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

Latest Posts

Americans Taking More Antidepressants Than Ever

Remember when the best-selling book Listening to Prozac came out almost 20 years ago?

Now Americans aren’t just reading about Prozac. They are taking it and other antidepressants (Celexa, Effexor, Paxil, Zoloft, to name just a few) in astounding numbers.

According to a report released yesterday by the National Center for Health Statistics (NCHS), the rate of antidepressant use in this country among teens and adults (people ages 12 and older) increased by almost 400% between 1988–1994 and 2005–2008.

The federal government’s health statisticians figure that Read more »

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

The Dalai Lama Tweets About Health

I follow a lot of intriguing people on Twitter. Each of them sends me noogets (a favorite slang word of mine) of information that either inspires, uplifts, informs or even amuses me.

But there’s one twitter-er that stands out. He really helps me–along with 2.6 million others.

The Dalai Lama tweets most mornings about the time I hit the deck. “What did he say this morning,” I ask myself frequently. Sometimes I pause for just a moment, but other times his words come back to me later in the day.

Now folks, I’m not going soft on you. I can’t even touch my toes, never mind do yoga. I realize that as a serious medical blogger, it’s not really accepted to let religion or politics seep into my posts.

But this very well-known quote seems to hint at the essence of our modern-day heart problems–atrial fibrillation in particular. Read more »

*This blog post was originally published at Dr John M*

Managing Stress With Meditation

In the early 1970s, when Dr. Herbert Benson was defining and testing the techniques he presented to the world in his revolutionary book, The Relaxation Response, I was a hippie teenager learning transcendental meditation (TM). Flash forward about 40 years and I’m sitting in an amphitheater packed with a few hundred medical students, faculty, and staffers from Harvard Medical School listening to the iconic director emeritus of the Benson-Henry Institute explain the myriad benefits of the relaxation response.

The relaxation response is a self-induced quieting of brain activity. It leads to a body-wide slowdown and a feeling of well-being that have measurably positive effects on disorders caused by stress or made worse by it, including high blood pressure, abnormal heart rhythms, and many digestive disorders. As Dr. Benson describes in Stress Management, Read more »

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

The Potential Risks And Benefits Of Vitamins: A Look At The Evidence

The discovery of various vitamins – essential micronutrients that cause disease when deficient – was one of the great advances of modern scientific medicine. This knowledge also led to several highly successful public health campaigns, such as vitamin-D supplementation to prevent rickets.

Today vitamins have a deserved reputation for being an important part of overall health. However, their reputation has gone beyond the science and taken on almost mythical proportions. Perhaps it is due to aggressive marketing from the supplement industry, perhaps recent generations have grown up being told by their parents thousands of times how important it is to take their vitamins, or eat vitamin-rich food. Culture also plays a role – Popeye eating spinach to make himself super strong is an example this pervasive message.

Regardless of the cause, the general feeling is that vitamins Read more »

*This blog post was originally published at Science-Based Medicine*

The Importance Of Balance In Achieving Good Health

One of the best things about writing a blog is when life provides Eureka moments. I read an essay this weekend that literally jolted the blogger in me.

If you are an athlete seeking a pinnacle; (That about covers all of us.)

Or a doctor striving to be the best that you can be–for humanity;

Or a parent wanting to provide the best for your children;

Or a learner wishing you could some day be smart enough to work in a think tank; (Ever wonder what a think tank looks like?)

Or perchance, Read more »

*This blog post was originally published at Dr John M*

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 »