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Video: “The Too-Informed Patient”

This video, “The Too-Informed Patient,” came my way lately. It’s featured on NPR’s Mar­ket­place website:

The Too Informed Patient from Marketplace on Vimeo.

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The pup­peteer skit fea­tures the inter­ac­tion between a young man with a rash and his older physi­cian. The patient is an informed kind of guy: He’s checked his own med­ical record on the doctor’s web­site, read up on rashes in the Boston Globe, checked pix on WebMD, seen an episode of “Gray’s Anatomy” about a rash and, most inven­tively, checked iDiagnose, a hypo­thet­i­cal app (I hope) that led him to the con­clu­sion that he might have epi­der­mal necro­sis.

“Not to worry,” the patient informs Dr. Matthews, who mean­while has been try­ing to exam­ine him (“Say aaahhh” and more): He’s eli­gi­ble for an exper­i­men­tal pro­to­col. After some back-and-forth in which the doc­tor — who’s been quite cour­te­ous until this point, call­ing the patient “Mr. Horcher,” for exam­ple, and not admon­ish­ing the patient who’s got so many ideas of his own — the doc­tor says that the patient may be exac­er­bat­ing the con­di­tion by scratch­ing it, and ques­tions the wis­dom of tak­ing an exper­i­men­tal treat­ment for a rash. Read more »

*This blog post was originally published at Medical Lessons*

Medicare’s Deficit Effect On The Economy

Medicare poses a deficit problem, note some very influential analysts. A former Congressional Budget Office head and a former Medicare chief chime in on the scope of the program’s impact on the economy, and the difficulties of trying to scale it back.

Yet, a presidential commission is considering just that among other measures. The 18-member, bipartisan commission released its report weeks ago and was scheduled to have voted today on a shocking scope of deficit-trimming measures that included changes to military spending, Social Security and Medicare, among other areas. But they deferred the vote until Friday to try to garner more votes from members who are also currently elected officials. The panel needs 14 votes and substantive approval from its roster of Congress members to gain serious attention.

In related news for Medicare recipients, the Employee Benefit Research Institute reports that seniors will need hundreds of thousands of dollars in savings to cover health insurance and other out-of-pocket health needs. (NPR, The New York Times, ACP Internist, The Washington Post, Reuters)

*This blog post was originally published at ACP Internist*

The New Healthcare Law: So Sad It’s Funny

Thanks to Scott Hensley over at Shots, NPR’s Health Blog, for highlighting this sad but funny video on where we’re going with healthcare. Scary what happens when theory meets reality:

-WesMusings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

“Dollars For Doctors”: Is Your Doctor Being Paid By A Drug Company?

An historic piece of journalism was published today. Six news organizations partnered on the “Dollars for Docs” project — ProPublica, NPR, PBS’s Nightly Business Report, the Chicago Tribune, Boston Globe and Consumer Reports. They examined $258 million in payments by seven drug companies in 2009 and 2010 to about 18,000 healthcare practitioners nationwide for speaking, consulting, and other tasks.

This webpage can be your gateway to the project, with links to a database searchable by doctor’s name or by state, and links to the journalism partners’ efforts:

Boston Globe
“Prescription for Prestige”
The Harvard brand, unrivaled in education, is also prized by the pharmaceutical industry as a powerful tool in promoting drugs. Its allure is evident in a new analysis of all publicly reported industry payments to physicians.

Consumer Reports
“Consumers Wary of Doctors Who Take Drug-Company Dollars”
Most Americans are skeptical of financial relationships between doctors and companies, according to a new, national from the Consumer Reports National Research Center.

Chicago Tribune
“Doctors Draw Payments From Drug Companies”
Follow drug company money in Illinois, and it leads to the psychiatry department at Rush University Medical Center, a prominent headache clinic on the North Side of Chicago, a busy suburban urology practice and a psychiatric hospital accused of overmedicating kids.

PBS
“Nightly Business Report”
A doctor talks about quitting drug company money when their marketing tactics crossed the line.

NPR
“Drug Companies Hire Troubled Docs As Experts”

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

3 Things That Make A Better Doctor

On Monday, NPR’s Scott Hensley posted:

“Between the Internet and all the data insurance companies and the government collect on doctors, you’d think it would be a lot easier than it used to be to find a good one. But it’s not.”

Sound familiar around here? See his thoughts: “3 Tips For Picking A Slightly Better Doctor.”

(Thanks to friend Cindy Johnson for the tip.)

*This blog post was originally published at e-Patients.net*

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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