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Is Chris Matthews Mean?

val-chris-matthewsLast year I attended a benefit to support Alzheimer’s research. Many important political figures were in attendance, and I was able to interview Senator Mark Warner, and hobnob with Newt Gingrich and Nancy Pelosi. I was most moved by my interview with Patty Smith – a young victim of early onset Alzheimer’s who vowed to speak out about her disease for as long as she was able to do so.

I had hoped to also get an interview with Hardball host, Chris Matthews – since his mom passed away from Alzheimer’s and he was keynoting the gala. Unfortunately, he didn’t have time for me – instead giving me his business card for follow up, noting that the email on the card had been changed and the phone number was to MSNBC’s general line (no he didn’t offer me any alternative means to contact him).

Today I decided to attend his book signing event at the National Press Club. My husband looked sideways at me, saying “Why are you going to cover Chris Matthews again? Wasn’t he mean to you before?”

“Oh, honey. I don’t think he was mean exactly. He’s a very busy celebrity and didn’t have time for an interview, that’s all.”

“Well, I thought he blew you off pretty quickly. It wasn’t polite. Mark Warner was very kind.”

I shrugged and picked up my laptop to live blog the event on Twitter (you can see it by searching #npcmatthews).

Chris said some humorous things during his talk, which I jubilantly Tweeted. Of course, I didn’t agree with some of what he said – but Tweeted it accurately. At the end of the presentation he invited all those who had purchased his book to come forward for a signing.

I waited about 20 minutes in line and finally got to the table. I introduced myself as Dr. Val – a full time blogger and volunteer at Walter Reed.

Chris said, “Oh, so you might be one of the ‘good ones.’”

I chuckled nervously.

“Make sure you say nice things about me on your blog! Tell everyone I’m nice, not mean.” He shouted loudly in front of the crowd.

As he handed me the book back I opened it to the page where he had signed, just to see what he’d written.

Amusingly it said simply:

“To Dr. Bell. Best Regards, Chris Matthews.”

So what’s your verdict? Is Chris Matthews mean?

Anyone want a book?

:)

Patients Aren’t Looking At Hospital Quality Data – But They Should Be

Photo of Dr. Michael Shabt

Dr. Michael Shabot

I recently interviewed Dr. Michael Shabot, Memorial Hermann Hospital System’s Chief Medical Officer, about how his hospital is taking steps to improve patient safety and healthcare quality. His hospital was awarded the 2008 National Health System Patient Safety Leadership Award at a ceremony at the National Press Club.

You may listen to your 20-minute interview here, or read my summary of it below.

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Dr. Val: Tell me about what Memorial Hermann has been doing in the area of hospital quality and safety.

Dr. Shabot: We operate Memorial Hermann Healthcare System on the premise that all patients, visitors, and staff will have an absolutely safe environment. In fact, six of our hospitals have gone a year without a single case of hospital-acquired blood stream infections, or ventilator-associated pneumonia.

Larry Kellner, the CEO of Continental Airlines, can travel on any one of his airplanes without checking on the credentials of the pilots. But would you advise a family member to go to a hospital without checking its credentials or being under the care of a physician whom you know and trust? I wouldn’t.

Every single one of our hospital employees has gone through our “cultural transformation” training. They are taught new ways of doing their current jobs – based on safety training with a proven track record in the aircraft and nuclear energy industries. We also feature employees who have “good catches.” Last month’s “good catch” employee found a medication that was packaged incorrectly from the vendor. It was in the correct bin of our computerized dispensing system, the outer package was correct, but the bottle inside contained a different dose. And this medicine was going to be given to a tiny baby in our neonatal ICU. That incorrect dose could have caused terrible harm, but thanks to the alert nurse – we caught the error.

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America’s Poorest City (Detroit) Leads The US In Healthcare Quality Reform

Photo of Nancy Schlichting

Nancy Schlichting

“Detroit is the poorest city in America. But we’re not going to be victims of circumstance. We’re going to rise up and lead the country in healthcare quality and become part of the economic solution for our community. The Henry Ford hospital name must mean something when people drive up to it.”
- Nancy Schlichting, President and CEO, The Henry Ford Health System, Detroit, Michigan
I sheepishly admit to being surprised that a hospital system in Detroit was singled out for a national award for hospital quality and safety. Who would think that the poorest city in America could be a beacon of light in these dark times in healthcare? The story of Henry Ford Health System, and its female president and CEO, Nancy Schlichting, is both inspirational and motivational. I had the chance to interview Nancy at a recent award ceremony at the National Press Club where she received the 2008 National Health System Patient Safety Leadership Award.


You may enjoy our conversation via podcast, but please forgive the “tinny” sound quality. I recorded our conversation with a little hand-held digital device instead of my usual recorded phone line.

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Dr. Val: Congratulations on winning the National Health System Patient Safety Leadership Award. Has improving patient safety at your hospital been a challenge?

Schlichting: On a given day, a patient may encounter up to 50 different hospital employees. Coordinating our efforts so that the patient’s experience is consistently positive and error-free is certainly challenging.

We have 7 pillars of performance at Henry Ford, and the first is “people.” We like to say that we “have to take care of the people who are taking care of people.” We need to make sure that they have the resources they need, that the processes are in place so they can do their jobs well, and that they get their individual needs met. For example, everyone knows my email address and they can contact me at any time if they’re not getting their problems resolved. I respond to every single email. This creates a culture of openness and responsibility. They know that the person at the top cares about them.

Dr. Val: A prominent community member experienced an unfortunate lapse in communication during his hospital stay, which resulted in compromise of his care, and he eventually died in the hospital. You personally met with his wife and promised her that you’d take the necessary steps to ensure that this never happened again. Tell me more about that.

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Cartoons & Cocktails 2008 At The National Press Club

I flew back from San Francisco just in time to get to the National Press Club’s annual “Cartoons & Cocktails” event. Two of my cartoons were auctioned off for charity – along with donations from many other artists. Lynn Johnston (the syndicated cartoonist behind “For Better Or Worse”) sent in two original cells, though political cartoons made up the bulk of the offerings (including a signed copy of the scandalous New Yorker cover about Senator Obama). It was truly an honor to have my work featured along with such talented peers.

Of course, I asked my husband to join me at the event to take pictures. I have a new iPhone – and its camera seems to have a bit of a learning curve. I was a little disappointed that my head was cut in half for most of the shots, and that my TV interview with an Indian political team was captured from behind my head. The Washington Examiner had its own photographer – so I might show up in the “social sightings” in one piece.

For your amusement, I offer my husband’s chronicles of the evening:

Writers Of Satirical Newspaper, The Onion, Deny Knowledge Of Otters

The Onion

I have been a fan of The Onion for many years. Its authors have mastered the art of news satire, and although they’re often irreverent, they’re equal opportunity lampooners. I always wondered what The Onion’s writers were like in person, and yesterday my wish to know them better came true at the National Press Club.

The writers are “20-30 somethings” with a wicked sense of humor and a healthy dose of self-confidence. They describe themselves as “schlubs” who have many “schlubby” friends. Most got their start working as reporters for small, midwestern newspapers. They dress casually and claim to be paid very little.

Of course, I bounced up to the panel as soon as the event was over and congratulated them on their science reporting and asked them to reveal to me who wrote the spoof article on medical peer review. It’s one of my favorite Onion articles of all-time, as it follows the science paper of a 5th grader (he wrote it about otters) as it undergoes peer scrutiny, shredding and denial for publication. You can read the article here.

Sadly, the panel members denied any memory of the otter article. I countered with my appreciation for their video news “Most Children Strongly Opposed To Children’s Healthcare” and they nodded politely. One writer asked me if I thought their scientific spoof articles were on-target, or if they betrayed their major lack of understanding of science in the first place.

“Well, as you writers well know,” I said, “‘science is hard.’ But you seem to be getting the right messages across. The medical community needs more reports like ’Fifth Grade Science Paper Doesn’t Stand Up To Peer Review.’ There’s not much to laugh about in healthcare these days.”

I snapped a few photos of the mysterious authors for my fellow Onion fans. Do you have a favorite Onion article or headline?

P.S. When asked why the paper was called The Onion, one of the panelists said that the first team of writers were so poor they ate onion sandwiches to survive (eww), so they named the paper after their food of choice. The company currently employs about 30 people (20 for video production and 10 newspaper writers). Fortunately those present at the event did not seem to have onion breath.

Onion Breath Test

Onion Breath Test

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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…

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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.

***

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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