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The Death Of In-Person Medical Conferences

Are medical conferences becoming obsolete? I think so.

It was apparent to me at the Heart Rhythm Society Scientific Sessions meeting and now a similar trend was noticed by Dr. Steven Sedlis at this year’s American Heart Association meeting:

It felt like a ghost town. I ran into Ira Schulman, my medicine resident at Bellevue when I was a third year medical student; we looked at one another and simultaneously blurted out “where is everybody?”
. . .

There are probably numerous reasons for plummeting attendance at AHA. The economy, the on-line publication of trial results prior to presentation, the ubiquity of conference calls, e-mail strings and yes blogs that keep one in regular contact with colleagues throughout the country and the world without the need for face-to-face encounters are just some of the obvious causes.

The scaling back of industry support may be another major factor at play here. Certainly there are fewer exhibitors and the exhibits are far less lavish. As Muhamed Saric pointed out when I met him on the floor of the exhibit hall there were no Siemens or Philips exhibits, and in fact I could not find any cath lab manufacturers presenting their products at the AHA. The need to diminish the influence of industry on the medical profession and the need to avoid conflicts of interest were brought up at many of the presentations at the session by leaders of the AHA and other thought leaders in academic medicine, but one unintended consequence of this well-intentioned effort seems to be less financial support for the meeting itself.

I’ve always enjoyed the socialization and camaraderie that comes with medical conferences, but with the uncertainty of the current health care climate for doctors, the rising costs of these conferences for attendees, and the increased comfort doctors have for receiving medical information via the internet and social media, the need for traveling to medical conferences has quickly become obsolete. While medical device company or pharmaceutical reps might still find these venues moderately entertaining, without their ultimate customers in attendance, the medical scientific session conference marketing circuit will slowly fade away.

*This blog post was originally published at Dr. Wes*


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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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