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Latest Posts

Kim Jong Il’s Health At The End Of His Life And Other Hot Topics In Medical News

kim jong il, north korea, health, reporting on healthKim Jong Il: Of course we’re going to highlight the lowlights of the North Korean leader’s health: CNN has the scoop on the dictator’s cause of death and previous illnesses. Knight Science Journalism Tracker’s Paul Raeburn rounds up previous analyses of Kim Jong Il’s psychological profile.

Breast Cancer: Companies are trying to build a better mammogram as they compete for a bigger slice of the $6 billion-and-growing medical imaging market, Sierra Jiminez reports for Fortune. Nearly 300,000 American women have been diagnosed with breast cancer this year.

Health Reform: The U.S. Supreme Court will devote an unprecedented week of oral argument over health reform when Read more »

*This blog post was originally published at Reporting on Health - The Reporting on Health Daily Briefing*

News You Should Know: Distracted Driving, Nurse Strike, And ADHD

distracted driving, cell phone, reporting on health, car accident, riskDistracted Driving: Studies of driving while talking on a cell phone may have overestimated the risk of car crashes, new research suggests, Amy Norton reports for Reuters Health.

Nurse Strike: Some 4,000 nurses are expected to strike for one day at eight Sutter Health hospitals in California on December 22, John S. Marshall reports for the Associated Press. We predict a less than peaceful holiday for patients and hospital staff.

ADHD: Read more »

*This blog post was originally published at Reporting on Health - The Reporting on Health Daily Briefing*

How The Swedish Mammography Study Should’ve Been Analyzed

We reviewed four stories on the Swedish mammography study that appeared in the journal Cancer last week. Three of the four stories gave a pretty clear indication that there were methodological concerns about the Swedish research (of the four reviewed, only HealthDay offered no such hint):

• 4th paragraph of AP story: “The new study has major limitations and cannot account for possibly big differences in the groups of women it compares.”

• 1st paragraph of LA Times blog story: “Critics charged that the study was poorly designed and potentially vastly misleading.”
• 2nd sentence of NY Times story: “Results were greeted with skepticism by some experts who say they may have overestimated the benefit.”

But none of the stories did a very complete job of explaining those potential limitations. Because of the confusion that must be occurring in the minds of women — especially those in their 40s — this is a time in which journalism must rise to the need and do a better job of evaluating evidence and helping readers make sense of what appear to be conflicting findings.

I was in Chapel Hill, North Carolina, when the study was published and had the chance to talk about it with former U.S. Preventive Services Task Force member, and a recognized thought leader on issues of prevention and especially of screening tests, Dr. Russell Harris, Professor and Director of the Health Care and Prevention Concentration of the University of North Carolina (UNC) School of Public Health. Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

JAMA’s Breast And Ovarian Cancer Article: Getting The Facts Straight

Journalist Andrew Holtz has been a colleague for longer than probably either one of us wants to remember. He is currently one of our story reviewers on HealthNewsReview.org. In fact, he was one of the reviewers on four stories we analyzed last week on the same study. He thought there were some important take-home messages that rose above the walls of our formal systematic review, so he wrote this guest blog post, and we thank him for it:

The Sept. 1 issue of the Journal of the American Medical Association included an article that is likely to have a strong influence on the advice given to women who have a very high risk of breast and ovarian cancer linked to mutations of the BRCA1 and BRCA2 genes. Of the four stories we reviewed, only the AP report scored well on our review criteria.

I know what my first journalism professor, Marion Lewenstein, would have done with at least two of the stories: Given them an “F” for factual errors without further consideration of their merits. Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

The Global Cost Of Fighting Cancer

Cancer is the world’s costliest disease, sapping the equivalent of 1.5 percent of the global gross domestic product through disability and loss of life, according to the American Cancer Society (ACS). Cancer cost $895 billion in 2008, and that’s before factoring in the cost of treating cancer.

Cancer and other chronic diseases cost more than infectious diseases and even AIDS, according to a report the ACS [presented last] week. While chronic diseases are 60 percent of all deaths globally, they receive only 3 percent of private and public research funding. The organization is calling for a new look at priorities by the United Nations and the World Health Organization. (Associated Press)

*This blog post was originally published at ACP Internist*

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…

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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…

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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.

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Click here for a musical take on over-testing.

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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…

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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…

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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…

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