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

Article Comments

Grand Rounds From The Shores Of South Africa

It’s not just the soccer world cup that’s on South African shores, but the great Grand Rounds (something that some would say is far more important than the world cup — okay, only one guy would actually say that, and he’s in a psychiatric institution in Outer Mongolia) is also presently hosted in South Africa! Proudly South African!

Time to see what the bloggers have dished up for us this week.



here is an interesting article sent by preeti kaur which is relevant in the context of the world cup. i must say i think that fifa should stick to soccer and plundering african countries and keep out of healthcare but i may be wrong.

greenpoint stadium


amy tendrich reflects on the lessons learned by the ada.

another blogger making her voice heard in the diabetic community is kerri sparling.

a kuduzela, an variation of the vuvuzela

philip hickey, a psychologists questions the tendency of modern medicine to add a diagnosis to pretty much anything, in this case sexual disorders.

in a somewhat related post james baker wonders if some things that modern medicine has labelled a disease may only be problems of living this thing we call life.

jo’burg stadium

a south african reflects on lessons learned from soccer. fifa, with their autocratic laws imposed on previously free south africans may demand royalties, but then again she has moved to far away shores, so i think she might be safe

the great doctor anonymous touches on an issue that i often think about, the end of a blog. this one touches a nerve with me because i also sometimes consider how long my own blog will live.

a sotho blowing a kuduzela

how to cope with chronic pain has a nice piece on professional sports stars and pain they feel. he concentrates on retired nfl players. if he were to look at soccer players i’m sure he would find the active players cry all the time, especially when the ref is looking.

polokwane stadium


bob vineyard of insureblog shines a light on an aspect of medical insurance that ultimately played a part in the demise of a cancer patient.

south african supporters armed with vuvuzelas, makarapas and glasses (to see better of course)




andrew holtz of mditv tells us that watching soccer may even be more dangerous than playing it, despite the expressions of pain and agony on the faces of the numerous world cup players forever diving.


a man i consider a great blog academic, doctor rich wonders about the motives of people trashing the jupiter trial in an otherwise respected journal.

an old style makarapa with matching spectacles. we can make a spectacle of ourselves if we want to

robin mockenhaupt looks at some financial aspects of prevention of disease in the elderly.

true style south african supporter








louise discusses how some clinics will get hit hard by delays in payments by medicaid.

the goal that wasn’t. well done fifa!








walter jessen tells us about a certificate that has recently been launched by the health on the internet foundation. this will hopefully help advice seekers to be a bit more critical about the things they read online.

david harlow looks at health information from a slightly different angle.
good old south african soccer glasses

dr deb gives us advice in the form of tips for mental fitness. have a look how many you do.

the now famous soccer city in soweto








the happy hospitalist has stumbled on a much cheaper alternative to using a translator when you and your patient don’t share a communal language. happy, i too have seen this technique used in south africa with similar results.

a band maybe? they at least all play the same note.






jill of all trades talks about something that has always been close to my heart, the training of the future doctors of the world. some day i hope to once again become involved.

the cheating devious uruguay understanding of foot in the word football.









the legendary blogger, dr charles takes a look at an isolation experiment that is supposed to mimic a trip to mars. in the end maby it only mimics isolation. besides, what’s a surgeon doing in such an experiment? do they want them to fight?

makes me proud.








doctor bates relays a short humorous story.

my team, although they went out early (and after all it’s not rugby)






alan dappen writing for get better health discusses a pleasant encounter with a patient, even though money issues were discussed.

maradona was often more entertaining to watch than the soccer.







and that’s it for this week’s edition. i hope it supplied a nice few posts for your enjoyment. please feel free to link here.

next week’s grand rounds will be held over at captain atopic’s place.

*This blog post was originally published at other things amanzi*

You may also like these posts

Read comments »

Comments are closed.

Return to article »

Latest Interviews

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…

Read more »

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 »

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 »