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Audio: ACP President: Not Enough Americans Have Been Vaccinated Against H1N1 Flu

stubbsOver 10,000 Americans (mostly young) have already died of H1N1 flu, and yet we’ve only vaccinated 10-20% of those who need protection. January 10-16 is National Influenza Awareness Week, and the American College of Physicians is doing its part to raise awareness of the ongoing need to protect Americans from the next wave of influenza.

I interviewed ACP President, Dr. Joseph Stubbs, about the current influenza season and Americans’ vulnerabilities to the virus. Please enjoy the audio of our conversation or read the transcript below.

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Tragic H1N1 Flu Death Of University of North Carolina Freshman

lillian-400x300.jpgIf you think that the H1N1 pandemic is slowing down and have grown complacent with vaccination now that vaccines are more widely available, please learn something from last night’s tragic loss of local college student from Rhode Island, Lillian Chason:

A University of North Carolina at Chapel Hill student, who friends said was battling complications from the H1N1 virus, died Wednesday evening, according to UNC Hospitals and a Facebook post made by her father.

Freshman Lillian Chason had been in critical condition at UNC Hospitals for weeks. Friends told WRAL News on Tuesday that she started feeling bad before Thanksgiving and went into the hospital on Nov. 20. Read more »

*This blog post was originally published at Terra Sigillata*

H1N1 Blogger Briefing With Anne Schuchat & Friends

valtraceyThe Department of Health and Human Services held a blogger-targeted webcast about the H1N1 flu today in Washington, DC. Although Secretary Kathleen Sebelius had planned to co-lead the event, she was called to the White House for some healthcare reform deliberations – which might take a while? (She promises to try again to speak to us bloggers at a later date, though, so I’ll be sure to let you know when that happens). Dr. Anne Schuchat, Director of the National Center for Immunization and Respiratory Diseases, carried the event with ease, and Jenny Backus (Acting Assistant Secretary for Public Affairs – pictured with me) moderated the incoming blogger and Twitter questions.

This was a particularly entertaining webcast for me because I was invited “behind the scenes” to witness the event at the HHS studio as well as submit questions for Dr. Schuchat’s consideration. The webcast is available for viewing on the HHS YouTube channel.

What you may not get from the webcast, however, is how much work goes into HHS’s efforts to communicate accurate information to the public. I was very impressed with the studio space (it has a National Press Club feel) and the staff are technically skilled and affable. So friendly were they that I “memorialized” our meeting with a few candid shots (below). Read more »

Do Physicians Have A Moral Obligation To Engage In Social Media?

Some physicians may be hesitant to participate in social media outlets, like Facebook and Twitter.

Well, get over it.

Great post by pediatrician Bryan Vartabedian who addresses this topic. Indeed, physicians have lost control of the online message, especially with, according to recent data, 60+ percent of patients visiting the web first when looking for health information.

Instead, anti-vaccine proponents and homeopaths have embraced the Internet, and now exert tremendous influence on patients. We doctors have no one to blame but ourselves for being so slow to get online. Read more »

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

Amy Wallace On The Anti-Vaccination Movement: Superb, Engaging Science Journalism

amywallace200px.jpgOne of the most engaging and clearly-written pieces of science journalism over the last year or so was published in Wired magazine last week. Amy Wallace’s, “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All,” is part interview with rotavirus vaccine developer, pediatric infectious disease physician, Dr Paul Offit, and description of the anti-vaccination movement in the United States.

Wallace’s work is the centerpiece a collection of smaller articles providing science-based information about vaccination that also refutes common anti-vaccination myths including “How To Win An Argument About Vaccines” and “The Misinformants: Prominent Voices in the Anti-Vaccine Crusade”.

Wired’s follow-up discussion of the issue includes, “A Short History of Vaccine Panic,” for those of us who “have a day job” and not enough time to read Paul Offit’s 2008 book, “Autism’s False Prophets.”
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*This blog post was originally published at Terra Sigillata - PostRank (PostRank: All)*

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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