Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Sedating Yourself With Food: Why?

Dr. Whoo and I seem to be in the same place at the same time — we both struggle with our weight because we’re using food for something other than sustenance. We use it to manage stress. Overeating is, after all, a wonderful sedative. It soothes the savage beast and all that. And it really works. I’ve probably saved my marriage and my job and kept from killing my kids and my husband by sedating myself with food. Read more »

*This blog post was originally published at The Blog that Ate Manhattan*

Pharma Discloses Physician Relationships – Now What?

This was the year that Pharma disclosed the names and payments of their physician consultants.  Look here for physicians speaking and consulting with Merck, GlaxoSmithKline, Lilly, and Pfizer.

Physician disclosure of conflict is important.  It helps put a physician’s opinion and point of view into a context. Disclosure has long been the standard in the academic world.  This represents the first time that such information has been made available to the general public.

But how will patients use this information and how will it affect care and outcomes?  Should patients flatly avoid physicians or others who have a relationship with a pharmaceutical company?  And should patients routinely screen physicians for conflict?

I don’t know the answer to these questions.  I’m not sure patients know the answer to these questions.  I suspect patients may not like the idea but would be willing to overlook a pharma connection when the reputation of the physician is impeccable.

Transparency is all the rage.  Expect more. But I’m wondering how the average health consumer will practically process the information.

*This blog post was originally published at 33 Charts*

Frosty The Snowman’s Heart And The Last Tomato Standing

snowmanLike a good Rochesterian (Rochester, NY that is), my husband decided to shovel the snow off our balcony after the 2-foot-deep deposits threatened to melt into our condo’s window cracks. I was comfortably blogging away in our living room when I looked up to find Mr. DrVal had built me a miniature snowman, complete with a heart made from the last tomato of our now fully dead Roma tomato plant.

A few amazing things about this photo: 1) How can ripe tomatoes still be growing at the end of December in Washington, DC? 2) How did he get Frosty’s hat to stay on his head? 3) How did he find my secret scrub stash and why did he wear them out to shovel snow?

Anyway – I’m sure you’ll agree that this is a rather charming and creative way to spend a Sunday after a snowstorm. But watch out, Frosty: I’d like to eat your heart out!

Teens Describe Their Ideal Realtionship With A Parent

As a parent, sometimes it is hard to know how our teens perceive us. We all want to be there for our children and have a great relationship with each of them, but sometimes they might not perceive our actions the same way we intend them to, so here is what a group of teens have to say about the perfect relationship with a parent. Just food for thought.

The perfect parent would …

  • Male, age 18: Listen. Everything else hinges upon listening.
  • Female, age 17: Be open to talk and understand me.
  • Male, age 17: Talk, express what they want and show affection, not think affection is understood, or a given. Read more »

This post, Teens Describe Their Ideal Realtionship With A Parent, was originally published on Healthine.com by Nancy Brown, Ph.D..

An Oncologist Offers Dating Advice

How do you know if a couple is right for each other?

Watch how they interact in a cancer clinic.

So says this oncologist in a poignant column from the Boston Globe. As Robin Schoenthaler writes, “When you’re a single woman picturing the guy of your dreams, what matters a heck of lot more than how he handles a kayak is how he handles things when you’re sick. And one shining example of this is how a guy deals with your purse.” Read more »

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

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…

Read more »

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…

Read more »

See all interviews »

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.

See all cartoons »

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…

Read more »

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…

Read more »

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…

Read more »

See all book reviews »