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Latest Posts

Oh Baby: Infant Denied Health Coverage Due To Weight

If you still think we don’t need healthcare reform in the U.S., consider this: A 4-month-old baby is being denied health coverage by an insurer in Grand Junction, Colo., because the baby is too fat, the Denver Post reports. Details: The 4-month-old boy is in the 99th percentile for his age in height and weight. He is being exclusively breast fed by his mother and has grown from around 8 pounds 4 ounces at birth to nearly 17 pounds. Four. Months. Old. Pediatrician deemed him healthy. Parents are healthy and relatively fit, and  also have a healthy 2-year-old boy.

And people say the government is going to destroy our healthcare system?

OK, let’s be reasonable: Chances are, once the wildfire of press around this spreads sufficiently the company will rescind its decision and offer this lad coverage. (And, for the record, he could be covered by the family’s prior insurer but the parents decided to shop around because that firm raised the family’s rates by 40 percent after the boy was born.)  And, no, I don’t know of other cases where someone was denied coverage for the “pre-existing condition” of having been born hungry. So in the interest of fostering adult-level debate let’s acknowledge that this is probably a VERY isolated case and does not reflect the ethos of all insurers everywhere.

But still: A fat baby getting denied coverage is beyond ridiculous. Read more »

Can You Name The 10 Vaccines That Adults May Need?

We’ve all heard about the importance of getting our flu shots this season, but did you know that there are 10 vaccines commonly recommended for adults? I spoke with Dave Lucas at ABC News about the low rates of adult vaccinations in the US, and encouraged people to ask their doctors if they’re up to date with their vaccinations.

On September 30th I participated in a social media event with the Immunization Action Coalition and learned from Executive Director, Dr. Deborah Wexler that: Read more »

Are You A Swine Flu News Junkie?

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Also stay tuned for updates from the International Influenza Vaccines for the World conference, in Cannes, France. MedPage Today has sent reporters there and will be giving Better Health key updates. I’ll keep you posted.

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

NBA All-Star Grant Hill On His MRSA Infection

Methacillin resistant staphlococcus aureus (MRSA) is a deadly bacterium that is becoming more and more common inside and outside the hospital setting. No one is immune, not even babies like this one who died from an unknown exposure. Seven-time NBA All-Star Grant Hill has also experienced the ravages of MRSA. I interviewed him about his near-death experience.

Dr. Val: Tell me about your recent experience with a severe staph infection.

Grant: I got my MRSA infection in 2003, afterI had a surgery on my ankle in the hospital. I had never heard of MRSA before and it was a very scary ordeal(at certain points, I didn’t think I was going to make it)and it took me a long time to recover. Dealing with my own infection made me realize just how severe MRSA could be. I want to make sure others do not have to go through what I went through. I got lucky with my infection because the doctors recognized it and we were able to treat it. I will always have scars on my ankle from the infection, so I never really forget what I went through and how lucky I was to survive.

Dr. Val: How common are staph infections among basketball players?

Grant: I don’t know exact statistics regarding basketball players, but the scary thing is, now it’s not just in hospitals. Now you’re finding MRSA infections in community settings like gyms, schools, homes and locker rooms. So there is definitely a need for conversation about this, and also about ways to prevent it.

Dr. Val: As an insider, what kind of behaviors have you observed that might put players at higher risk for contracting MRSA?

Grant: One thing I have learned through all of my injuries is that tomorrow is never really promised. As athletes there are so many ways that we can get injured, we can’t underestimate something like MRSA, especially because there are easy ways to prevent it. It’s important for players to know that MRSA can be spread by sharing athletic equipment, towels and razors. To help stop the spread of MRSA in locker rooms and on sports teams, players need to wash their hands frequently and stick to using their own personal items. They also need to know that when working out, they should keep a towel down between them and shared equipment. When it comes to locker room surfaces, those should be disinfected with a bleach solution. I am very conscious of all these prevention methods in my life, because I realize how important the prevention side of it is.

Dr. Val: Now that you’ve had a staph infection, what precautions do you take to prevent re-infection?

Grant: All those little things my mom used to tell me to do still ring true. I make sure to wash my hands frequently and cover any of my cuts -I keep a whole stash of bandages in my locker. I also keep my towels to myself and disinfect with a bleach solution, that’s really easy to make. It only takes a few minutes out of my day to take these steps, but I know first-hand that it can make a world of difference. You know, I often find myself telling my daughters the same things because as a father, it is important that I keep my family safe and healthy.

Dr. Val: What should athletes know about MRSA and what advice do you have for them?

Grant: Athletes of all ages should be encouraged to hit the court or the field and have a good time while remembering the easy prevention steps. Because I have spent so much time not playing, due to injury, I am having so much fun just playing. Everyone should remember that theycan help prevent the spread of MRSA easily, so no one has to waste time on the sidelines.

Dr. Val: What’s the most important thing that you’d like to tell Americans about MRSA?

Grant: Wow, how much time do you have? I really want people to realize that MRSA is a serious infection. As I’ve mentioned, before I got it and I hadn’t even hear about it. My ordeal really opened my eyes to this and that it can affect anyone! The scary truth is that more deaths each year are caused by MRSA than AIDS. But, there are easy things people can do to help reduce the spread of MRSA. This includes: washing your hands frequently, not sharing your personal items like towels and disinfecting with a bleach solution. There is more information and tips about how to prevent getting MRSA, including a playbook of prevention, at

*This post was originally published at my other blog site – URL pending*

This post originally appeared on Dr. Val’s blog at

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…

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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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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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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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