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What “The King’s Speech” Teaches Us About Stuttering

The film “The King’s Speech” won the Academy Award for Best Picture [on Sunday night.] The movie has come in for some criticism for its depiction of the political machinations surrounding the abdication of Edward VIII  and Britain’s appeasement of Hitler. The British-born writer Christopher Hitchens, unsparing and deliciously eloquent as always, puts the politics of  George VI in a far less favorable light than the movie does.      

But ”The King’s Speech” has won almost universal praise for its portrayal of the reluctant monarch’s stuttering, a speech pattern that includes involuntary repetition of sounds and syllables and “speech blocks” that cause prolonged pauses. Many young  children who stutter grow out of the problem, but perhaps as many as one in every 100 adults are affected by the condition, 80 percent of whom are men. Stuttering clusters in families, so researchers have been searching for inherited genes that might cause the condition. Last year, in The New England Journal of Medicine, NIH researchers reported some success with results showing an association between three mutated genes and stuttering, although those mutations are probably responsible for a very small minority of cases. 

It’s been said that ”The King’s Speech” will do for stuttering what “Rain Man” did for autism: Plant a sympathetic view of a disability in the public consciousness. One danger of such a quick infusion of awareness, however, is that it can harden into a fixed, if largely favorable, stereotype. We are finding out — or are being reminded — about all the famous people who have stuttered (many of them writers). First-person accounts are popping up all over the place because of the film. The best I’ve come across is by Philip French, a British film critic, who describes vividly what it was like to listen to the radio broadcasts of the real King George VI, wondering if he would make it to the end “like a drunken waiter crossing a polished floor bearing a tray laden with wine glasses.” Read more »

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

Fix Healthcare Soon Or The Patient Will Be Beyond Saving

The top vote-getting answer on my poll about what people feel about the election: Different lunatics, same asylum. We are getting jaded by our system. Being the “flaming moderate” that I am, I find it hard to hear the substance of the rhetoric on either side, just the shrillness and rancor of the voices.

From the physician’s perspective, it is very hard to know who to favor in this election. The democrats seem to love lawyers and hate tort reform, and they also favor an expansion of government. The republicans love big businesses and “free market,” accepting the bad behavior of insurance and drug companies as “the market working itself out.” They both seem hell-bent on sticking it to the other party at the expense of getting anything done — and this in a time of crisis for our industry.

The results of this playground brawl between the two gangs of bullies is that all of us wimpy kids (the ones without power) end up lying bloody in the dirt. Here are the facts as I see them about healthcare in our country:

1. It costs far too much. The top item on the agenda needs to be cost control. The only way to control cost is to stop paying for things that are unnecessary or for which there is a cheaper alternative. I know that’s not simple as it sounds, but so much of the discussion is about coverage and how things are paid, while the real issue is not who pays, it’s what and how much gets paid. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

How Will Today’s Elections Affect Healthcare Reform?

All eyes are on today’s mid-term elections and how they’ll play out across the country. The results are likely to affect the recently enacted healthcare reform legislation, Politico reports. Although repealing the legislation would be difficult, Republicans may be able to challenge its implementation if they gain control of the House. Attempts to modify the law could require a delicate balance since, as noted by the Washington Post‘s Ezra Klein, some of its provisions, such as coverage for dependents age 26 and younger, are individually popular.

Reuters has published a Q&A on what the election results could mean for the healthcare reform law. The Wall Street Journal is asking readers to weigh in on whether the legislation is affecting their votes. (Politico, Washington Post, Reuters, Wall Street Journal)

*This blog post was originally published at ACP Internist*

Paralysis As Criminal Punishment?

CAIRO — A Saudi judge has asked several hospitals in the country whether they could damage a man’s spinal cord as punishment after he was convicted of attacking another man with a cleaver and paralyzing him, the brother of the victim said Thursday.

Every time I think my country is screwed up, I read this sort of thing and feel better about it. And kudos to the hospital that (apparently) just said, “No.”

SOURCE: “Saudi judge considers paralysis punishment” – World News – Mideast/N. Africa – MSNBC.com

*This blog post was originally published at GruntDoc*

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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