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Antidepressants To Treat Dementia: How Can They Help?

“Wow, Celexa?”

“Yeah, who knew?”

I overheard this conversation in the ladies’ room immediately after a session speaker advised treating agitation and aggression in dementia with citalopram. Indeed, there was a bit of a murmur in the audience when Dr. Aleta Borrud made the suggestion during her talk at the Mayo Update in Hospital Medicine 2011 course.

Part of the reason for the reaction may be– as a physician I spoke with noted– that Read more »

*This blog post was originally published at ACP Hospitalist*

Tips To Reduce A Physician’s Risk Of Being Sued

A few pearls from a session on legal risks and mitigation strategies from an HM ‘11 session by Harvard’s Allen Kachalia, MD, JD:

–A relatively small number of injured patients actually file claims and get compensation.
–Many filed claims do no have actual errors in them, but the majority do.
–Poor outcomes are correlated with claims, and so is patient satisfaction. Satisfied patients are less likely to file.
–There is no evidence that hospitalists’ risk of having claims filed against them is higher than primary care internists.

To protect yourself against claims, document well. Don’t go back and change a record (you can addend, but don’t alter). Document as contemporaneously as possible. Also, “as simple as it sounds, don’t abandon your patient, and don’t stop providing necessary care,” he said. Read more »

*This blog post was originally published at ACP Hospitalist*

Implementing An EHR: 5 Quick Tips

Dr. Jay Anders, the CMIO of EHR vendor MED3000, offered a few tips during a Medical Group Management Association (MGMA) session on implementing an EHR successfully:

1. Make a clear communication pathway. Everyone needs to know what’s going on, from the physicians to the receptionist.

2. Clearly identify the needs of every physician who is going to use the EHR. The needs of an internal medicine doctor aren’t the same as a dermatologist. Make sure the EHR meets those needs.

3. Get a physician champion for the EHR who will be responsible for talking about the project to peers and answering questions, and be the first person to implement it. Pay that person for his or her time spent in championing duties.

4. Some people need more time than others. Don’t let a resistant doctor stop the implementation. Develop a plan for dealing with resisters that includes how you’ll respond to negative comments, how to implement other colleagues despite the resister, and how to sell the benefits of the EHR to the resister.

5. Expect the EHR implementation to be time-neutral. Most EHRs don’t save time; their value is in improved patient care and documentation, which leads to better reimbursement.

*This blog post was originally published at ACP Internist*

My Patient, The “Health Nut”

A version of the following post, by Kimberly Manning, FACP, appeared on the blog “Life at Grady.”

“My blood pressure is still borderline? Man!”

“Yeah…and from looking through the chart, it was 150/96 on your admission. It’s pretty much been that since you’ve been here, give or take a few points. That’s a little more than borderline, actually.” I paused for a moment, realizing that I sounded a bit discouraging. “I don’t think this would be hard to get under control at all, sir. I mean…you’re such a motivated patient, you know?”

I studied my patient carefully. He was in his late thirties, although he could totally pass for a twenty-something all day, every day. His skin looked like someone had grabbed him by the tip of his toe and uniformly dipped him in milk chocolate — not a single blemish anywhere.

“I eat right and I exercise…in fact, I’m a health nut! I’m really kind of surprised that my pressure keeps running high.” Read more »

*This blog post was originally published at ACP Hospitalist*

Reflections Of A Clinician-Educator

A version of the following post by Kimberly Manning appeared on the blog Reflections of a Grady Doctor:

May and June mark the end of our academic year in medical education. The medical students either advance to the next level or become sho’ nuff and bonified doctors — albeit uncertified and untrained — but doctors nonetheless. The interns exit the novice stage and become residents — one week asking someone senior what to do, the next telling someone junior what to do. And of course, the senior residents and fellows finally get the stamp of approval that officially releases them from the nest. It’s kind of bittersweet for folks like me — the surrogate mommies and daddies that helped guide them along this path to becoming full-fledged physicians. Read more »

*This blog post was originally published at ACP Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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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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