August 19th, 2008 by Dr. Val Jones in News
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A small research study suggests a link between depression and poorer driving test scores. In fact, there also seemed to be a dose-response relationship with anti-depressants. In other words, the study subjects on the highest doses of anti-depressents got the lowest driving test scores.
Since depression can impair one’s concentration – the link is certainly plausible. I thought it was interesting that anti-depressants seemed to increase the risk for low scores. One would hope that those on anti-depressants were less symptomatic, but it’s also possible that the dosage correlated somewhat with the severity of the disease.
Drivers with conditions that could impact their driving abilities (such as epilepsy or stroke) should report their impairments to the DMV. Will the list of reportable impairments eventually include depression? I doubt it, but it is reportable to the Vehicle Licensing Agency in England.
On the spectrum of risk factors for sloppy driving, I wonder where depression stands?
- Cell phone usage
- Advanced age
- Driving in a foreign country
- Driving while eating/drinking
- Driving while intoxicated
It would be neat to see these risk factors compared to one another on a graph. Has anyone seen such a thing?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 8th, 2008 by Dr. Val Jones in News
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Thanks to Dr. Deb for highlighting two interesting psychology research studies which offer new insight into lie detection. The first was conducted at my undergraduate alma mater, Dalhousie University, in Nova Scotia. After analyzing 697 videos of people reacting to emotion-evoking photos, researchers concluded that study subjects who tried to modify the natural response to a cute or alarming photo still retained flickers of the real emotion in their facial expressions. These “microexpressions” were identifiable by computer analysis of facial muscles, and may support the development of a new type of lie detector – a digital, facial expression analyzer.
The second research study found that people are less accurate in recounting false stories backwards than they are at describing a reverse chronology of true events. In other words, discerning truth from error may be as simple as asking someone to tell you what happened beginning at the end and working backwards. If they have a really difficult time keeping the facts straight – they are more likely be falsifying the information.
I don’t know if either of these lie detecting approaches (analyzing microexpressions or backwards story telling) will work on sociopaths and exceptionally good liars. But for the garden-variety fibber, they may just work.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 2nd, 2008 by Dr. Val Jones in True Stories
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I posted this true story on my blog previously, but I think it bears repeating (especially with the recent news of increased violence against physicians and threats at gunpoint). Details of the story were altered to ensure privacy of all involved.
***
The son of a business tycoon experienced some diarrhea. He went to his local emergency room immediately, explaining to the staff who his father was, and that he required immediate treatment.
Because of his father’s influence, the man was indeed seen immediately. The physicians soon realized, however, that there was nothing emergent about this man’s complaints. After several blood tests and a stool sample were taken, he was administered some oral fluids and monitored for several hours, they chose to release him to recover from his gastroenteritis (stomach flu) at home.
The man complained bitterly and said that he wanted to be admitted to the hospital. The physicians, with respect, explained that he didn’t show any signs of dehydration, that he had no fever, his diarrhea was indeed fairly mild (he had only gone to the restroom once during the hours of his ED visit – and that was when he was asked to produce a stool sample). The man’s pulse was in the 70’s and he had no acute abdominal tenderness.
The man left in a huff, and called his father to rain down sulfur on the ED that wouldn’t admit him.
And his father did just that.
Soon every physician in the chain of command, from the attending who treated him in the ED right up to the hospital’s medical chief of staff had received an ear full. Idle threats of litigation were thrown about, and vague references to cutting key financial support to the hospital made its way to the ear of the hospital CEO.
The hospital CEO appeared in the ED in person, all red and huffing, quite convinced that the physicians were “unreasonable” and showed “poor judgment.” Arguments to the contrary were not acceptable, and the physicians were told that they would admit this man immediately.
The triumphant young man returned to the ED for his admission. Since the admitting diagnosis was supposedly dehydration, a nurse was asked to place an IV line. The man was speaking so animatedly on his cell phone, boasting to a friend about how the doctors wouldn’t admit him to the hospital so his dad had to make them see the light, that he moved his other arm just at the point when the nurse was inserting the IV needle. Of course, the poor woman missed his vein.
And so the man flew into a rage, calling her incompetent, cursing the hospital, and refusing to allow her to try again.
At this point, the ED physicians just wanted him out of the emergency room – so they admitted him to medicine’s service with the following pieces of information on his chart:
Admit for bowel rest. Patient complaining of diarrhea. Blood pressure 120/80, pulse 72, temperature 98.5, no abdominal tenderness, no white count, patient refusing IV hydration.
Now, this is code for: this admission is total BS. Any doctor reading these facts knows that the patient is perfectly fine and is being admitted for non-health related reasons. With normal vital signs, and no evidence of dehydration or infection, this hardly qualifies as a legitimate reason to take up space in a hospital bed. And when the patient is refusing the only treatment that might plausibly treat him, you know you’re in for trouble.
The man was discharged the next day, after undergoing (at his insistence) an abdominal CAT scan, a GI consult, an ultrasound of his gallbladder, and a blood culture. His total hospital fee was about $8,000.
Do you think he paid out of pocket for this? No. He submitted the claim for payment to his insurance company. Their medical director, of course, reviewed the hospital chart and realized that the man had no indication for admission, and refused medical care to boot, so he denied the claim.
So the son appealed to his father, who then rained down sulfur on the insurance company, threatening to pull his entire business (with its thousands of workers insured by them) from the company if they didn’t pay his son’s claim.
The medical director at the insurance company dug in his heels on principle, assuming that if he continued to deny the claim, the hospital would (eventually) agree to “eat the cost.”
In the end, the insurance company did not pay the claim. The CEO of the insurance company called the hospital CEO, explaining that it was really the doctor’s fault for admitting a man who didn’t meet admission requirements. The hospital CEO agreed to discipline the physician (yes, you read that corretly) and eat the cost to maintain a good relationship with the insurance company that generally pays the hospital in a timely manner for a large number of patient services.
Welcome to the complicated world of cost shifting in healthcare.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 13th, 2008 by Dr. Val Jones in True Stories
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My caller ID displayed an unfamiliar number and I answered the phone hesitantly. Background noise and static nearly drowned out the caller’s determined intent to introduce himself. “This is Dr…. [couldn’t quite make it out]. Is this Val Jones?”
“Dr. Who?” I asked, trying to recognize the voice.
“Dr. Anderson. Is this the Val Jones I know?”
My mind raced through its physician contact list, without finding a match.
“Doctor… Anderson?” I said, trying so hard not to betray my lack of name recognition.
“Yes, yes, that’s right. I was your pediatrician. Remember me?”
Suddenly it all came back to me – this dear gentleman did indeed take care of me when I was young. I remembered him as a tall, fit man with white hair and kind eyes. He had stitched my face after I was bitten by a dog, put my shoulder back in its socket, and diagnosed fractured ribs after I fell out of a tree house. I guess I went to see him pretty regularly growing up, though I hadn’t thought of him in decades.
“Wow! Of course! Dr. Anderson I… I’m so surprised to hear from you after all these years. My goodness. How did you find my cell phone number?”
“Well, it wasn’t easy. Your parents have moved off the farm, and your university didn’t have any recent records. I finally found someone you used to work with and they found you on the Internet and got me in touch with Revolution Health…”
“Gosh, I’m sorry you had to go through all that to find me. What was it that you needed to talk to me about?”
“Well, I’m 90 years old now, and I’ve been thinking about my former patients. I was going through my records and I found your file a few years ago. My wife and I have been praying for all the kids I used to treat, and we started praying for you a while back. You were such a bright little girl – I always knew you’d do great things in this world. I guess I was just curious how you’d turned out and what you were doing in life. This is kind of like a follow up visit I guess.”
I was stunned. I became misty-eyed as I imagined this 90 year old man and his 91 year old wife praying for his former patients, remembering them fondly and even going out of their way to contact them for follow up, for no other reason than to know how they were making out in life, and wishing them well.
I spent about half an hour telling my pediatrician about my life and catching up with his. His wife had undergone biltareral knee replacements after her 90th birthday and was walking around with the help of a cane. He had 5 grand children that were doctors, was actively involved in his church, and still traveled extensively.
“Gee, Dr. Anderson – I’m so glad you’re doing so well. It was so nice of you to call.”
“I’m so glad I got to hear your voice, Val. Nothing makes me happier than to know you’ve grown up to be a doctor. Now take good care of your patients, ok? Keep track of them, and make sure they’re doing alright.”
As I said goodbye I thought to myself, “Those are some pretty big shoes to fill. But it sure feels good to be a patient who was NOT ‘lost to follow up.'”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 8th, 2008 by Dr. Val Jones in Expert Interviews
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With the recent news about the high prevalence of Post Traumatic Stress Disorder (PTSD) in military veterans returning from Iraq and Afghanistan, I decided to interview Revolution Health’s expert psychiatrist, Dr. Ned Hallowell, to find out more about PTSD and what to do about it.
*Listen To The Podcast*
Dr. Val: What is post traumatic stress disorder (PTSD)?
Dr. Hallowell: As the name implies, it is the response a person has to any traumatic experience or event. The brain really changes in response to trauma, and people can be quite crippled by it. Some will actively avoid people and situations that remind them of the event, others experience “triggers” that set them off into a panicky or dissociated state. PTSD can cause “flashbacks” where people feel as if they’re right back at the scene of the incident, they may also have nightmares or problems with relationships, job function, substance abuse, major anxiety or depression and even suicide.
PTSD exists on a spectrum. You can get fired from your job and experience mild trauma, but if the firing was really unfair and unexpected it can change you fundamentally for years to come. It isn’t the actual event that determines whether or not a person develops PTSD, it’s how you –given your particular neurochemistry and genetics – are able or not able to assimilate, accommodate, and deal with the traumatic event.
Dr. Val: How does a person know if they have PTSD?
Dr. Hallowell: If something terrible has happened to you and you’re not able to calm down, put things into perspective or get back to your old self – then you may have PTSD. Instead of getting your equilibrium back you’re rattled, anxious, and sleeping poorly. Fear builds on fear and you can even become afraid of life itself and begin withdrawing, avoiding, and shutting down, and self-medicating.
What you want to do is “name it” – in other words allow yourself to consider that you may have PTSD, and then get professional help. A mental health professional who specializes in PTSD is ideal. Dr. Bessel van der Kolk has written several excellent books on the subject.
It’s also worth noting that people can get vicarious PTSD. There have been cases where practitioners have developed PTSD simply by listening to accounts of trauma.
Dr. Val: Is early intervention important?
Dr. Hallowell: This is controversial. Some people believe that it’s important to talk about the event right away, but I’m of the belief that people should remain connected to others but not be required to talk about it until they’re ready. I could see someone after a mugging or car accident and never talk about the event – my role is just to create a “safe place” for them to be. Later on we might talk about it, or we might not. Discussing the details of a traumatic event can retraumatize you – and in a funny way you can develop a habit of reliving the trauma, almost the way that people become addicted to worry. However if the patient wants to talk about the trauma, that suggests to me that they need to – and I let them be the guide.
Dr. Val: What happens if PTSD is not treated?
Dr. Hallowell: It can wreak havoc on people. “Avoidance” as a lifestyle is very incapacitating. If you can’t go places and do things, you’re feeling anxious all the time, and having nightmares and flashbacks, you can’t enjoy life.
Dr. Val: Can PTSD be prevented? In the case of soldiers, for example, who are likely to experience horrible things in times of war – can they be mentally prepared for this kind of thing?
Dr. Hallowell: Part of what makes trauma traumatizing is that it’s unexpected. So it makes intuitive sense to me that if you’re prepared for what you’re going to see or experience that you will find it less traumatic when it happens. The surprise and lack of control are what’s overpowering about trauma. Having a plan (knowing what to do in case of a traumatic event) and knowing what to expect afterwards (and how to get help) will go a long way in reducing the damage of trauma. You can still be traumatized, however, even if you’re “ready” for it.
Dr. Val: Tell me a little bit about kids and PTSD. Do they express PTSD differently?
Dr. Hallowell: In children, the dissociative state is pretty common – they become vacant and unreachable. Sometimes the opposite happens and they are inconsolable, experiencing night terrors, crying, and temper tantrums. However, kids are remarkably resilient and I’ve seen play therapy work wonders for them after traumatic events.
For example, four-year-olds might sit on the floor and not talk to me at all about the trauma they’ve been through, and the next thing you know they’re reenacting the scene with their toys and dolls. They have no idea that they’re replaying the event this way (a form of “displacement”) – and may do it over and over again for a period of six weeks… and the next thing you know they’re over it. It’s remarkable. They use their imagination to heal themselves. It’s the greatest therapy in the world. No medication is used, and it’s a permanent fix. It’s almost like doing psychoanalysis at the point of the childhood trauma. When you’re 40 you try to relive these experiences in analysis to resolve the conflict – but as a child you’re actually doing the work near the time of the incident.
Dr. Val: What’s the most important thing for families to do for loved ones who have PTSD?
Dr. Hallowell: Connect with them. Understand them, listen to them, and don’t let them get isolated. Take their concerns seriously, and don’t judge them. Then find out what they need and get them to a mental health professional who understands PTSD.
*Listen To The Full Conversation Here*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
