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How Cellphones Kill

San Francisco recently passed a law requiring disclosure to consumers of the amount of radiation emitted by cellphones at the point of sale. Research has been inconclusive on whether there is a link between cellphone usage and cancer. More definitive findings could be years away.

Understandably the law addresses a universal concern that we all have. We are more fearful of threats we can’t see, smell, hear, taste, or touch. Radon, carbon monoxide, and radiation fit these criteria.

Yet, cellphones kill in other ways which are far more immediate, equally as subtle, and just as concerning. This silent epidemic is increasing at an alarming rate. Everyone sees it, but does nothing about it.

Cellphones and driving don’t mix. Cellphones and walking probably isn’t a good idea either.

When talking on a cellphone or even a telephone, the user is completely engaged, hooked, and oblivious to any other information or sensory input. Although as a nation we pride ourselves on our productivity, our technology, our lack of sleep, and our ability to multitask, the truth is no one can multitask even though we think we can. Walk up to someone talking on the phone and ask them a question. What do they do? Typically he gestures you to hold on to your question with a raised hand as he focuses on the telephone conversation.

If he can’t talk to you at the same time while standing still, then is it safe talking on the cellphone and driving or even crossing the street? Not surprisingly the answer is “no.”

A report by the Pew Internet and American Life Project found that 6 in 10 adults talked on cellphones while driving, nearly half of adults were riding in a car when the driver was either talking on the cellphone or text messaging, and 44 percent felt unsafe when riding in the car. Aside from driving, 1 in 6 adults actually bumped into something or someone when talking or texting on a cellphone.

It is clear from the study that more people are putting their lives and yours at risk. Although I rarely use my cellphone, I’m not immune from this epidemic.

Just the other day when driving my daughter to her reading class as I was making a left turn from the designated turn lane, a bright yellow pickup truck at a high rate of speed ran the red light which had been up for a couple of seconds.

Fortunately, I had stopped before entering the intersection and slammed on my horn to alert the driver of the near miss. She was on her cellphone. Fully engaged. Completely oblivious to what could have happened. No flicker of acknowledgement that she even heard my car horn.

In other words, it is very likely my small sedan would have been unable to withstand a head-on or side-impact collision from a pickup truck. I shutter to think what might have happened that Sunday morning on Father Day’s.

Had police officers responded to the accident scene, the driver invariably would have said: “I don’t remember seeing a red light. I don’t remember seeing a car in the intersection.” The irony is that she would have been completely right. She would have walked away unharmed, very likely clueless that her simple act of talking killed two people, free to repeat the behavior again.

Do yourself a favor and make sure you are not someone who is a dangerous driver. Make your car a cellphone free zone. Turn it off before entering the vehicle. If you must take a call, then pull off the lane like you would when allowing fire trucks and ambulances the right of way. Even more importantly be very alert for distracted drivers on cellphones. Sixty percent of drivers may be in this group and unfortunately the number will only increase. Hands-free devices make no difference in improving safety. The brain and user is fully hooked to the conversation and unable to see beyond the call.

Look both ways before crossing the street when walking or driving into an intersection. Boring, basic, and even more necessary.

As for me, I think I might be able to find a Hummer for cheap.

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

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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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