January 14th, 2007 by Dr. Val Jones in News
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Technically, the jury’s still out on this one, but Dr. Ellen Bialystok’s (cognitive psychologist) work is very interesting. She has compared cognitive skills in monolingual and bilingual children, as well as a fairly recent study comparing dementia rates in monolingual and bilingual adults in Canada. I wanted to go back to the original source articles, but I wasn’t willing to pay the journal article fees. Sorry. Still, this seems to be what she found:
Bilingual children were ~55% more able to block out misleading information than their monolingual peers.
Bilingual adults tended to show the first signs of dementia at an average age of 75, but monolingual impairment began at an average age 71.
Yes, there are a gazillion unanswered questions here: does it matter what age you become bilingual? Does it matter which languages you speak? Do you have to speak both of those languages all the time or can you have learned a language back in college and not use it now? What about if you speak 3 languages?
Still, there are some interesting findings here worth a deeper look, wouldn’t you say?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 12th, 2007 by Dr. Val Jones in Medblogger Shout Outs
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Dr. Richard Reece’s latest blog post lists “12 health care predictions for 2007” – I looked into his crystal ball and was quite intrigued. Here are some highlights (see his blog for the full transcript):
- The home care market will boom
- Obesity will eclipse smoking as the #1 public health issue in America
- Web based patient education will become extremely popular
- High deductible health plans (powered by health savings accounts) will dramatically expand their reach
- Employee wellness and prevention programs will bloom…
What other trends do you think he missed? Do you disagree with any of his predictions?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 10th, 2007 by Dr. Val Jones in True Stories
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** This follows from the previous blog post**
A week later a 10 pound package came for me in the mail – it was a copy of the patient’s entire medical record. It took me almost an hour to find the part that had to do with the paralysis event, but as I read through the chart I saw my note and then gasped.
My note was simple: it documented my physical exam findings, the time I first found him paralyzed, the time I called the surgical team, the time it took them to get to the patient’s room. It was all clearly written and nicely documented. But the entry just above mine was from a nurse who had apparently turned the patient earlier that morning to wash his posterior. She noted that the patient was having some neck pain afterwards and that she had given him some Tylenol.
Then came my note.
And then came another note from the nurse, dated 3 months after the incident, and labeled “addendum:”
“Paged Dr. Jones to evaluate patient with complaint of inability to move lower extremities. Dr. Jones responded that she would examine him after rounds. I told Dr. Jones that it was an emergency but she said the patient would need to wait.”
I was horrified. That’s not at all what happened – the nurse was clearly afraid that she would be held responsible since she was the one who had moved the patient earlier that morning, possibly displacing his (recently operated upon) spine and causing a bleed. She obviously wrote the note to make it look as if the irreversible paralysis was due to the slowness of my response.
And so I felt helpless and very afraid – is this what will end my medical career? I thought about all my years of training, how careful I always tried to be, how much I cared for my patients – and would it all end with this insanity?
As it turned out, I had to prepare for a deposition. I studied every angle of the case, read every piece of the chart, sweated it out for many weeks. And then I got another call from the lawyer one day: “They’re settling out of court. You don’t have to come in. Just forget about it.”
I was relieved, but angry. I also felt very sorry for the patient. But most of all I wondered about the legalities of practicing medicine – how vulnerable we docs are, how a complication can be seen as malpractice… and how another healthcare professional can be so damaging. Sometimes practicing medicine scares me – lives are at stake, and even the best intentions can lead to life-altering events.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 9th, 2007 by Dr. Val Jones in True Stories
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An attorney from the hospital where I used to work called me out of the blue. He asked me if I remembered a Mr. So and So. “I’m not sure,” I said uneasily. “The name does sound familiar.”
Slowly the case came flooding back to me. I was on call on a weekend covering the neurosurgical step down unit. A nurse paged me to tell me that someone couldn’t move his legs. I asked if it was a new problem. “Yes, he could move them just this morning.”
I ran to the patient’s room and found an anxious appearing, young obese man lying flat in bed with a neck brace on. He had recently had a cervical laminectomy (a neck spine procedure). “I can’t move” he said, a bead of sweat trickling off his brow. “Can you feel anything?” I asked.
“Nothing below my neck.”
I took my metal tuning fork out of my coat pocket and pressed it firmly on his toe nail bed to see if he’d withdraw from pain. Not a flinch. My heart started racing. This is a surgical emergency.
I called the neurosurgery team and told them about the sudden paralysis. They arrived on the floor in under a minute, confirmed the diagnosis, grabbed the chart and took the patient to the O.R. immediately.
Hours later I heard that the man had had a rare complication of neck surgery – a small arterial hemorrhage that rapidly compressed the spinal cord. The surgeons evacuated the blood immediately – though it was anyone’s guess if the man would fully recover.
And apparently he didn’t. Four years later he was suing the hospital for malpractice, and I was named in the lawsuit.
“But I didn’t do anything wrong,” I told the attorney.
“Well, you’d better read the record,” he said ominously.
**See my next post for the end of the story!**
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 7th, 2007 by Dr. Val Jones in Opinion
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I used to believe, quite naively, that hospitals were depressing places simply because no one had noted the connection between environment and recovery. It seemed that white walls, antiseptic scents, and cork boards were somehow required of hospitals – and no one had bothered to imagine anything different.
I thought that the solution was fairly simple – get some creative minds to come in and make recommendations for change. So one day I called the chair of the department of interior design at Parsons School of Design and asked whether she might send her students to my hospital to consider how to improve our situation. She was intrigued with the idea – and we soon had an entire team of bright young designers measuring the floors and windows, considering the limitations of our square footage, and getting to work on some dramatic proposals for exciting change.
Several months later the Parsons students made a presentation to our hospital’s executive team, and this was met with great enthusiasm. We all thought that we were on the verge of an exciting breakthrough for patient wellness. But alas, in the end not a single design suggestion was implemented as our administrators told us that there was no money available for environmental improvements.
I found out much later that our acting CEO was making about ½ million dollars per year in salary at the time. All the while the poor patients had to recover in a grim void of sensory stimulation.
There is ugliness in hospitals – and it runs deeper than the white walls. As with many sectors, money is the deciding factor regarding whether or not something gets done. I think that hospitals should take a hard look at their white walls, and the white linings of their executive pockets and ask themselves whom they were built to serve.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
