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

Latest Posts

Saved By Dance: One Doctor’s Story Of Burnout And Recovery

By Susan Biali, M.D.

Ten years ago, I was an emergency medicine resident and wanted to die. Today, I’m a general practitioner in part-time practice and in love with life. What made the difference? I signed up for a dance class.

Reports on physician burnout list the personality traits that set us up for trouble: we’re excessively conscientious, feel overly responsible, want to please everyone, and function on an extremely high level –- even if we’re overloaded, exhausted, or our personal life is falling apart. We burn out because we bend over backwards to help others, until something (like our minds or our health or our marriages) finally snaps. Now imagine this: what if we took some of that deep caring and hyper-responsibility, and turned it on ourselves?

When my depression hit bottom and I became a serious risk to myself and my patients, my chief resident asked me to take a stress leave. On impulse I went on a solo tropical vacation and one night at the resort, as I watched an exuberant group of salsa dancers burning up the stage, my eyes filled with tears. I suddenly remembered that when I was a little girl, I practiced incessantly in the basement to my ABBA records, preparing myself for the moment that I would live my dream and finally become a “Solid Gold Dancer.” That night, in that darkened tropical theater, I knew how I would save my life. Read more »

*This blog post was originally published at KevinMD.com*

Chest Pain: It’s Hard To Figure Out Which Patients Have Dangerous Pathology

Seems like I’ve been on a real run of chest pain patients lately.  Which is fine — it’s part of the gig.  I did have a very interesting pair the other night.  They were seen in sequence, right next to one another, in room 7 and room 8.  They were both totally healthy women in their mid-fifties.  And they were both over-the-edge, crazy, crawling-out-of-the-gurney anxious.

Anxiety is an awful red herring in the work-up of chest pain.  People who are having an anxiety attack often if not always manifest some chest pain (pressure, tightness, whatever) as a prominent symptom of their anxiety.  On the other hand, someone having a heart attack who is experiencing chest pain will also be anxious — and for good reason! Read more »

*This blog post was originally published at Movin' Meat*

Top Five Signs of Common Mental Health Conditions

Disorders like depression, anxiety, obsessive compulsive disorder (OCD) and bipolar disorder all have warning signs. If you are concerned about these signs in yourself or others, talk to a trusted adult and get help!

Clinical Depression

  • Loss of appetite
  • Insomnia and trouble sleeping almost every night
  • Unable to focus on even simple activities
  • Extremely low energy
  • Loss of interest in things you normally enjoy Read more »

This post, Top Five Signs of Common Mental Health Conditions, was originally published on Healthine.com by Nancy Brown, Ph.D..

All Teens Under Pressure To Be Above Average

My heart is going out to teens these days, especially in my high-achieving community. It seems school districts and parents alike have lost the sense that “average” is really OK, and in some cases, much healthier than “above average.”

An emotional goal of adolescence is to answer the question “who am I” acquiring self-certainty as opposed to self-consciousness and self-doubt. Most teens approach life expecting to succeed and achieve their goals rather than being paralyzed by feelings of inferiority. On a normal path, adolescents seek out people who inspire them and gradually develop a set of ideals and goals for their future. This is all perfectly normal, and if all goes well, teens become young women and young men who believe they can do whatever they set their minds to and are willing to work hard enough for. This process gets stunted if the expectations set for them are unreasonable. Read more »

This post, All Teens Under Pressure To Be Above Average, was originally published on Healthine.com by Nancy Brown, Ph.D..

The Friday Funny: Real Pet Therapy

pettherapy

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 »