionado of classical music, you’ll love our orchestra.”

“Yes well, be that as it may I have patients to attend to and no time to dawdle, will you assist me in locating them?”

Smiling reassuringly, I extended my hand. “I’ll need to see your license, DEA, and proof of malpractice insurance please. I’ll contact my colleagues at Boston Mercy, run a check for OIG exclusions, and query the National Practitioner Data Bank. Take a walk with me; we’ll stop by my office and pick up a few forms.”

“What!? he asked in his best ‘I save lives every day and who are you to question my credentials‘ voice. “I believe that my word should be quite good enough! I graduated summa cum laude from Harvard Medical School I’ll have you know!”

“Oh I’m sure everything will check out fine. In the meantime, I just happen to be hosting Grand Rounds this week. I believe that our friends in the medical blogging community will be able to both entertain and educate us while we wait.”

“By the way, it’s Medical Staff Services Awareness Week, did you happen to bring me a present…?”

“Well,” he said patting his lab coat pockets “I do believe that I have an extra Godiva bar if that would suffice.”

“Chocolate? That’ll do. Hand it over!” (Note to all potential medical staff applicants, chocolate is a good gift…)

“Thanks for the treat Dr. Winchester, and now I have one for you, this week’s collection of the best of the medical blogosphere – Grand Rounds.”   

From Is there A Doctor in the House, the touching story of It.

From Surgeon’s Blog, the story of Big Joe: living proof of our fallibility; of useful tests that can mislead; of procedures aimed toward helping that sometimes make things worse.

Six Until Me ponders her well-stocked medicine cabinet, and wonders what would happen to it if she ever really got sick.

From Emergiblog: Consider yourself a little crazy? Perhaps nursing is the career choice for you.

Aggravated DocSurg reveals how a date with IRIS may help you avoid the need for a central line.

Aidan Charles (The Examining Room of Dr. Charles) has just announced publication of his second book! Trinities is a collection of tales, essays, and poems drawn from his favorite blog posts.  Congratulations to one of the medical blogosphere’s most gifted writers.

The Tangled Neuron‘s Antipsychotic Medications and Alzheimer’s chronicles one phase of a daughter’s search for answers about her father’s dementia.

Straight From the Doc tells of research with engineered heparins, which may prevent the formation of the protein clumps that form in the brain and contribute to Alzheimer’s.

True Confessions from Hsien-Hsien Lei of A Hearty Life.  She reveals that KFC is one of her favorite fast food indulgences, trans fats and all.   

The Diet Dish reminds us that large portions don’t always equate to boat loads of calories and small portions don’t always mean minimal calories in Portion Distortion.

Fixin’ Healthcare offers tips on how to avoid gaining weight over the holidays.

Anxiety, Addiction & Depression Treatments wants to go on record in support of the Winterhaven, Florida Chief of Police who took a stand on obesity.

Good childhood nutrition can help ward off coronary atherosclerosis and heart disease later in life according to Disease Proof.

Nutrition & Life offers some common-sense tips on healthy living.

The Family Fork suggests that salt intake is linked to obesity, particularly in children.

Medpundit argues that shortening waiting room times for all emergency room visitors regardless of the nature of their illness, does not necessarily improve healthcare and reduce errors.

Rickety Contrivances of Doing Good spends a busy night in the ED and questions whether the “lunar effect” of the full moon is real.

Clinical Cases shares how custom Google search engines help patients find reliable medical information.

Movin’ Meat explains why the decision not to settle a baseless malpractice claim is a lot like letting a bear maul you while hoping that he won’t get all your food.

The Daily Rhino says that the summer after medical school finals is a glorious time – all the perks of being a doctor (i.e. telling people you are a doctor, and are thus superior to them) but none of the responsibilities. But after a few beers one Saturday night, it became quite another story.

Just Up the Dose reveals what she learned about the silkworm’s scarf during her recent Urology rotation.

Anatomy Notes provides a lesson on referred pain. Sometimes the brain gets confused, making you think that one part of the body hurts, when in fact another part of the body, far removed from the pain, is the real source of trouble.

Medical student Anthony Rudine is concerned that some patients pay the price for physician training.

Medical student Kristen Heinan finds it hard to let go of what happens at the hospital when she’s out in the “real world”.

The Medical Blog Network has released HealthTrain, an Open Healthcare Manifesto.  Part of HealthTrain’s goal is to work toward a new “integrity standard” for healthcare open media, including blogs. As of 10/20/06 there were 32 signed supporters, including several bloggers represented in this edition of Grand Rounds.

Neonatal doc wonders why some women don’t seem to mind sporting a moustache.

Summer Sethi reminds us that radiologists are in demand

Not My Second Opinion investigates porphyria, hypertrichosis, and lepromatous leprosy, with a nod to Halloween.

It’s a Nursing Thing asks for suggestions on performing trach care without turning an already critically ill patient hypoxic.

Fruit of the Womb advocates a preconceptional visit to your Ob/Gyn since the best prenatal care begins before conception.

“Am I going to get well?” The Cheerful Oncologist does his best to answer. 

Wandering Visitor wonders why with the possibility of developing a disease like Melanoma so many people are still baking on the beaches and going to tanning salons to look “healthy?”

Cancer Treatment & Survivorship addresses whether patients should discuss complementary & alternative therapies with their health care providers.

Diabetes Mine offers sound advice on the use of DexCom and Continuing Glucose Monitoring (CGM) in the management of diabetes.

Hospital Impact posts a patient letter, a daughter’s thanks for the string quartet that played for her dying father in the hospital’s palliative care unit.

Dr. Anonymous joins the Walmart Free Antibiotics discussion and reminds docs to have the courage to ‘just say no’ to unnecessary antibiotic prescriptions, and patients to hold back their wrath if they don’t get the prescription they were hoping for.

InsureBlog jumps into the Walmart discussion with kudos to the retailer for establishing a low-cost generic prescription plan.

Health Business Blog, reporting from the Harvard Business School alumni health care conference, thinks the Biogen CEO talks sense when he discusses regaining our perspective on risk.

Dr. Enoch Choi of Tech Medicine chronicles of the woes of trying to appropriately immunize children while complying with recently passed California law.

UK Community Pharmacist opens a new blog with a post about documenting patient interventions.

Dr. Deborah Serani looks at the world-wide epidemic of school violence.

Teen Health 411 warns of the dangers of excessive web use by teens, and adds that maybe it’s time we encourage them to interact with people in the community and make some friends the old-fashioned way.

Barbados Butterfly reflects on recent referrals; who needs sleep anyway?

Inside Surgery advises Stay off the roof!  Falls are the second most common trauma fatality in the US in people aged 18 to 49 years of age.

Medicine for the Outdoors answers the question “should patients with head injury be kept awake?”

A Chronic Dose heads to the gym and confronts her own insecurities in the form of blond ambition

The Fitness Fixer gives lessons in good stretching technique (forget lunge and lean.)

   

Stay tuned for next week’s episode of Grand Rounds, hosted at The Rumors Were True.  This week Topher compares learning a stack of stuff in medical school to eating a stack of pancakes every morning. I submit that hosting Grand Rounds is much the same – eat up!  : )