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Cognitive Impairment Often Goes Undocumented In Hospital Charts

A recent JHM study found that hospital staff often don’t recognize cognitive impairment in patients age 65 and older. This was especially true for patients on the younger end of the spectrum, and those with more comorbidity.

Of the 424 patients (43%) in the study who were cognitively impaired, 61% weren’t recognized as such by ICD-9 coding. Interestingly, there was no significant difference between patients with documented and undocumented cognitive impairment as far as mortality, length of stay, home discharge, readmission rates, incidence of delirium, or receipt of anticholinergics. One troubling finding: a significant number of patients with cognitive impairment received anticholinergic medication, even though it’s not recommended for patients with any type of CI. Read more »

*This blog post was originally published at ACP Hospitalist*

Online Psychotherapy And Telehealth’s Tipping Point

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If you told me last year that web-base psychotherapy would gain traction I wouldn’t have believed you.  That was before I met Mark Goldenson, CEO of Breakthrough, a silicon valley based web startup that matches patient and therapist through a secure online portal.  Breakthrough clients can review a therapist’s qualifications and fees, view sample video, and initiate therapy by video or phone.

In a 2.0 world marked by clouds, hives and democratized healthcare, Breakthrough is cultivating one-on-one relationships through improved access to mental health services.  Everyone should be talking about this. Read more »

*This blog post was originally published at 33 Charts*

Standing Up To Bullies: A Father Shows His Son How It’s Done

Brad 1975009Brad asked how I think I influenced his development as a child. I think I taught him about leadership, perseverance, patience, problem solving, pattern recognition, innovative thinking, and compassion for others. The irony is I believe he taught me more than I taught him.

Mutual trust and respect must go hand and hand with the love for a child. Kids are people too. They have the same emotional responses to perceived events as we do as adults.

One of many incidents of mutual respect comes to mind. Brad was 11 years old in the 6th grade.

My accountant, at that time, was an avid stamp collector. I thought learning about the sub culture of stamp collecting would be a terrific intellectual experience for both of us. My accountant took us to several stamp shows and taught us how to value stamps. We started collecting. We accumulated a nice stamp collection. The collection had great potential to increase in value. We both learned a lot and grew together in the stamp collecting business. Read more »

*This blog post was originally published at Repairing the Healthcare System*

Plastic Surgery Addiction: Tips For Surgeons

A few years ago I wrote about the “Suitability” of a patient for plastic surgery. I was reminded of this topic by two cases in the recent lay media:

The first involves Heidi Montag, 23, who in November had multiple surgical procedures and is being compared to Joan Rivers.

According to People, Montag even kept her family in the dark about her intended transformation to become her “best me.” Telling only her husband Spencer Pratt, Montag had a nose job revision, chin reduction, mini brow lift, Botox in her forehead and frown area, fat injections in her cheeks, nasolabial folds and lips, neck liposuction, ear pinning, liposuction on her waist, hips, inner and outer thighs, buttock augmentation and breast augmentation revision. Read more »

*This blog post was originally published at Suture for a Living*

Medical News Of The Obvious: Music Impacts Behavior

Students exposed to songs with a positive message were more likely to help others after listening. A British study randomized students into groups who listened to socially conscious songs or those with negative or nonsense meanings. Then, a researcher pretended to knock pencils off the table by accident. Those who’d listened to positive songs helped more quickly and picked up almost five times as many pencils. Other subjects were asked to help with another research project, and three times as many volunteered.

Help! by the Beatles and Michael Jackson’s Heal the World were cited in the study, which is in press at the Personality and Social Psychology Bulletin. Let us know your favorite “help” songs that get you through the day.

*This blog post was originally published at ACP Internist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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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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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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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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