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Change of Shift: Vol 2, Number 12


Welcome to Change of Shift, the best of the nursing blogosphere!

Thanks so much for Kim for inviting me to be a host. Actually, she asked me about a year ago. So, I'm sorry that it took so long for me to accept the invitation. You may be familiar with my work on Grand Rounds this year and/or last year. Hopefully, I can uphold the high quality of this nursing blog carnival.

By the way, if you haven't already, I encourage you to check out my interview with Kim on Doctor Anonymous LIVE which is my internet radio show. It was a great time and I hope to have Kim back soon on the show. Now, onto the links!

The holiday season can be very stressful, especially Christmas Eve. But, as ERNursery shares, even though the ER was packed with people, there was still room for A Holiday Surprise.

From the UK, Mousie relates a tragic story of a eight year old girl and how her death affected her mother. Reading this really made me think about a lot of things. The 20 comments really shows the impact of this story as well.

Emily from Crzegrl.net reflects on how difficult it is to be a flight nurse in her post "Potent Thanks." She writes, "I am grateful for every moment I am given with those I love." How true.

Do you remember playing the game telephone when you were growing up? Oh yeah, I did - with the soup cans and the wire and the whole thing. How does this relate to patient care? Well, Rae tells us in a post called "Let's Play Telephone." Phone triage and phone handoff of patients are always interesting. The end of the post shows how one can make a diagnosis just by talking for another 3.3 minutes on the phone.

A Float Floor RN shares a story of how difficult one shift can be. Did you know that "Sometimes It Just Hurts To Be In The Hospital" - especially when you can't get any narcan?

Kintropy In Action describes two hypothetical patients with possible diagnoses and possible treatment plans. He gives three pieces of advice from a parent of a child with disabiliies. He ends this post with a simple statement, "Let's work together, doctors, to keep her well, shall we?" I agree.

When I was a medical student (which wasn't that long ago), I remember that it was a challenge to find a case of C. difficle infection in the hospital for a case study write up. Now, it's so commonplace, that we add the letters MRSA and VRE in this discussion as well. Heart Matters reminds us that we as health care professionals and the public need to still respect C. diff and its potential fatal complications.

Speaking of MRSA, Fit Buff writes an educational post defining the term, its symptoms, and ways to prevent acquiring/spreading this contagious and potentially fatal disease.

Getting back talking about medical school, I remember my first day on the ward. It's that stereotypical first day that's depicted on television shows where virtually everybody ignores you and you as a student question why you're even there when you only feel like you're in your way. The Oracle is a student nurse now and shares a similar story in this post called, "What?"

The docs I work with at the hospital have 10-20 and sometimes 30 years more clinical experience that I do. I get intimidated when I sometimes have to say, "I think that's done a little bit differently now." Disappearing John RN asks, "How do you teach someone who knows more than you?" The story of a less experienced preceptor and a more experienced pupil.

When you pass on from this earth, have you ever thought of who will sit in judgement of you? Brain Scramble has and believes that it will not be a deity, but your patients will meet you at the pearly gates -- maybe.

What is high quality health care? This is something that Life in the NHS is asking. Even though, as a health care provider, you may hit your number targets for cost and quality numbers, the patient's perception of health care is also important.

Did you know that according to the CDC, one person out of one million who are immunized with the flu shot may be at risk of getting Guillian-Barre syndrome? The Pixel RN discusses this further and also nurse-run shot clinics.

Congrats to Pixel One, Purl Two for passing a national certification exam in her specialty. Unfortunately, she's not feeling the love from her employer who rewarded her with a huge 1/2% raise. Yeesh!

Kate from the Alternative Nursing Careers blog proclaims that nurses can do so much more than pass meds. Do you want to go beyond clinical nursing? In these posts, she outlines three steps to get you started. She also describes the career of information technology and how nurses are uniquely qualified for this type of work.

Patient privacy and confidentiality are issues that medical professionals constantly struggle with. The Nurse Practitioners Place shares some tips on how to keep patients comfortable as they share information with you.

That's it! Thanks so much for checking out Change of Shift: Doctor Anonymous style! Feel free to check out the rest of my blog. Make yourself at home. Also check out The Doctor Anonymous Show where we go "Beyond The Blog" to bring you the brightest stars in the medical blogosphere. Thanks Kim for the opportunity to host Change of Shift. The next edition of CoS will be December 13th over on Emergiblog. So, get those posts ready!

Listen LIVE tonight


BlogTalkRadio Listen Live

Thursday, November 29th, 2007 at 10:00pm Eastern Time

Join us tonight for Kerri Morrone who authors the award winning blog Six Until Me. I'm hoping the show will be "featured" again on the front page of the Blog Talk Radio website. We'll just have to see.

Also, this radio host and blogger was given some props by Alan Levy, the BlogTalkRadio CEO on a radio show last night. Don't believe me? Well, tune in to my show tonight and I'll play the sound clip for you. HA!

For first time Blog Talk Radio listeners:
*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.

*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.

*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of my show site. If you are registered with the BTR site, your registered name and picture will appear in the chat room. (If not, you will be designated as "guest")

*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!

The Kerri Morrone Interview


This week The Doctor Anonymous Show welcomes Kerri Morrone who authors the award winning blog Six Until Me. In my opinion, Kerri is one of the most popular bloggers in the diabetes blogosphere. Kerri, a type I diabetic, has reached out and touched so many people with diabetes and their families.

Join us on Thursday, November 29th at 10pm Eastern Time where we will talk about her blog, her life, and other things. She's planning a wedding for next year. That's got to be fun!

Yes, she's a Boston Red Sox fan - and as you probably know, they beat my Cleveland Indians on their way to a World Series victory. I was watching some of those games during my blogtalkradio shows. Finally, I think she has a thing for Larry Bird. If we have time, we'll have to go into that.

I've been having a string of shows where I have internet issues at the beginning of the show. Will that happen again? Will the chat room be working? Will a mutiny occur during the show? Will chaos ensue? Well, you'll just have to tune in to find out. Check back here Thursday for more details.

Grand Rounds


Grand Rounds 4.10 is now up and running at Prudence, MD: Medicine, General health care, and science. GR comes to us all the way from the Philippines this week. I wasn't able to submit anything but she still gave my blog a plug. Thanks so much for this!

This blog carnival of medical posts is already the 10th volume for the fourth year of Grand Rounds. I’ve been hanging around for a while, eversince I caught the GR bug at Doctor Anonymous’ blog. It’ll be my first time hosting this, thanks to Dr. Nicholas Genes of Blogborygmi. 
And I think the G.R. is a fine opportunity for me and for other bloggers, too, both medical and non-medical practitioners, to be able to learn more about the practice of medicine in other places (as I’m a general medicine practitioner here in the Philippines) and also other stories that are medically related that happen in other parts of the world, as well as locally. I’m glad that there’s a good turnout of posts for this week.
When I was on my blog break, I neglected to mention that Grand Rounds 4.09 was posted up at Mexico Medical Student. This was a great mix of links and music. I encourage you to check it out, if you haven't already.

My apologies to the past two hosts for not submitting anything. I was in my own little GR recovery period. Hopefully, I'll be submitting back to GR soon.

If you don't know what Grand Rounds is, it is a weekly compilation of the best posts from the medical blogosphere that moves to different sites each week. And, who doesn't like reading about medicine and science? Next week, Grand Rounds moves to Enoch Choi's Medhelp site.

The Cardiac Feud: DeBakey Vs. Cooley


I wouldn't call myself a history buff, but I enjoy reading about the past - especially about medicine. In today's New York Times, it tells the tale of what apparently was a huge feud in medicine - specifically cardiac medicine - for four decades. For me, the most controversial medical issue I remember learning about was the discovery of the AIDS virus and the two people who tried to get the credit for that.

But, this cardiac feud is one of the best historical stories that medicine has. Both these surgeons were pioneers in the area of cardiac surgery working in Houston. And, for 40 years, these two gentlemen spoke little to each other and couldn't even stand to be in the same room after "the incident." What happened? Here it is from the NYT:

The breach began in 1960, when Dr. Cooley left Dr. DeBakey’s practice at Methodist and moved the few hundred yards to St. Luke’s Hospital, where he later established the Texas Heart Institute. But it was an incident in 1969 that turned the rift into a full-blown feud.

It happened when Dr. Cooley, without approval from Dr. DeBakey or Baylor, commandeered an artificial heart from his former partner’s lab and implanted it in a patient at St. Luke’s.

Over the years, Dr. DeBakey has called that first-ever use of a total artificial heart a theft, a betrayal, unethical and “a childish act” to claim a medical first. Dr. Cooley defended the implant as a desperate, if ultimately unsuccessful, act to save a life.

What? Did I read that right? I mean, in today's medical world, I can't even imagine something like that happening - especially with all the double checks, paperwork, and bureaucracy that happens in today's operating rooms and hospitals. But, to think about it, I'm trying to think logistically how that happened, and it fascinates me.

I encourage you to read the entire NYT article. It really gives you a flavor of all the background that happened after "the incident" in 1969 and the decades that followed. Apparently, recently, they have reconciled. But, to be a doctor there in the 1960s. Definitely interesting to think about and dream about. A whole different world of medicine and a whole different world around us back then....

What's up with Sitemeter?


Every time I try to log into Sitemeter this morning, I get a message saying that my account is unavailable. Is anyone else having this problem? Does anyone know what's going on with sitemeter today? Maybe it's just my account? Yeesh!

Update (3:30pmET): After finally getting to load up the front page of Sitemeter, I found this announcement dated today:

Sometime during Thanksgiving day SiteMeter experienced some major internal system problems. At the moment it appears that access times to SiteMeter.com and all stats pages are extremely slow.

We are also aware that access to s21 accounts appears to be disabled. We are working as quickly as we can to try and find out what the problem is and to get everything back online and working normally. We apologize for the inconvenience. Sincerely, The SiteMeter Team

Doctor SWAT



I'm back from my blog break! Thanks to everyone who sent me all the supportive e-mails and comments. Nice to know I was missed, but, now, I'm back...

People may not believe that I'm old enough to remember this tv show from the 70s. But, you betcha I remember the TV show SWAT. The intro is above on a youtube clip. One of the most memorable tv themes - ever.

Apparently, now docs are being a part of these SWAT teams. How cool is that? In this AbcNews article, Dr. Alex Eastman's day job is a surgeon at Parkland Memorial Hospital in Dallas. But, in his spare time (hehe), he is part of the Dallas SWAT team (cue music). He wears a bulletproof vest and the whole thing.

Having a doctor along can mean the difference between life and death when a cop is shot. Police Lt. Carlton Marshall is living proof. Marshall was shot in the neck during a raid Oct. 17.

Within minutes of hearing "officer down!" Eastman and his partner, Dr. Jeff Metzger, went to work. Metzger held the officer's head while Eastmen performed an emergency tracheotomy, cutting a hole in the officer's neck to allow him to breathe.

Now, with the writers strike still going on in Hollywood and New York, here's an idea for a new television show. Watch Doctor SWAT on Thursday night right before The Doctor Anonymous Show. Dr. Eastman and Dr. Metzger play "good doc" and "bad doc" - Fighting crime and saving lives at the same time. Tune in Thursday night for Doctor SWAT (cue music).

Change of Shift here next week!


As I revealed on The Doctor Anonymous Show last week, I volunteered to be the host for the wildly popular nursing blog carnival named Change of Shift. What was I thinking? I guess I wanted to get all of my hosting duties all done in one month.

Actually, Kim has been asking me for the past year to be a host. So, I figured now was the time to step up and "take on the nurses" as she describes in a recent post. So, look out! Next week, CoS is coming here. How do you participate? Well, follow this link to Emergiblog for details.

Medscape Pre-Rounds Interview

Welcome to all of you who clicked on over from the Medscape site from my Pre-Rounds interview with Dr. Nick Genes! As of this posting, there have already been over 250 clicks over here (that's a lot for this little blog that could - hehe).


Welcome to my blog! I hope that you check out some of my other posts and my internet radio show. For those who haven't checked out my interview, I have copied it below. Enjoy!

"Dr. Anonymous" Survives Turbulent Year for Medbloggers

It's been a tumultuous year for "Dr. Anonymous." Since we last spoke to the mysterious but jovial figure behind the eponymous Web site, he has been featured in the national media but has also received hate mail and personal threats. For a while he thought about quitting his online activities, but he somehow pressed on with a new style and new technology to carry his thoughts. I caught up with him recently.

Dr. Genes: You prophesied last year that your writing would evolve -- more commentary on news, less about personal life and your opinions. Has it unfolded that way, and if so, why?

Dr. A: Hosting Grand Rounds has always found me at transition points. Last year, I was changing from blogging about patients to more news-oriented posts. Now, as we'll discuss more below, I find myself shifting again to incorporating more live Internet radio shows in addition to posts.

Blogging has really been a reflection of my life. Blogging about patients was a comfortable zone in which to write. Then, I wanted to push my writing skills a little bit to do commentary on current events. I guess now, I find it challenging and exhilarating to see what I can do with live Internet radio. Who knows what will happen a year from now? We'll see.

Dr. Genes: Where are you finding the material to comment on, and how do you decide what's blogworthy?

Dr. A: Even in high school, I was a news junkie. I like to know what's going on in the world around me. For blog posts, I hit the US and world health news headlines first and see if anything finds my fancy there. In the past few months, I've also been drawn to commenting about news that is more local to me: for example, a local high school student diagnosed with MRSA, a recent high school shooting incident, or even a tornado that occurred less than a mile from my office.

Dr. Genes: Are you concerned or frightened when other anonymous medbloggers get outed? Have you ever considered calling it quits or going public under a new guise?

Dr. A: On January 26, 2007, my blog was featured by a major news organization. This was the start of the best and the worst week ever in my blog life. The first couple of days were the best, with congratulatory comments and emails. Then the negative feedback and personal attacks started. Being the type of person that I am, I took the negative stuff too personally -- and really considered quitting blogging altogether. But, my blog friends really kept encouraging me to continue, and after days of thought, I did come back. That was definitely a long week for me.

As far as other medbloggers being outed, I was at a medical meeting in May, using the free Wi-Fi, reading blogs instead of paying attention to the lecture, when I learned that both Dr. Flea and Fat Doctor took their blogs down on the same day. That sent a huge ripple throughout the medical blogosphere. (Editor's note: Fat Doctor has resumed blogging.)

In the days that followed, there were reports of other medblogs being taken down, and some (including me) questioned the future of the medical blogosphere.

I started the I'm a Blogaholic group blog during this time. This was an opportunity for a few popular medbloggers who had to shut down their own blog to maintain contact with their readers until their new blog was up and running. I think it really fulfilled a need at that time -- if, for anything else, to give scared medbloggers a place to meet and vent about the current situation.

Dr. Genes: Last time we spoke, you were immersed in blogcasts. Now you've graduated to live blog talk radio with a chat room and dial-in participation. Can you explain the attraction? Isn't there enough interactivity and participation on blogs -- and perhaps more time for reflection, references, and nuanced thought?

Dr. A: Blogcasts are "prepackaged podcasts." I enjoyed them at first, but found myself frustrated with the entire editing process. I wanted to get the blogcast out to the listener as soon as I could -- and editing really slowed the process down.

I was immediately drawn to the live Internet radio show because it is real-time interaction with the blog reader -- better than any instant message or text conversation, or even a live chat room. For a live show there is also no audio editing involved, and the radio show site almost immediately puts it into a podcast format for listeners to download. Even with technical difficulties I have had during the show (and I've had a bunch), it's a different type of exhilaration I get doing a show live as opposed to writing a really good post. It's hard to explain.

Dr. Genes: What's next? Are you thinking about video?

Dr. A: I tried that during my best/worst week ever. I recorded and posted a video blog. But I eventually took that down -- basically out of fear of being outed at the time.

Dr. Genes: Yikes! Well, what about some new writing you're particularly pleased with?

Dr. A: Over the past few months, my best writing has been about ethical issues in medicine that hit the front pages of newspapers. These, by far, generated many more comments than other types of posts. I encourage readers to check out the following: The Ashley Treatment, Uterus Transplant, and The Baby Emlio Debate.

As for radio interviews, I've always wondered how a person's real voice would sound. I've read a person's blog for months, and in my mind, I have a "voice image" of what they sound like. It's been a lot of fun talking with them on Internet radio and seeing if my mental image of their blog voice matches with the real voice.

What's next? I'm going to further explore this talk show gig. I'm thinking about trying to assemble a colorful cast of characters to do a monthly or weekly analysis of health news that makes headlines in the mainstream press. Maybe I'll call the show "DA 360," or "The Dr. A Factor," or "The Weekly Show with Dr. A." Those names aren't taken, are they?

Dr. Genes: Ah, no. But readers are welcome to tune in when Dr. Anonymous hosts Grand Rounds on Tuesday, November 13, 2007. Dr. A will be organizing and presenting the week's best writing from the medical blogosphere -- from students, economists, nurses, researchers, and doctors (anonymous or not) -- on his site. As a bonus, he'll be introducing Grand Rounds live, over Internet radio, on Monday, November 12, 2007; you can download the archived version to listen to that broadcast. Check it out!

Nicholas Genes, MD, PhD, second-year resident in emergency medicine, Mount Sinai Hospital, New York, NY
Medscape Med Students. 2007; ©2007 Medscape, Posted 11/13/2007

Happy Thanksgiving


I know it's not until tomorrow. But, I'll probably forget to post this tomorrow. So, there you go! Gobble, gobble! Have a great turkey day. Happy Thanksgiving, everybody. Who's going shopping early on Friday? Not me. HA!