Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (4)

Grand Rounds: Edition 6.34

Grand Rounds logoAs the newly-appointed director of content for Better Health and personal editorial advisor to the infamous Dr. Val, I’ve been given the honor of hosting this edition of Grand Rounds — a weekly summary of the best health blog posts on the Internet.

This week’s submissions cover a nice mix of issues important to health and medicine, which I’m presenting in super-organized, far-from-creative alphabetical order. (Excuse my conservativeness as I’m originally a product of the Mayo Clinic, and even after jumping ship nearly five years ago, I’m still affected due to my unchanged physical location — I’ll find my more liberal social-media sea legs soon, promise!)

From geriatrics to Viagra, PET scans to personality disorders, dentists to American Idol, you’ll find it in this ever-so-tidy session of Grand Rounds.

Best of health,
Maria

GRAND ROUNDS: EDITION 6.34

A Healthy Piece Of Mind puts cancer in the context of the Serenity Prayer: The Audacity Of Trope: Cancer Stories.

ACP Hospitalist reports that the FDA has launched a campaign to help healthcare providers report misleading drug advertising and promotion: Join The Ad Police!

ACP Internist writes that telemedicine is changing the playing field in primary care as internists sign up to diagnose patients over the Internet: Doctors Delivering Diagnoses Online.

Behaviorism And Mental Health shares the idea that it’s wrong to consider certain lifestyles and mindsets as pathological: Personality Disorders Are Not Illnesses.

Colorado Health Insurance Insider blogs about how hospitals that don’t treat Medicaid patients will end up losing money under the new healthcare reform law: Colorado Expanding Access To Medicaid And CHP+.

Diabetes Mine writes about American Idol contestant Crystal Bowersox and how the media has reacted to her having diabetes: Doin’ Her Thing With The ‘Betes.

EverythingHealth offers tips on how to keep kids safe when communicating with others on the Internet: Keeping Kids Safe On Social Networking Sites.

Health AGEnda discusses a recent article calling for improved training in geriatrics for primary care physicians: Report From The Brain Trust.

HealthBlawg tells how electronic health records will soon be required as a condition of licensure for doctors and healthcare centers in Massachusetts: HIT Incentives In Massachusetts: Less Carrot, More Stick.

HealthNewsReview comments on Senator David Vitter’s recent request to have the U.S. Department of Health and Human Services remove breast cancer screening recommendations from its website: Senator Strikes Out By Politicizing Mammography Recommendations.

How To Cope With Pain explains that change is hard and offers the helpful advice of trying “half a habit” at first: Change A Habit Slooowly.

In Sickness And In Health (U.K.) summarizes new research that suggests that Viagra may improve the delivery of chemotherapy drugs in women with breast cancer that has spread to the brain: Viagra Could Help Women Too, But Not How You Think.

In Sickness And In Health (U.S.) writes about couples and illness, describing how other relationships in your life can affect your health or your partner’s health: My Mother, My Partner?

Jill Of All Trades, MD provides a public health doctor’s tips for patients who don’t have health insurance: My Top-15 Resource List For The Uninsured.

Laika’s MedLibBlog highlights research on how lack of sleep can affect your risk for obesity, diabetes and heart disease: What One Short Night’s Sleep Does To Your Glucose Metabolism.

Lockup Doc talks about when non-psychiatric illnesses in people with mental health histories are minimized or dismissed by healthcare providers: Psychiatric Patients With Medical Illness May Not Be Taken Seriously.

MD Whistleblower warns that dentists’ habit of overprescribing penicillin has “serious consequences” for patients: Why Do Dentists Prescribe Antibiotics So Often?

MedInnovationBlog talks about the obsession Americans have with medical technology and how it affects healthcare: Americans And Their Medical Machines.

Mental Notes debunks myths about depression after childbirth and reports on a recent study that used PET scanning to identify new moms at higher risk: What Causes Postpartum Depression?

Novel Patient shares thoughts on facing life’s difficulties and how to keep a positive attitude: Seeing Double.

Nutrition Wonderland presents new research on obesity that helps explain why dieting doesn’t always work as expected: When Cutting Calories Doesn’t Cut It.

Nuts For Healthcare says that “big pharma” should pay attention to significant advances in vaccine development: Vaccines, Vaccines…And How We Got To Provenge.

Supporting Safer Healthcare highlights confidentiality concerns about using portable data devices to store sensitive healthcare information and patients’ medical records: Lost Data Causing “10-Out-Of-10” Pain For Healthcare.

Suture For A Living tells the story of a recent brush with domestic abuse and provides resources to get help if you need it: Domestic Violence.

The Covert Rationing Blog conducts an “intervention” on behalf of two fellow medical bloggers in regards to American obesity, discrimination, and “demonizing” the obese: Defending The Anti-Obesity Movement, Again.

The Examining Room Of Dr. Charles tells the story of how a patient triggered memories of a doctor’s first experience with human anatomy: White Silken Ribbons.

The Happy Hospitalist says one group of physicians at his hospital wants to be compensated for their time on call: Should Hospitals Pay Doctors To Be On Call?


You may also like these posts

Read comments »


4 Responses to “Grand Rounds: Edition 6.34”

  1. rlbates says:

    Welcome, Maria! Nice edition.

  2. Thanks for hosting Grand Rounds this week and including my latest posting! Very neatly organized!

  3. First rate Grand Rounds with the Mayo excellence showing through. Can’t wait to read all the fascinating posts. Good job, Maria and Val.

  4. drcharles says:

    Thanks for hosting and welcome!

Return to article »

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…

Read more »

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…

Read more »

See all interviews »

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.

See all cartoons »

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…

Read more »

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…

Read more »

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…

Read more »

See all book reviews »