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

Latest Posts

MTV Reality Show Runs More Like A Contraceptive Ad And Covers Little To No Side Effects

In this week’s episode of Teen Mom 2, Kailyn heads to her gynecologist for birth control and leaves with a Mirena IUD in her uterus.

The entire encounter, obviously edited, ran more like a commercial for Mirena than a contraceptive counseling session. Other contraceptives were mentioned generically only  -”a patch”, “a ring”, “the pill” – but when it came to the IUD, all we hear is the word Mirena – six times, to be exact, during the entire 2 and a half minute encounter with the doc.

DOC: If you don’t like the birth control pill, you do have other options. You know that there’s a birth control patch.
KAILYN: (suspiciously) Yeah
DOC: There’s a once a month vaginal ring. The ring itself is not uncomfortable. (Hands her the ring) They’re one size fits all – Right Isaac? (Baby plays with Nuvaring) They’re cool, right?
KAILYN: I just feel like me putting something in myself is all that much more room for error.
DOC: There’s also the Mirena.
KAILYN: Whaaaat is Mirena? Read more »

*This blog post was originally published at The Blog That Ate Manhattan*

Would The Personhood Amendment Ban Birth Control Pills?

On November 8, Mississippians will be voting on ballot amendment 26 , the so called “Personhood Amendment” that if passed, would declare a fertilized egg a person.

The question at hand is, would the Personhood Amendment be used to outlaw contraception?

Dr. Freda Bush, an Ob-Gyn and spokesperson for the Personhood amendment in Mississippi, seems to think it will not. In a press conference in support of the amendment in September, she stated this -

The personhood amendment will not ban the use of hormonal contraceptives.

The video of this press conference is being used to reassure voters about the intent of amendment 26. And yet the information Dr. Bush presents about contraception and the amendment stands in complete contrast to that which the personhood movement itself has presented. Here is the standard “talking point” on contraception from personhood sites at states across the country seeking to pass similar amendments – Read more »

*This blog post was originally published at The Blog That Ate Manhattan*

Should New Mothers Leave The Hospital With Birth Control?

image from www.blisstree.com

It depends on the method and whether the mother plans to breast feed.  Ideally, it is recommended that women abstain from sexual relations for at least 4 to 6 weeks after having a baby to reduce the risk of developing vaginal infections and of course, becoming pregnant.

Pregnant women have an increased risk of developing blood clots because of hormonal changes.  This is commonly referred to as a hypercoagulable state.  Birth control pills that contain both estrogen and progestin (aka combination pills) are not recommended for the first 42 days after the delivery because they increase the risk of blood clots in the legs (Deep Venous Thrombosis, aka DVT) and also decrease breast milk production. The vaginal ring and patch are also not recommended. However, birth control pills that only contain progestin are safe to take immediately after delivery because they don’t increase the risk of developing blood clots nor do they reduce the amount of breast milk production. The Depo- Provera injection may also be given as well because it is a progestin-only product. What women are at increased risk for developing a DVT? Read more »

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

TV Doctors Tout IUDs As The Best Contraceptive Option: Why It May Not Be

That’s the opinion of television’s The Doctors, a syndicated TV Show that appears to be giving Dr Oz a run for his money, in USA Today. In fact, that’s the headline – IUDs: The Best Contraceptive Option.

What you know about birth control: Nearly half of all U.S. pregnancies are unintended; abstinence is the only sure-fire way to prevent pregnancy (and protect you from STDs); smoking while on the Pill may increase your risk of heart attack or stroke; as long as you are still getting a period, you can get pregnant during menopause. But here’s something you may not know:

We think IUDs work best.

This is contraceptive education at its worst. Read more »

*This blog post was originally published at The Blog That Ate Manhattan*

Contraception i-Pocketcards: Med Student Cheat Sheets For iPhone

“A baby crying is the best birth control.” – Anonymous

TitlePage

Despite a world full of crying babies, access to effective and timely contraception remains a pressing women’s health issue.
All students in the health professions learn the basics of contraception.  Most health care professionals will prescribe contraception at some point in their training or clinical practice.  Some clinicians make contraception and family planning the primary focus of their practice.

Contraception i-pocketcards is a resource for each of these health care providers – from the medical student working his first gynecologic clinic to the experienced ED doctor wondering which emergency contraceptive method to use in her patient with a history of DVT.

Reviewed on the iPod Touch.  Also available on the iPhone and iPad.

If you visit a medical book store, you may notice the rack of medical pocket cards: EKG interpretation, 2011 Antibiotic guide, medical Spanish, and many others.  As a medical student, these cards may have been your lifeline – they were mine.    Likely among these cards is one related to prescribing contraception. Contraception i-pocketcards, like many good medical apps, is one that effectively replaces another white-coat-cluttering object.  For $3.99, this app contains all of the information about contraception found on six pocket cards. Read more »

*This blog post was originally published at iMedicalApps*

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…

Read more »

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 »

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 »