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What “The King’s Speech” Teaches Us About Stuttering

The film “The King’s Speech” won the Academy Award for Best Picture [on Sunday night.] The movie has come in for some criticism for its depiction of the political machinations surrounding the abdication of Edward VIII  and Britain’s appeasement of Hitler. The British-born writer Christopher Hitchens, unsparing and deliciously eloquent as always, puts the politics of  George VI in a far less favorable light than the movie does.      

But ”The King’s Speech” has won almost universal praise for its portrayal of the reluctant monarch’s stuttering, a speech pattern that includes involuntary repetition of sounds and syllables and “speech blocks” that cause prolonged pauses. Many young  children who stutter grow out of the problem, but perhaps as many as one in every 100 adults are affected by the condition, 80 percent of whom are men. Stuttering clusters in families, so researchers have been searching for inherited genes that might cause the condition. Last year, in The New England Journal of Medicine, NIH researchers reported some success with results showing an association between three mutated genes and stuttering, although those mutations are probably responsible for a very small minority of cases. 

It’s been said that ”The King’s Speech” will do for stuttering what “Rain Man” did for autism: Plant a sympathetic view of a disability in the public consciousness. One danger of such a quick infusion of awareness, however, is that it can harden into a fixed, if largely favorable, stereotype. We are finding out — or are being reminded — about all the famous people who have stuttered (many of them writers). First-person accounts are popping up all over the place because of the film. The best I’ve come across is by Philip French, a British film critic, who describes vividly what it was like to listen to the radio broadcasts of the real King George VI, wondering if he would make it to the end “like a drunken waiter crossing a polished floor bearing a tray laden with wine glasses.” Read more »

*This blog post was originally published at Harvard Health Blog*

Medical Aspects Of “The King’s Speech”

Over the weekend I went to see “The King’s Speech.” So far the film, featuring Colin Firth as a soon-to-be-king-of-England with a speech impediment, and Geoffrey Rush as his ill-credentialed but trusted speech therapist, has earned top critics’ awards and 12 Oscar nominations. This is a movie that’s hard not to like for one reason or another, at least most of the way through. It uplifts, it draws on history, it depends on solid acting.

What I liked best, though, is the work’s rare depiction of a complex relationship between two imperfect, brave, and dedicated men. At some level, this is a movie about guys who communicate without fixating on cars, football (either kind), or women’s physical features. Great! (Dear Hollywood moguls: Can we have more like this, please?)

The film’s medical aspects are four, at least: The stuttering, the attitude of physicians toward smoking, a closeted sibling who had epilepsy and died at an early age (just mentioned in passing), and the king’s trusted practitioner’s lack of credentials.

At the start, Prince Albert (young King George VI) has a severe speech impediment. It’s said that he stutters, and on film Firth does so in an embarrassingly, seemingly extreme and compromising degree. He’s the second of George V’s sons, and might or might not succeed to the throne depending on events in history, his older brother’s behavior, and his capacity to serve the Empire at the brink of war. Being effective as the king of England in 1936, and especially at the start of war in 1939, entails speaking confidently.

Prince Albert’s been through the mill with doctors who’ve tried to help him talk. Some recommend he smoke cigarettes — these, they advise, would help him to relax because they’re good for the nerves, they say. One asks him to speak with a mouthful of marbles, on which this doctor watching the film worried he might choke. Eventually Albert’s wife, Elizabeth (Queen Mother to be), finds a speech therapist in London, Lionel Logue, who uses unorthodox approaches with, by rumor, exceptional results. Eventually Prince Albert — or “Bertie” as the therapist insists on calling him — trusts and accepts help from this peculiar Australian who, it turns out, developed his methods of assisting stutterers through his work with shell-shocked soldiers in WWI. Read more »

*This blog post was originally published at Medical Lessons*

It’s American Stroke Month

AHA-ASA logoMay is American Stroke Month as designated by the American Heart Association and American Stroke Association. As I talk about in this video, stroke is the third leading cause of death in the United States, and every 40 seconds someone in the United States suffers from a stroke.

The key thing to recognize is that symptoms are sudden — whether it’s weakness on one side of the body, difficulty with talking, difficulty with walking, or other neurological changes. One of the important things to remember is that even subtle weakness or difficulty with speech can be an early sign. Read more »

*This blog post was originally published at Doctor Anonymous*

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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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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Unaccountable: A Book About The Underbelly Of Hospital Care

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