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Latest Posts

How Patient Complaints Affect Defensive Medicine

Doctors often have a communication disconnect with their patients. A recent piece from the New York Times encapsulates the issue, citing a recent New England Journal of Medicine perspective.

According to oncologist Ethan Basch, “Direct reports from patients are rarely used during drug approval or in clinical trials. If patients’ comments are sought at all, they are usually filtered through doctors and nurses, who write their own impressions of what the patients are feeling.”

There are a variety of reasons for this. Some doctors feel they have a better sense of the patient’s symptoms than the patient himself. Biases can affect how doctors and nurses perceive symptoms. Read more »

*This blog post was originally published at KevinMD.com*

Who’s Really Overcrowding The ER?

If you think the overcrowding in emergency rooms across the country is because of the uninsured, think again.

A new study in the Annals of Emergency Medicine reports that of patients who are frequent users (over 4 times a year) of emergency departments (ED), the uninsured represent only 15 percent of those frequent users.

Also, the frequent ED users were more likely than occasional users to have visited a primary care physician in the previous year.

They also found that most patients who frequently use the ED have health insurance and the majority of users (60 percent) were white. These findings contradict the widely held assumption that frequent users are minorities or illegal immigrants without insurance. Read more »

*This blog post was originally published at EverythingHealth*

When Patients Attack Doctors And Nurses

With the attention rightly focused on patient safety, what about healthcare workers? It’s somewhat of a hidden phenomenon, but attacks on doctors and nurses are on the rise.

Rahul Parikh writes about this in a recent Slate piece. He cites data from the Bureau of Labor Statistics, which found “healthcare workers are twice as likely as those in other fields to experience an injury from a violent act at work, with nurses being the most common victims.”

In the article, Parikh goes on to detail an attack on a physician who initially refused to give his patient opioid pain medications. Read more »

*This blog post was originally published at KevinMD.com*

Social Media Tips For Healthcare Professionals

Whenever I talk about medical professionals using social media, people are surprised by what I say. Most people think they can hide online and never have to reveal their real identity. I think they are wrong. In the online world, it’s much easier to find out private information about someone who wasn’t cautious enough than in real life. A recent example includes Doctors warned of Facebook flirts (e-Health article):

The Medical Defence Union said it was aware of a number of cases where patients have attempted to proposition doctors by sending them an unsolicited message on Facebook or similar sites. The medical defence body said it would be “wholly inappropriate” to respond to a patient making an advance in such a way. Read more »

*This blog post was originally published at ScienceRoll*

Finding Health Care Professionals on Twitter

My social Network on Flickr, Facebook, Twitter...Image by luc legay via Flickr

A little over a year ago, before Twitter was the tech/pop culture phenomenon it is today, doctors like myself had a problem: how do you identify other health professionals on Twitter? (At the time, there must have been at least dozens. Dozens.)

This was the first solution. In retrospect, it was hilariously cobbled-together:

This is a feed containing the conversations of all known doctors and medical students who use Twitter: http://feeds.feedburner.com/doctorsontwitter. (If that doesn’t work, you can try the original feed from Yahoo Pipes instead.) Technical details, for those interested: I used this list of doctors/medical students on Kidney Notes, ran each person’s Twitter feed through Yahoo Pipes, then burned a FeedBurner feed.

When FriendFeed debuted, I created “The Doctor’s Room,” which was populated by both Twitter feeds and RSS feeds of physicians. Unfortunately, the “room” feature was poorly designed by FriendFeed (which has since been acquired by Facebook). Like the Yahoo Pipes experiment, the FriendFeed room was an educational failure. Read more »

This post, Finding Health Care Professionals on Twitter, was originally published on Healthine.com by Joshua Schwimmer, M.D..

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.

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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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