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Psychiatrist Considers The Difficulties That Would Arise When Treating Children

My hat goes off to kiddy shrinks.  It’s a tough field, full of issues we don’t see in adult psychiatry.

Our comment section often buzzes with talk about the over-diagnosis of bipolar disorder in children and the ethics of giving psychotropic medications to children.  The Shrink Rappers never comment on these things.  Why?  Because we don’t treat children.  I have no idea if the children being treated are mis-diagnosed, over-diagnosed, wrongly-diagnosed, or if the increase in treatment represents a good thing—- perhaps children who would have suffered terribly now are feeling better due to the option of medications.  I’ve certainly had adult patients tell me their children were treated with medications, the children have often eventually stopped the medications and emerged as productive adults.  Would they have outgrown their issues anyway.  Or did the treatment they received switch them from a bad place to a good place and enable them to carry on in a more adaptive way?  Ugh, my crystal ball is on back-order at Amazon!

Why I’m Happy I’m Not A Child Psychiatrist: Read more »

*This blog post was originally published at Shrink Rap*

Cancer Diagnosis Doesn’t Stop Woman From Starting A Family

In 2007, Melanie Jaggard went to the hospital for a punctured ear drum and was given the shock of her life. She had cancer; a very rare form that was located at the base of her brain.

Adenoid cystic carcinoma (ACC) is the second most common cause of salivary gland cancer but can affect other areas of the body. Melanie is one of only 20 to 25 people in the United Kingdom to have ACC and had a 2-inch tumor removed from her head following a delicate 10-hour operation. She was single at the time, cancer free and one year later met the love of her life, Charlie Jaggard, on an online dating site. Charlie proposed three months after their first date and life was good, until she received the news that the cancer had returned, this time metastasizing to her lungs. Surgery was not an option because the tumors were too numerous and radiation was too risky to the lungs. However the couple was not discouraged. They married in January 2009 and Melanie decided to be a victor rather than a victim. Although 89 % of people with ACC survive after 5 years only 40% survive after Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Comic Books Educate Children About Their Medical Conditions

I’ve recently come across Medikidz, a fantastic initiative with a mission to help children understand medical information, especially diseases. I cannot imagine a better way to promote such important messages to children.

Millions of children worldwide are diagnosed every day with conditions that even their parents may find difficult to comprehend. Most children don’t understand their medical conditions, or associated investigations, procedures and treatments, and are often scared by what is going on around them.

That is where the Medikidz come into action!

The Medikidz are Read more »

*This blog post was originally published at ScienceRoll*

Back To School Tip: Your Child May Need A Comprehensive Eye Exam

Dori Carlson, O.D.

In a recent interview with the president of the American Optometric Association (AOA), Dr. Dori Carlson, I learned the surprising statistic that about 1 in 4 school age children have an undetected or undiagnosed vision problem. School vision screenings, while helpful, still miss more than 75% of these problems. And for those kids who are discovered to have a vision problem during a school screening, upwards of 40% receive no follow up after the diagnosis. Clearly, we need to do better at diagnosing and treating childhood visual deficits. My full conversation with Dr. Carlson can be listened to below:

Dr. Carlson told me that the solution involves Read more »

School Nurse Gives Some Insight Into Her Job

Well, what better time to post my interview with Erin at Tales of a School Zoned Nurse than now, when everyone’s headed back to the classroom?

Erin is a school nurse in the “cash strapped state of California.”  Her position covers two elementary schools and a middle school – almost 2000 students!!  She has been blogging since last year and her blog has definitely become one of my favorites.

She says she was never too set on working in a hospital.  After nursing school, she worked at a couple of summer camps, which gave her the idea to look into being a school nurse. She was hired right away and “leapt in without a second thought.”  She is starting her second year in this position.

Erin’s daily schedule is quite varied: Read more »

*This blog post was originally published at code blog - tales of a nurse*

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…

Read more »

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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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