The viewpoints recently expressed about Grand Rounds are a sign of growing pains. Traditionally, grand rounds in the academic setting has been case and/or topic oriented and limited within the boundaries of a department. The medical blogger Grand Rounds is much more diverse and with time will exhibit enormous growth.
It has been obvious for some time the large commitment undertaken by a host. That the host has the discretion to edit and present Grand Rounds to their chosing should be understood. Already, there are groups that have established related carnivals and perhaps this should be encouraged, as well as coordinated to create a network. The early stages will be touch and go; two steps forward and one or two back. Somewhere along the way a new direction will take place. Meanwhile, anyone who commits to the task of host should exercise their prerogative to mold Grand Rounds as they see fit.
Back for a moment to my exchange with Topher about the last Grand Rounds. His email took me back to the days when I was a medical student and my perspective of health care was focused entirely upon sick and injured people. This past summer I was hiking a portion of the Applachian Trail near Erwin, TN and met a young man who is a medical student in Charleston. When I inquired about his experience so far, he responded in a fashion that indicated the perspective is largely unchanged from my early days long ago at another institution.
I am "retired" and, therefore, somewhat free to practice medicine in a manner that my experience has taught me. All of my activities are office and community based. The patient load runs from 25 to 40 people daily with the majority referred by other physicians. The usual presentation is an unhealthy lifestyle, overweight or obese, and suffering with type-2 diabetes, systemic hypertension, degenerative arthritis, dyslipidemia, heart disease, acid reflux, irritable bowel syndrome, polycystic ovary syndrome, endometriosis, chronic fatigue, fibromyalgia and/or depression. Everyone has a label. Almost everyone is on at least one medications and most are taking three or more.
With patience, persistence and encouragement these people can be taught a more healthy lifestyle. Ninety percent of them show improvement in their medical condition(s), decrease or eliminate the need for medications and they feel better. One-third of the population end up taking no medications.
Keep in mind that the improvement in the disease did not come about due to the medical therapy for the disease. It is a result of healthy nutrition, increased physical activity, sleeping well and managing stress. This is personally directed health care and it is hard work for these people. I warn them the solution is simple but it is not easy. And, the problem needs continued attention or it will relapse.
Many, if not most, of these people could have avoided their medical problems if they pursued more healthy lifestyles. Everyone needs to be reminded that the goal of life and health care is good health. Sick care is for those times that fall short of the goal and there is always a need for sick care but it is not the goal.
Technorati Tags: Lifestyles