Hello, and welcome to Grand Rounds, a medical magazine!  My name is John Joseph Pack MD and I am pleased to bring you the opportunity to explore what I hope will be one of the preeminent medical publications available to physicians, allied health professionals, and the public. 

Grand Rounds will be geared toward physicians, first and foremost, and will share not only medical information and opinions from our physician community, but other elements important to the average physician’s lifestyle, including art, history, travel, book reviews, fiction and non-fiction writing, and much more, all designed to pique your interest and satiate your constant thirst for high-quality information, wisdom, and entertainment.  I believe the broad scope of Grand Rounds is not only unique but a strength and helps differentiate us from that of our competitors.  I envision a place where physicians can go and surround themselves with things that are important and relevant to their lives. 

Not all of the categories in Grand Rounds will appeal to everyone or necessarily succeed.  You, our readers, will decide which sections blossom and which one’s wilt, requisite to your own individual tastes.  I will be following your preferences closely and adding or subtracting accordingly.  You will have a say in the direction of the magazine.  The magazine is for you, and we will embark on our journey into Grand Rounds collectively. 

The purpose of Grand Rounds is not only to share knowledge, and to convey wisdom and enlightenment, but also to bring the physician community together.  It feels like we are all running around at full speed but getting nowhere; too stressed to talk or connect.  Medicine is under attack and has been for some time now and I feel that, as a profession, we are tantamount to a ship without a rudder, drifting with the tide, prone to the vicissitudes of the sea instead of being up in the crow’s nest, on the bridge, and in the engine room charting our own course. 

Physicians have become a fractured group, but it’s time to coalesce, to start forming strong bonds, like the covalent and ionic bonds we learned of in inorganic chemistry.  Bonds that will last and that are not easily broken.  We have to start speaking with a shared  voice but we seem to have no medium to do so or have lost the collective will to make that happen.  I am hoping that the discourse, energy, and enlightenment generated by Grand Rounds will help chart that new course, where we return to being the Kings and Queens of the chessboard instead of the pawns we have become, being moved around the board by hospitals, corporate interests, and even private equity, at the pleasure of their own agendas. 

A physician’s duty is to our patients, and our patients only.  This duty has become harder to achieve as a growing number of us are now employee’s, taking marching orders instead of giving them.  Nowadays, advocating for the patient on one too many occasions can put you in the crosshairs of your employer, creating a palpable conflict of interest and even jeopardizing your job.  Physicians in current practice have to navigate through a veritable obstacle course to perform their duties, including purposeful insurance payment denials that has now become a business model for most insurance companies, coupled with dismal reimbursement for services and procedures, aggressive hospital case managers, length of stay scrutiny, inpatient and outpatient formularies, the broadening scope of inpatient pharmacy’s control over care, including second guessing physician orders regarding insulin doses, antibiotic choices, coumadin dosing, heparin administration, deviation from “expert guidelines,” and whatever other algorithms hospitals follow to meet their own government metrics in its quest for “cookie cutter” medicine that any technician can then follow. 

Personally, I noticed the wheels starting to come off the cart about 25 years ago, when one of the hospitals I attended changed the name of the Department of Internal Medicine, to the Department of Primary Care.  As an internist, I found this unwelcome and unnecessary, especially in a hospital without outpatient clinics.  This was coming from hospital administrators, but it was unclear what their purpose was and what the impact was to me or my profession.  Several years later, hospitals started to close ER panels, which many physicians used to sustain and diversify their practices.  Even though it was nerve-wracking to admit seven patients while being on call for the ER, the majority of them after midnight, and get no sleep and have office hours the next morning, it was also the life blood to some practices.  Enter the “hospitalist,” an employee of the system and pre-configured to do its bidding.  Next, our physician nomenclature was challenged by new-age lexicon, subverting our status further and making physicians generic, interchangeable, and, ultimately, replaceable.  We were now “primary care providers,” or just “providers,” and “proceduralists,” “intensivists” or “hospitalists.”   When did we, as physicians, make these choices, because I don’t remember the American Medical Association having a vote.  Even more concerning, it seems we as physicians have embraced this new hip jargon, using these words to describe ourselves!  Like Marlon Brando said in the movie Apocalypse Now, “Oh, the horror.”  We worked hard to earn the distinction, honor, and respect of being called doctor.  Next came the abundance of NP’s and PA’s, which, again, we as physicians helped usher in. There is a place for the valued members of the allied health professions, don’t get me wrong, but it’s become obvious, again due to corporate interests, that we are being replaced, to some extent, by the allied health professionals.  For example, and I am quite sure you have your own examples, my hospital used to have two MD’s in the ER at all times.  Now there is one and a “physician extender,” an NP or a PA.  As a physician, not good.  As a patient, not good. 

We must take back our profession, but we will have to fight to get it back, and we must start that mission by having a unified voice and an agenda to that end.  I would like us to begin to have that discourse here on Grand Rounds and start to shape our own future again.  I invite you to join me and be a part of something special and make this our raison d’etre, or reason for being. 

Grand Rounds is not intended to be a radical website nor a site for groupthink.  All voices are welcome and if this fosters debate, we should make arguments in a professional manner, pro or con, with the goal of coming to a better understanding as individuals, and collectively as physicians. 

My wish is for physicians to take an active role in Grand Rounds, to make your voice heard, to engage and to learn and to teach, and to make Grand Rounds a respectable publication and a site worth visiting.  Only you, our readers and contributors, can do this.  I can only set the process in motion.  Let’s start to develop a platform to make medicine a better place for all of us:  Physicians, nurses, allied health professionals, and patients alike.  To date, the physician outreach to participate in Grand Rounds has been staggering.  “How can I help?” or “Glad to help!” has been the common response, and that doesn’t surprise me, because this is who we are; physicians are people who genuinely want to help.  It’s in our DNA, otherwise we would not have gone into medicine.  There are certainly easier things to do in the world, but I can’t think of any other profession that offers what medicine brings to the intellect and the soul.

In addition, I would like to figure out a way to engage with physicians internationally, widen our focus and bring our collective energy, strength, and wisdom to those physicians who are shouldering responsibilities with so much less then us.  Let’s make global outreach part of our platform, with the end-goal of developing a better way to deliver healthcare to all of us on the planet.  Let’s find a way to bring them into the fold and show our support to our physician brothers and sisters in India, or China, or Bolivia, or the Central African Republic.  Let’s find out what their challenges are and how we might be able to help.  Let’s bring our opinions and advice to them, and them to us.  I suspect their ingenuity is remarkable and that we have as much to learn from them as they from us.  As physicians in the wealthiest country in the world, and arguably, the best trained doctors in the world, it’s time to engage on a global scale.  I am very receptive to thoughts from our readers about how we can achieve this.  Let’s reach out and make them understand they are a part of us and we are part of them.   

Above all, let’s continue to give our best to every single patient.  Afterall, we will all be patients ourselves someday.  Even more important than what I think, what do you think?  Feel free to bring your vision to Grand Rounds, and let’s start making a difference.  Lastly, as we lift ourselves up through knowledge, debate, and unity, and we form those strong covalent bonds we elevate our profession as a result, let’s acknowledge the work of some other institutions dedicated to making the world a better place.  In accordance with that principle, the website pledges 25% of all profits to the following three charities:  Doctors Without Borders, Action Against Hunger, and the African Wildlife foundation.  Thank you for listening and thank you for your support.  Let’s continue to try to make the world a better place.