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Changing One’s Behavior Is Harder Than It Looks

Glenn Laffel, M.D., Ph.D., of Pizaazz hypothesizes about why we often don’t make changes that would benefit our health. He says:

“Somewhere in the course of our daily lives, though, most of us do exhibit behavior that suggests at least some disregard for our health. We don’t change our diet, though we know we should. We don’t floss, take medications as prescribed, or get the screening tests we’re supposed to.”

He knows multiple complex causes exist for this and questions whether being diagnosed with a chronic condition motivates people to improve health behaviors exploring whether the delay between health behaviors and health outcomes contributes to unhealthy behavior. After looking at attrition rates in a diabetes self-management program, he concludes:

“It calls attention to a key distinction behavioral psychologists like to make in explaining human motivation: there’s a difference between awareness of the need to act, and the volition to act.”

Family doctor Kenny Lin, M.D., previously recommended that people “tackle one behavior at a time.” He says: Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Red-Light Cameras Save Lives

Most people don’t like them. Privacy advocates abhor them. But, really– how many things can you name that save lives AND generate revenues for cash-strapped local and state governments? Red-light cameras are one such item.

A recent study by the Insurance Institute for Highway Safety has shown that red-light cameras saved 159 lives over a four-year period in the 14 large U.S. cities where the study took place. The scientists claimed that more than 800 traffic fatalities would have been prevented during the course of the study if the cameras had been deployed in all large U.S. cities.

The scientists compared fatal car crash rates in U.S. cities with populations of at least 200,000 for two four-year periods: 1992 to 1996 and 2004 to 2008. They excluded cities that had already deployed red-light cameras in the earlier period, and cities that instituted cameras during the later period.

In the 14 cities that used red-light cameras during 2004 to 2008, the rate of fatal red-light running crashes was 35 percent lower than in 1992 to 1996. The crash rate did drop in cities that never deployed camera programs, but only by 14 percent.

Based on these data, the scientists determined that the rate of fatal red-light running crashes was 24 percent lower in cities with cameras in 2004 to 2008 than it would have been had they not deployed the cameras. In fact, the benefits of red-light cameras were actually larger than this. The rate of all fatal crashes at intersections with signals (not just red light running crashes) dropped by 14 percent in cities that deployed red-light cameras, whereas it increased by 2 percent in other cities. Read more »

*This blog post was originally published at Pizaazz*

Drunk Fans At Sporting Events

Among fans who attend live sporting events, drinking alcohol is nearly as commonplace as root-root-rooting for the home team. And while virtually no one has a problem with a fan who pushes back a beer or two during the game, flat-out drunk fans can ruin the experience for those sitting nearby. Worse yet, these people frequently get behind the wheel of a car after the game is over.

Recently, Darin Erickson and colleagues at the University of Minnesota decided to find out just how many fans go overboard at games, and their findings are worrisome, indeed. Using standard blood alcohol testing on 362 adult volunteers who were leaving 13 professional baseball and three professional football games, the scientists found that 40 percent had measurable levels of alcohol in their blood and a stunning eight percent were legally drunk (as defined by a blood alcohol level of .08 or greater). The highest alcohol level recorded by the scientists was .22.

Erickson’s group also observed that Monday Night Football attendees were more likely than other fans to have been drinking. In addition, fans who were 35 years old or younger were eight times more likely to leave the game drunk, and those who attended tailgating parties before the game were 14 times more likely to leave the game drunk.

The latter finding is consistent with a study from the University of Toledo, in which scientists gave breathalyzer tests to tailgaters at a college football game. The scientists found that an astounding 90 percent of the participants consumed alcohol during tailgate festivities, and among them, the average blood alcohol concentration was 0.06, well on the way to being legally drunk.

Maybe these people should save the money they spent on tickets and go to a bar. Erickson’s study was published in Alcoholism: Clinical & Experimental Research.

*This blog post was originally published at Pizaazz*

Weight-Loss Counseling: Is Race A Factor?

Most people know that the U.S. is struggling to contain a surging epidemic of obesity, and that the problem is most acute among African-Americans. Whereas about 27 percent of all adult Americans are obese (defined as having a body mass index of 30 or more), fully 37 percent of African-American adults are obese, and that number jumps to an appalling 42 percent among African-American women.

Over the years, public health officials have provided evidence that socioeconomic and cultural factors drive this racial disparity. Now, a new study suggests there is another reason as well: Obese African-Americans receive less obesity-related counseling than their white counterparts, and it matters not whether the physicians they see are African-American or white.

To reach these conclusions, Sara Bleich and colleagues from the Johns Hopkins School of Public Health used clinical encounter data from the 2005–2007 National Ambulatory Medical Care Surveys (NAMCS). The sample included 2,231 visits involving African-American and white obese people who were at least 20 years old and who visited family practitioners and internists that were either African-American or white. Asian and Hispanic patients and physicians were excluded from the study because their numbers were too small to permit hypothesis testing.

For each encounter in the study, the scientists determined whether the patient received guidance on weight reduction, diet and nutrition, or exercise from his or her physician. Read more »

*This blog post was originally published at Pizaazz*

Nutrition Labels For Alcoholic Beverages?

Virtually all bottled beverages you can buy have handy-dandy nutrition labels from which you can access information about calories, carbs, and so forth. All beverages except the ones containing alcohol, that is. Why is that?

Maybe it’s because alcoholic beverages contain little to no protein, sodium, cholesterol, Vitamin A, Vitamin C, calcium and iron (remember that alcohol is metabolized as a fat, not a carbohydrate) — so why bother? Then again, alcohol does contain calories — a lot of them. Would people drink less if they knew how many calories they were consuming? Would they drink less if they knew how many “servings” of alcohol were contained in the bottle they just purchased?

Maybe it’s because of the cost of performing nutritional analyses on each vintage of wine, each and every year, would turn profitable vineyards into money losers? Then again, plenty of niche beverage producers who run reasonably narrow margin businesses have never complained about the requirement to provide nutritional information.

The Tax and Trade Bureau is the federal agency that decides what information must appear on the labels of alcoholic beverages. Currently, it does not require manufacturers of wine, beer and the hard stuff to list ingredients. It does require them to list chemicals that folks might have an adverse reaction to things like sulfites, aspartame, and dyes.

The Tax and Trade Bureau also mandates that wines containing 14 percent or more alcohol by volume must state this fact on a label. Wines containing less than 14 percent can either specify the alcohol content or affix the words “light wine” or “table wine” to their labels. In addition, “light” beer bottlers must state calorie and carbohydrate content, and distilled liquor bottlers must specify the alcohol content by volume. Read more »

*This blog post was originally published at Pizaazz*

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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