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Glen Campbell “I’ll Be Me” Movie Documents His Final Years With Alzheimer’s Disease

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Country music legend Glen Campbell is dying of Alzheimer’s disease. In an effort to raise awareness of the illness he and his family made the brave decision to bare their lives by creating a documentary of Glen’s farewell tour. I highly recommend that you watch this film with your loved ones… and a box of Kleenex.

One of the most remarkable aspects of Glen’s disease was the preservation of his musical abilities despite severe cognitive impairment. Although he rarely knew where he was or even how to tie his shoes, he was able to perform songs in front of live audiences. With redirection and prompting, he managed to participate in 151 concerts across the United States within the span of ~18 months. Accompanied by his gifted guitarist son and daughter, and his doting fourth wife Kim, Campbell was able to maintain his musical self for longer than his physicians ever anticipated.

The documentary held nothing back – from violent outbursts brought on by paranoid delusions of golf club theft, to inappropriate table manners, to hypersexuality triggered by too high a dose of Aricept – the trials and tribulations of being a caregiver for someone with dementia were painfully acute. In brief moments of insight, Glen himself would manage to stammer a “Thank you. For being so nice to me. I have been an ass.”

One of the saddest moments of the movie was a brief clip of his daughter testifying before congress. She explains that memories are what lives are made of – and that although she is holding fast to the memories made with her dad, she knows that soon he will not even know who she is, and that their time together will be meaningless to him. Campbell listens silently next to her with a pained expression and misty eyes.

The movie’s final song, artfully strung together from clips of Glen singing repeat phrases into a studio mic, is haunting:

“I’m Not Going To Miss You”

I’m still here, but yet I’m gone
I don’t play guitar or sing my songs
They never defined who I am
The man that loves you ’til the end
You’re the last person I will love
You’re the last face I will recall
And best of all, I’m not gonna miss you.
Not gonna miss you.
I’m never gonna hold you like I did
Or say I love you to the kids
You’re never gonna see it in my eyes
It’s not gonna hurt me when you cry
I’m never gonna know what you go through
All the things I say or do
All the hurt and all the pain
One thing selfishly remains
I’m not gonna miss you
I’m not gonna miss you

Alzheimer’s is a terrible, cruel disease. I share the frustration of the Mayo Clinic neurologists who treated Glen Campbell – unable to do much more than simply document his decline and mentally prepare his family for the next stages of the disease. To all those who are taking care of people with Alzheimer’s I offer my sincere admiration and respect. To those who face a genetically higher-than-average chance of contracting the illness (such as myself), I tremble and hope for a cure.

All You Need To Know About Dr. Oz And The Dietary Supplement Scandal

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Comedian John Oliver did an excellent job explaining everything that’s wrong with the Dr. Oz show and the dietary supplement industry. Please watch this video for a good laugh:

I’ve been warning folks about Dr. Oz for many years – and I hope that John reaches more people with his message.

To be fair, there are reputable companies who manufacture safe and effective vitamins and supplements too, as I have noted here.

Writing Fellowships Available For US Medical Students And Residents

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In case you hadn’t seen this announcement in my Twitter stream – there are a number of writing fellowships available for US medical students and residents. (Bloggers and those heavily engaged in social media are preferred.) Join The American Resident Project Writing Fellows in brainstorming about how to make the healthcare system better for future generations. Fellowships are awarded on a rolling basis. Opportunities for travel are included. From their website:

The American Resident Project is a platform for future physician leaders – medical students, residents and physicians newly in practice – to connect, explore ideas for transforming American health care delivery, and exchange these views with other health care providers and opinion leaders across the country.

Sponsored by ThinkWellPoint, The American Resident Project focuses on key issues affecting today’s frontline physician workforce, including:

  • New care coordination models
  • Strategies for patient engagement
  • Innovations in health technology
  • Join our growing community, lend your voice and share your ideas on these and other important topics shaping the future of health care delivery in America.

    I will be playing a mentorship role in the program going forward, and look forward to meeting some of my young Writing Fellows in the near future!

    Apply for the fellowship here.

    10 Steps To Finding A Good Doctor And Having A Great Healthcare Experience

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    I’m excited to announce that US News and World Report has invited me and some other social-media savvy physicians to participate in a live Twitter chat about how to find a good doctor. The chat will be held on Thursday, March 20th at 2pm EST. You can join the conversation by following the #DoctorFinder hashtag or take the pre-chat poll here.

    Most people, including physicians, rely on personal references to find a good doctor. But what do you do when you’re far from home, or you don’t know anyone with firsthand knowledge of local doctors? My parents recently asked me to recommend a physician for them in a state where I knew none of my colleagues personally. This is the 10-step process that I used to help them navigate their way to an excellent specialist – I hope it helps others you find the right doctor as well!

    1. Determine what kind of doctor you need. You’d be surprised how many different specialists treat the same symptom – depending on its underlying cause. Take “back pain” for example – should you see a primary care physician, an orthopedist, a neurosurgeon, an anesthesiologist, a rheumatologist, or a rehab specialist to evaluate your symptoms? That depends on the cause of the pain, which might not yet be evident to you. The first step to finding a good physician is to figure out which type is best suited to your potential diagnosis. Bouncing from specialist to specialist can be costly, so if you’re not sure which kind of physician specializes in treating your disease or condition (or if you haven’t been diagnosed yet), start with a primary care physician first.

    If you’d like to ask an online physician about your symptoms (or find out which specialist would be the most appropriate for you or your loved one),  eDocAmerica.com is my favorite online physician consultant service (note that I answer questions for them.)

    2. Compile a list of all the doctors (of the specialty you need) in your area. This list can be generated by your insurance carrier or by an online search of doctor-finder databases such as Healthgrades.com, Vitals.com, or US News & World Report’s Doctor Finder directory.

    3. Narrow online choices by your preferences (available via  Healthgrades.com or Vitals.com databases.) Check out the doctors’:

  • Hospital affiliation(s)
  • Office location(s)
  • Educational background
  • Specialty interests
  • Languages spoken
  • Years in practice
  • Gender
  • Types of insurance accepted
  • Review CV if available (often on affiliated hospital website)
  • Check out patient reviews (take them with a grain of salt in case they are skewed by an unfairly disgruntled patient)
  • Make sure they’re accepting new patients
  • 4. Do an online “background check” of your top choices.

    5. Make an appointment – consider the following qualities in a good physician experience:

    • The team: courteousness of scheduling staff, professionalism of nurses, PA’s, techs, etc.
    • Facilities – cleanliness, comfort
    • Medical records/communication – how will they provide you your data? EMR? Email?
    • Timeliness/convenience

    6. Come prepared

    • Bring your list of medications
    • Bring a list of your medical and surgical history/conditions
    • Bring a list of your allergies
    • Bring contact information for your other physicians/providers
    • Bring your insurance information

    7. Ask the right questions

    • How many procedures (like the one I’ll need) have you performed previously?
    • What are the risks/benefits of the procedure? Alternatives?
    • What should I read to learn more about this?
    • If unsure of diagnosis: What else could this be?
    • Are there other medicines that are less expensive that we could substitute?

    8. Go with your gut

    • Did the doctor explain everything clearly?
    • Did the doctor seem to care about you?
    • Do you trust your doctor to be thorough with follow up?
    • Do you like your doctor?

    9. Get a second opinion

    • If the doctor did not meet your expectations in any significant way, find another one
    • If you want to be sure that you’re on the best path, get a second opinion from one of his/her peers or do it online: eDocAmerica (for generalist questions), Best Doctors (to be matched with top national specialists)

    10. Reward good doctors with good online recommendations so others can benefit. Physician ratings are only as reliable as the reviewers. Help other patients locate good doctors by promoting those who deserve it.

    Talk Therapy And The American Resident Project: How Can The Next Generation Of Physicians Improve The Healthcare System?

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    I have been an outspoken, and often times exasperated, patient advocate and student of healthcare reform. There is no doubt that the U.S. healthcare system is operating far below its potential in terms of efficiency, effectiveness, and affordability. In fact, an entire industry of policy wonks and consultants have sprung up in both the public and private sectors – all with recommendations about how to “fix” our system. In my opinion, the most insightful suggestions will come from those who are currently doing the work of healthcare (i.e. clinicians) and change will be adopted and promoted most fervently by the young and freshly minted among them.

    Medical students, residents, and physicians newly in practice now have a place to voice their opinions – The American Resident Project is an ambitious movement to promote fresh thinking from tomorrow’s physician-leaders. I am pleased to be supporting this effort here on my blog and in face-to-face meetings with fellows at medical centers across the country. I hope you’ll bookmark the website and join in the community conversation about how to innovate  in the midst of a broken system. This is more than a think-tank for change – the ideas and opinions of young doctors may be our best hope for a brighter tomorrow.

    Stay tuned for some fresh ideas in the setting of some healthy talk therapy!

    Latest Interviews

    How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

    It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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    Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

    I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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    Latest Cartoon

    Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

    “When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

    Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

    “The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

    Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

    Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

    “As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

    Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

    “I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

    Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

    As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

    Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

    ***

    Click here for a musical take on over-testing.

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    Latest Book Reviews

    The Spirit Of The Place: Samuel Shem’s New Book May Depress You

    When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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    Eat To Save Your Life: Another Half-True Diet Book

    I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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    Unaccountable: A Book About The Underbelly Of Hospital Care

    I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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