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The art of being different – a girl scout’s story

Girl scout cookie season is upon us, and recently our office was swarming with youngsters taking cookie orders. I wasn’t sure which girl I should order from (one can’t really order from each of them and expect to maintain any semblance of a normal BMI) and as I was considering how to choose, one energetic little girl simply walked right up to me and asked if I’d like some cookies.

She was slim and blonde, with bright eyes and an honest face. I knew the “sales pitch” didn’t come naturally to her, and I tried to make it easier by joking a bit. She was shy, but on a mission. I asked her which type of cookie she liked best, and if her daddy ate too many of them. She was innocently pleased with the interaction and disappeared down a hallway near some cubicles.

Many weeks later a large delivery of girl scout cookies arrived. There was a mass distribution strategy in place with moms and girls cutting open cardboard boxes of cookies and delivering them to buyers. I asked if my cookies were on the list. They told me that they didn’t sell me the cookies, so I’d need to wait for the specific little girl who sold them to me to stop by.

About a week later, when I had assumed that my little girl scout had forgotten about my order (and the rest of our staff had well and truly gorged themselves on thin mints), her dad came into my office with a pretty bag tied with a ribbon and a hand written card from his daughter. He told me she asked him to deliver it personally, because she wanted her service to be different than the other girls. Her dad joked that he was trying to train her about “differentiators” but I was quite touched by the effort she had made to make me feel like a special customer.

Later that afternoon I sat down to write a thank-you card to the girl. I wanted her to know that her efforts made a difference, and that I noticed her hard work in making my cookie purchase a personalized experience (not just part of a bulk delivery service). I put some stickers on the card, I used colorful paper, and a big red envelope.

A few days later I asked her dad if she liked the card. This is what he wrote to me:

“She loved it. She saw it at breakfast and came screaming upstairs to show it to everybody. Thanks!”

That really made my day. I hope in some way that I’ve encouraged this little girl to continue to reach for excellence, to stand out in the crowd, and to know that her work is appreciated. It is this sort of attitude toward life that will help her grow up to be… a revolutionary.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.


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5 Responses to “The art of being different – a girl scout’s story”

  1. kelly says:

    Such a sweet (in more ways than one) story! It definitely differentiates your blog! :)

  2. earthling says:

    Val – I just love your blog! Every post is insightful and humorous. Next step – podcasting ;-)

  3. ValJonesMD says:

    Thanks everyone – I will do my best to keep the good thoughts flowing!

  4. wellth says:

    That was so kind of you to make the budding, blonde Revolutionary-in-training a fun card! I toast with you, and more Thin Mints than I will ever blog about, to the art of being D-I-F-F-E-R-E-N-T.

  5. Anonymous says:

    WOW THAT WAS THE BEST STORY , BESIDES WELLTH’S ARTICLES:) THAT I HAVE READ I REALLY , REALLY ENJOYED THAT STORY, IT WAS LIKE LOOKING AT A NORMAN ROCKWELL PAINTING BUT WITH WORDS INSTEAD OF PAINT…. CHEERS AND COOKIES TO YOU!!!!!!

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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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