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Latest Posts

Home Allergy Awareness Leads Some To Question The Campaign’s Real Intentions

The NHS Choices Behind the Headlines project in the UK analyzes claims that there is an epidemic of home allergies. Excerpt:

At least 12 million Britons now suffer from allergies caused by dust mites, The Independent has today reported. The newspaper says that a report by the charity Allergy UK has revealed an epidemic of “home fever”, a range of symptoms caused by dust mites and other triggers around the home.

The report has been published as part of Indoor Allergy Week, which is intended to raise awareness of the kind of steps that can be taken to remove allergy triggers, or ‘allergens’, from the home. A survey in the report suggests that, currently, around two-thirds of people with allergies experience symptoms such as sneezing and itchy eyes caused by allergens including dust mites, chemicals, pets and mould.

This new report raises lots of questions, such as Read more »

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

Cancer Patient Threatened With Legal Action Because He Blogged About Bad Hospital Experience

I’ve recently come across a really controversial story about a cancer patient who blogged and complained about his hospital treatment and has been threatened with legal action by an NHS trust.

Daniel Sencier was worried about delays at Carlisle’s Cumberland Infirmary and had surgery at another hospital. He complained to North Cumbria University Hospital Trust and it came up with an action plan to improve care.

But Mr Sencier, 59, of Penrith, then received a letter threatening legal action. The trust declined to comment.

Mr Sencier, a photography student, had expected an apology but then received a letter saying the trust would consider legal action if his blog contained “unsubstantiated criticism”.

*This blog post was originally published at ScienceRoll*

What Americans Can Learn From England’s Experience With Electronic Medical Records

The development and use of an electronic medical record is extremely important for communication, rapid diagnosis and clinical decision making, increasing efficiency in working up patients, decreasing the cost of duplication of testing and time delays in medical care and treatment.

There are many other advantages of using a functional electronic medical records. A person could be anywhere in the world and have his medical information immediately available. The results of all testing should immediately be communicated to the treating physician. All imaging studies should be digital.

Patients’ physicians could immediately read and use them for their clinical decision making.

These are only a few of the advantages of the electronic medical record. Read more »

*This blog post was originally published at Repairing the Healthcare System*

Would You Prefer Longevity Or A Perfect Figure?

I’ve spent some time thinking about this survey.   I couldn’t find any better information on the survey than the press release from the University of the West of England (UWE).  Perhaps in the future it will be published in a journal for better review.

The  survey was apparently done by the  new eating disorder charity The Succeed Foundation in partnership with the University of the West of England (UWE).  The editor’s notes indicate 320 women (ages 18 – 65 years, average age 24.49)  studying at 20 British universities completed The Succeed Foundation Body Image Survey in March 2011.

Notably, the survey found that 30% of women would trade at least one year of their life to achieve their ideal body weight and shape. Read more »

*This blog post was originally published at Suture for a Living*

British Women Would Trade Longer Life For Thinner Bodies

College-aged women in the UK say they would trade longevity for an ideal body weight.

320 women studying at 20 British universities (ages 18-65; average, 24.49) completed a survey in March.

The research, conducted for new eating disorder charity The Succeed Foundation, in partnership with the University of the West of England (UWE), found that nearly 30% of women would trade at least one year of their life to achieve their ideal body weight and shape:
–16% would trade 1 year of their life
–10% would trade 2-5 years
–2% would trade 6-10 years
–1% would trade 21 years or more Read more »

*This blog post was originally published at ACP Internist*

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…

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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…

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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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