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Dr. Val: Back By Popular Demand?

I started medical blogging in 2006, and posted something new every day for over two years straight. I met some terrific fellow bloggers in those “early years”, and soon wondered if we might reach a larger audience if we pooled some of our blog content. This blog site (Better Health) was born in October 2008, and soon grew to have over 130 contributors! We developed a large following on Facebook and Twitter and partnered with such prestigious organizations as the CDC, Harvard Health Publications, and the American College of Physicians. We actually grew so large so fast that I had to hire a small staff to help me run the blog… Which became logistically challenging and pretty expensive, rather quickly!

Because Better Health has always been a labor of love, and not a well- oiled, monetization machine, I eventually had to close the doors. It broke my heart. It was such a shame that a collection of the best medical blog writing just couldn’t be supported financially – at least I couldn’t find a way to do so! In January 2012 I posted a farewell note and decided to continue my social media life on Twitter and Facebook instead.

A few days ago I noticed a large uptick in Twitter followers and was surprised to see that I had been recommended (by Healthcare IT News) as one of the top 10 physicians to follow on Twitter. In the article it commended my work as a Better Health blogger… the blog that I had recently shuttered.

I had been toying with the idea of starting a personal blog again because I found it rather challenging to say all I wanted in only 140 characters, and this new influx of followers gave me food for thought. What if I just keep it simple this time? What if I write blog posts at Better Health when the spirit moves (instead of feeling pressured to post something every day or to include 100′s of others in my blog posts?)

So that’s what I’m going to do. This is just me again – the way it all began. But without any regard for traffic, numbers, or popularity. Maybe only a handful of people will read my posts here. And that’s ok with me! So welcome back to the OLD new me. The cycle is complete?

P.S. I will continue to blog at Healthline to educate patients about their eyes, and I also hope you’ll listen in to my Healthy Vision radio show. Or follow @drval on Twitter?


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3 Responses to “Dr. Val: Back By Popular Demand?”

  1. Sean says:

    Of course you know I’ve always been a fan. :)

  2. Sunil D'Monte says:

    Great, welcome back!

  3. Peggy Polaneczky says:

    Welcome back, Dr Val! You’re voice is always a welcome one in the blogosphere. And congrats on the mention inHealthcare IT News.

    Peggy

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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.

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