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Latest Posts

Follow Along With The Fit Family Challenge!

Tina Thompson, Mario Lopez, Dr. Val Jones

The Boys & Girls Clubs of America (BGCA) are about to kick off their annual Fit Family Challenge. The goal is to support families as they commit to a lifestyle of healthy diet, regular exercise, and strong moral qualities.  It’s called the “Triple Play” approach – a game plan for body, mind, and soul. I’m honored to be their “mind” coach again this year, and will help to shepherd 250 BGCA families from across the country. Five finalists will be chosen to compete in Los Angeles for the title of fittest family near the end of 2012. We have timed the competition to coincide with New Year’s Resolution planning, and hope that these fit families will inspire others to turn over a new leaf in 2013.

As part of my support for the competition, I’ll be publishing several blog posts (at Better Health and the Fit Family Challenge Blog) with evidence-based healthy eating tips for the families – and for anyone who wants to follow along with the Triple Play Fit Family Challenge. I can’t wait to see how lives will change – and how together we can tip the scales against obesity, disease, and unhealthy relationships. Please join the Boys & Girls Clubs in this important initiative.

Do We Have Enough Information About The Whole Genome Sequence To Improve Medical Care?

cake with double helix decoration - text: One base pair at a time

The popular proverbial saying “you cannot have your cake and eat it too” implies that one cannot consume something and preserve it at the same time–in other words, we cannot have it both ways.  Well, for once, maybe we can have our cake–our whole genome sequence (WGS)–and eat it too. I believe having our WGS and consuming it in small bite sizes over a lifetime may be the only way to integrate it into medicine and public health.

Rapid advances in genomic sequencing technologies are making the possibility of reliable and affordable whole genome sequencing (WGS) a reality in the next few years. We all carry about 6 billion base pairs of DNA in each of our cells, with 5-10 million inherited variants that are different among us. This genetic variation along with environmental influences provides a blueprint for health throughout the life span, and is related to virtually every disease of public health significance. There is definite interest among the public and scientists about the personal utility of this information.  In a recent survey by Nature, attitudes towards genome sequencing were explored among a sample dominated by scientists and professionals from medicine and public health. Although only 18.2% of respondents had had their genome sequenced or analyzed, 2/3 of those who had not reported they would take the opportunity should it arise. Curiosity was reported as the main single factor influencing respondents.

Can this information be useful today in improving medical care and preventing disease?   Read more »

*This blog post was originally published at Genomics and Health Impact Blog*

How Old Is Too Old To Be An Organ Donor?

I happened to see this press release from American Society of Nephrology via Eurekalert regarding an article in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN) advocating the safety of kidney donation in individuals over 70 years old.  The press release does note that kidneys from these elderly donors do not last as long as those from younger living donors.

Currently, as noted on the University of Maryland Medical Center website:

Donors need to be between the ages of 18 and early 70s and can include parents, children, siblings, other relatives, and friends. An ideal donor should have a genuine interest in donating and a compatible blood type with the recipient.

Donors should be in good general health. Donors do not need to be Read more »

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

Army Searches For Rabid Animal That Infected And Killed A Soldier

Wow, that is awful beyond belief.

Army seeking troops bitten by stray animals following rabies death – Army – Stripes.

SEOUL – The Army is redoubling its search for anyone who might have been bitten by a wild animal in Iraq or Afghanistan following the Aug. 31 death of a soldier from rabies, the service’s public health command stated Wednesday.

“The death of this soldier is very tragic, and we are taking actions to Read more »

*This blog post was originally published at GruntDoc*

Going Beyond General Breast Cancer Awareness

Some breast cancer voices raise questions about simply raising “awareness” about breast cancer in October.

Some of them believe that raising awareness about screening, for example, should not be the only message or even the main message of the month.

Katherine OBrien.jpgKatherine O’Brien, who has metastatic breast cancer (MBC), and who publishes the ihatebreastcancer blog refers to being caught in “October’s pink undertow.”

Plunked down in the middle of breast cancer awareness month is National Metastatic Breast Cancer Awareness Day on October 13.

O’Brien says that people like her with MBC have different concerns from those with early stage cancer. She wrote to me: “The day is not about general cancer awareness; it’s about acknowledging the distinct needs of people who have the advanced, incurable form of breast cancer.

She quotes Ellen Moskowitz, past president of the Metastatic Breast Cancer Network (MBCN): Read more »

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

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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