The Yellow Jersey, prize for the 'General Classification' is undoubtedly the most coveted in cycling. This is the best of the best; team leader, hill climber, accelerator, tactician. The pre-race contenders this year included the resurgent Lance Armstrong, Aussie Cadel Evans, youngster Andy Schlek and the eventual winner, Alberto Contador. These posts are groupe du maillot jaune;

Mudphudder is an intern and, like reaching the Yellow Jersey, it's all about pushing limits, where "each day things are made a little tougher than the previous day just to see if that’s what pushes me over the edge." Raw stuff.

At the forefront of current healthcare discussion is President Obama's public health plan. Mother Jones, RN weighs in from a nurse's perspective.

Leslie at Getting Closer to Myself considers a new anti-Lupus drug from the patient perspective, with some healthy skepticism in a very well written and rational post.

Doc Gurley interviews the British-born award-winning novelist and historian, Jacqueline Winspear, in a vid-post honouring the death of two men - the last WWI British vets, Henry Allingham and Harry Patch.

The mountains, for all but a few, spell pain. It is where the winners and losers of the Tour are decided, and the Polka Dot jersey is awarded to he who dances up the Cols fastest and most consistently. 2009 has seen Italian Franco Pellizotti take control of the Mountains, first winning the polka dot jersey in the 13th stage, and he hasn't let it out of his grip since;

How to Cope with Pain blog examines some of the evidence for accupuncture as analgesia. It may be useful for some types of pain, but probably not for the wrecked cyclists.

Canadian Medicine News' Sam Solomon reports on a recent medico-legal decision that could have interesting implications regarding non-emergency mid-air care.

Louise at Colorado Health Insurance Insider posts about the importance of joint responsibility in healthcare. You can't be pushed up a mountain, nor can patients summit unassisted.

Sprinters' Jersey
Big strong blokes, well adept at picking a point and driving it home, at speeds of up to 65km/h on the flat! Aussie Brad McEwan is a three time Green Jersey winner, claiming the sprinter's title in 2002, 2004 and 2006. This year has been a battle royale between Brit Mark Cavendish and Thor Hushovd of Norway;

Paul S. Auerbach at Wilderness Medicine shares the result of repeated toenail trauma.

Over at Health Business Blog, David ponders; Less is More. He thinks.

Barbara Kivowitz' post at In Sickness and In Health sights a recent study on Caretaker Stress.

This year's tour has not revealed any new drug dopers, but 'Gear'-related controversy is never too far away from the Tour. Last year, Riccardo Ricco freakishly broke away from the lead group several times, winning two stages before being disqualified for using CERA, a synthetic form of erythropoetin. French Customs even searched some of this year's team support cars at border crossings!

Dr Shock considers the Unintentional Consequences of FDA Black Box warnings on SSRIs.

Unintentional consequences certainly go hand in hand with blood doping... hypercoagulability, anyone?

Medical marijuana has been a hot topi recently at EverythingHealth; Toni Brayer posts about the services offered in California.

At Florencedotcom, Barb discusses recent politics in California, and notes wisely that "equating occasional long reaches down a dark foxhole with 'patient safety' is a huge disservice". Oh, and that California is full of bad actors.

Crash!
Sometimes things just go badly; on the 16th Stage of this year's Tour, Jens Voigt crashed whilst descending at around 75km/h. He was unconscious for several minutes, and was treated at Grenoble Hospital.

At Listed as Probable, this compilation of incidents fits this category perfectly, on a light note.

Bongi posts about foreign gratitude when an ill-informed international phone call querying his care.

Sometimes it's actually safer to apologise for your part in the crash, as Apologizing for errors halves malpractice suits, according to ACPHospitalist.

Team directeurs

The Directors Sportif are the master tacticians of the tour. They plot and plan and map the future of their team's race, emphasising individual rider's strengths whilst achieving the best overall result for the team. Much like the authors and commentators of health policy;

Medicine and Technology's Dr Joseph Kim considers that Healthcare Reform may push doctors away from clinical medicine.

Kim over at Emergiblog recently attended the BlogHer 2009 conference, and she relays a session she attended with Valerie Jarrett, a Senior White House Advisor.

HealthBlawg covers a recent Conference he attended in NYC; Social Communications & Healthcare. Dave Harlow describes it as "a lively event with an energized crowd."

Le Peleton
No summary of le Tour would be complete without a mention of the peleton. French for 'platoon', these riders are the guts of the Tour. It's amongst the peleton the domestiques ply their trade, climbers hide in the sprints, sprinters attempt the climbs and the Grand show that is the Tour unfolds!

Grupetto
The grupetto or autobus is a group of sprinters who are poor climbers. They work together as a bunch to survive the treacherous passes in the Alps and Pyrenees. Traditionally, the last man in the tour is known as the lantern rouge, and until 1989, the rider wore an actual red light! More often than not, the grupetto make it all the way to Paris...

In addition to covering Rugby League Players and their latest escapade, Queensland's 'high brow' daily newspaper, The Australian, has effectively bumped up sales of Stilnox. Those idiots.

More to the glory of Australia's Rugby League fraternity, whose escapades with booze, drugs and disrespecting women and themselves have hogged far too much media time in the last few years. But, even after a scathing Four Corners documentary and various other embarrassments and scandals, these sportsmen are idolised as role models in the community. Moreover, young men want to be them, young women want to notch their bedposts in some Brisbane's most glamorous nightclubs.

When the state Rep side is accused of being high two nights before a match (in which they play badly and eventually lose), the papers cover the story. If the culture was to humiliate and shame those involved, I'd understand. It's just that somehow, the publicity always ends up a little bit positive. Poor players, so naive and brainless, their lives are tough so they have to relax with chemicals. Give me a break.

But, all that's not my biggest beef here. In fact, if it was just about footballers getting wasted, I wouldn't have considered throwing my two cents in the ring. But here's the thing; in this latest incident, the players are accused of using zolpidem, with alcohol and caffeine, as a stimulant.

Somehow, Australia has developed a Stilnox fascination. It's all about the wonderful sleep tablet that doubles as a stimulant. Given that it's illegal to advertise prescription drugs in this country, a mention in the front section of a broadsheet is advertising gold. Plus, Heath Ledger used it, so it must be either controversial or worth talking about.

The dangers of zolpidem use are well documented. Incidences of sleep-eating, sleep-walking, sleep-talking and even 'sleep sex' have been reported. And not in small numbers. These are patients who've not used alcohol and have no prior history of complex sleep behaviours.

Sure, the drug knocks you out, but I've had conversations with at least ten patients about taking a tablet, and waking up with three missing. Patients who live alone. Seriously, people will take more tablets whilst they're asleep. One of my learned colleagues described it as Parasitic pharmacy. Not surprisingly, the TGA has added more an more warning labels to the medicine, and insurance companies have refused coverage for pack sizes greater than fourteen tablets.

Simply, we have unintelligent Leaguies effectively advertising the stimulant effects of a drug that's extremely susceptible to abuse, and with known adverse effects. And seriously, they're suggesting it's used as a stimulant. What kind of positive outcome could that possible have?

There needs to be some responsibility on the part of News Ltd. (publishers of the Australian); sure, they interviewed the President of the Pharmacy Guild, and whilst I'm sure he's a fine pharmacist, I'd be asking someone who works in drug information for an opinion, not a politician.

Mostly the problem is that they named the drug. I think there'd be a substantially more negative stigma if the article had only mentioned that a 'sleeping tablet' was used. Then at least the average reader would think;

"They're using sleeping tablets to keep them awake?!!? Wow, what morons."

Rather than, "Sweet, I'm gonna find me some of that Stilnox next time I go out."

It seems that the buzzword of Accountability is woefully absent from several sides of this equation; the Leaguies aren't held responsible for either their behavior or their consequently poor showing on the field, and News Ltd. will claim 'editorial privilege' to explain away their irresponsible copy.

This week's Mystery edition of Grand Rounds 5:44, is up now at Doc Gurley's place.

Grand Rounds was originally established by Emergency Medicine physician, Nicholas Genes in September, 2003. His concept was to highlight and capture the best medical blog posts in one place each week. The rotating nature of the hosts for Grand Rounds promotes community awareness of new bloggers, and encourages cross linkage to more content.

Please forward your submissions to captain DOT atopic AT gmail.com with “Grand Rounds” in the subject line. Deadline will be this 2pm (Pacific) this Sunday, 26th July. I look forward to reading all your submissions!

Next, I'm sitting at my desk after watching the evening news, thinking about a patient I saw two days earlier. Their symptoms confuse me. It's 8:30pm, and I'm sparked into action. The books come out, notes and Medline searches and pens. I order and refine and learn. The books spring to life and I systematically devour multiple chapters. I feel like a learning machine.

I'm usually a morning person. This night, I am a Learning Robot. All day I've been in mental hibernation, and something's pressed my on button. I work well past midnight.

I get up at 5:30am and go for a run, feeling supercharged in body and mind. Today, I will be a Study Robot.

This week at AMSA I've met with students from all around Australia and New Zealand, and a continuing theme for discussion is whether medical school should be post-graduate or under-graduate. There's presently a mix across the two countries, but I would suggest that the actual trend is more towards post-graduate courses, and certainly that's how it is in the USA.

I'm an advocate for post-graduate medical schools, for several reasons. Clearly, my bias is that I'm at a post-grad school. There's the potential for some very young doctors to be out there, particularly in Queensland. At shortest, a five year medical degree after finishing highschool at 17 means that, aged 22, you're a Doctor. That's pretty young, sure, but I don't think that age is the defining factor.

I've also heard an argument that an important aspect is about the 'entry process'. The post-grad entry process takes, from signing up for the GAMSAT, sitting it, getting through the interview, a few weeks of waiting by the mailbox, a fantastic letter and showing up for O-week, all takes about fourteen months. Not exactly the blink of an eye, you might say. That time certainly allows for some lengthy deliberation between "I think I'd like to do Medicine." and;

"Wow, I'm gonna become a Doctor... I guess that means several years of super-intense study, being chained to a hospital for 70 hours a week for at least five years, neglecting the majority of my existing social relationships, earning good money and, most importantly, shouldering the responsibility of caring for society."

Sometimes I get the vibe that application to undergrad medicine in Australia happens more along the lines of;

"I'm top of my school. I like helping people. I think I'll study medicine.", and the person ticks the box.

New Zealand has an entry year, so instead of slogging one's self in the final year of highschool, a set Health Sciences First Year provides the barriers to entry. I think that this provides some sort of medium between a protracted post-graduate entrance program and a somewhat impulsive high-school entrance program.

The key point I'm pushing here is that there needs to be time for prosepective doctors to really, and I mean really think about why they're doing medicine. Importantly, candidates should be able to have a good concept of functioning in the adult world, and essentially what it is to communicate with people who are not close family, highschool friends, uni mates and colleagues.

A good way to think about it is languages. I'm sure you've noticed that highschool kids have their own way of communicating, be it the absence of vowels in text messages or the use of 'like' every third word, there's just a certain style to it.

University students, at least undegrads, also have a somewhat more developed form of specific language, with their own wee evolving dictionary of slang and popular terms.

Medicine, indeed, has an entire language of its own. The innumerable acronyms and abbreviations, clinical terms and anatomica. An entire sector of clinicans who can appreciate the difference between aortic stenosis and aortic sclerosis, and the prognosis attached to each.

As exemplified by Guy Ritchie's Lock, Stock and Two Smoking Barrels, which provides subtitles to translate cockney rhyming slang, it's a lot easier to converse in a language you can understand. The best method of understanding regular, non-tertiary educated lay-people is talking to them. That way, terms like 'knock up' (dyspnoea), and 'chroming' (huffing paint fumes) don't sound like a foreign language.

My point is, that before someone breezes from the highschool to undergrad to medical dialects, it's pretty essential to be able to talk to everyone else. Sure, medical school has several classes in which these aspects of communication are taught from a theoretical perspective, but they just don't compensate for real life experience. Post-graduate medical students not only have more years under their belts, but they're probably more likely to have a job. The job might even involve talking to people! Frankly, the more you live, the more you talk, the more you see, the more you understand.

My last seven days have been, to put in bluntly, sleep deprived. This is far from complaint, though, as I've been enjoying several events in addition to the pre-exam slog for Surgery Rota.

The annual AMSA Convention started last Sunday Night, and has extended through the week. AMSA Convention strikes me a some kind of rite of passage for Aussie Med students; it's a hugely long week of education and partying. It winds up on Saturday Night with a Black Tie Gala Ball, at a Mystery Location. It's the Conventio's 50th year, and the line up has been most enjoyable. Plenary sessions have included such topics as Indigenous Affairs, Stem Cell Research and the Dumbing Down of Medical Teaching. The Social evenings have been exteremely well organised, complete with some of the most enthusiastic costuming I've ever seen. Ever.

Meantime, late nights have become even later with Le Tour De France being covered on SBS2; an easy way to turn a midnight bedtime into 2am, especially as the really good racing seems to happen from about halfway through the stage to the finish line.

Plus, The Ashes started last night, with the English talking themselves up after winning a series against the Aussies four years ago (seemingly ignoring the 5-0 white-wash the suffered on the return series a meagre 18 months later). Whilst there has certainly been some important changes to the Aussie's lineup, the home team will still need to play some pretty tactical cricket to keep the Australians in check. Coverage winds up at around 3am, each morning.

I'd been told that Surgery came with long hours, but this is bananas; some people will do anything to watch sport. Right then, time for a snooze.

I am a nerd, that much is clear.

Medical school, believe it or not, is entirely filled with nerds. In fact, by definition, enrolling in medical school would constitute a nerd. It's that whole 'Life-long learning' thing.

I'd define a nerd as someone who enjoys 'knowing lots' about a certain subject, or many subjects. A nerd may or may not be socially well adjusted, and I'll elaborate on this further down. But the crux of it, really, is that a nerd is someone who loves learning and learning lots. In lots of detail. Being a Nerd is no longer negatively connotated; intellectual acheivement is praised and rewarded. Think about Nobel Prize winner... Yep, they're all Nerds.

Anyway, at Med School, there are two types of nerds; Closet Nerds and Open Nerds.

An Open Nerd is proud of knowing lots. They wear their desire for knowledge on their sleeve, and, if extroverted will engage in nerdy banter with other nerds about the subject of choice. When they study, they don't hide it, and often work relatively evenly throughout the term, in addition to the ususal pre-exam study push. As a result of being comfortable with showing certain level of knowledge, Med Students who are Open Nerds are more likely to 'take the bait' in social situations when a lay-person asks about a health problem. Open Nerds still indulge in regualr passtimes, of course, but they make no apology for having to clear time in their schedule to study. Open Nerds often come across as either arrogant know-it-alls, or as faecetious to their Closet Nerd peers, who reckon they should just relax and get out more often.

A Closet nerd isn't as relaxed about knowing lots, except in certain situations. The appropriate situation to 'know lots' is during an exam. Comparatively, inappropriate times to 'know lots' include classtime and social occasions. When concentrated in groups, Closet Nerds often display how well socialised they are by establishing other areas of interest that require no acknowledgement of 'knowing lots', such as sport. Closet Nerds regularly prioritise these extracurricular activities ahead of study. Open Nerds might think that Closet Nerds drink too much and don't know enough, but Closet Nerds do, indeed, know lots. They excel in written exams and, when truly pressed or questioned, will reveal the fulminant knowledge of their field. Come exam time, Closet nerds shrink into their study holes and disappear for several weeks, emerging infrequently. The exception, of course, being exams, where Closet nerds will reappear on the social radar in all their glory once the final exam finishes.

Both groups, secretly, respect the other's qualities; be it the highly social nature of the Closet Nerd, or the Open Nerd's consistent dedication to study.

At the end of the day, we're all Nerds.