I'll Take That Call Now.

Jill of All Trades, MD is a family physician blogger who has a post on KevinMD titled Why answering a cell phone during an office visit is a problem. She writes from the perspective of a primary care doc, and talks about the awkwardness of patients talking on the phone during their office visits. She talks about it with a detective/spy metaphor:

Me: “Your recent lab test shows that your diabetes is currently not sufficiently controlled with the current regimen. Your hemoglobin A1C, which is a lab test that tells me what your sugar level has been at home for the past three months, is 8.1. We need to add a medication at this point because…”

“Riiinnnggg!!,” a quite startling sound lifts me off my seat, as if signaling a new secret-agent assignment.

Patient: “Oh, Doctor, hold on one minute please.”

Is this a conspiracy? Before I can even respond, she picks up the cell phone and starts talking to this rather shady intruder.

Patient: “Hi, honey. I’m at the doctor’s office. What do you need? …”

I wait about thirty seconds, with what seems like an eternity in the secret agent world, and she is still on the phone with this suspicious invader. At this point, I decide to exit the premises.
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For some people, answering the phone immediately seems to be a bit of a compulsion. And for someone who's waited a long time to see an over-booked doctor, I can see why they might want to take a call. Maybe it's a call that was prearranged for a time long after the patient thought they'd be free...but the patient was surprised to find the doctor was running late, and so why should they put someone on hold for a doctor who's kept them waiting? Why is it a one-way street? Oh, because it is.

In psychotherapy it's a different story: people pay for time by the chunk and there aren't patients backed up waiting to fit into the same time slot. I feel like it's the patient's time, and I don't feel like I should say to an anxious mother, "Don't take that call." Still, I'm always a bit surprised when people feel the need to take non-urgent calls during an appointment, and to talk for a bit. I feel a little uncomfortable listening. And even for those who quickly say, "I'm with the doctor, I'll call you back," I'm not sure what that gains over having the phone off.

Does my phone ring during sessions? Yes, because sometimes I forget to turn it off--and if it rings, I reach over and silence it . Do I answer it during a session? Never. Whatever it is waits until the session is over. The only exception I make is if I'm trying to get in touch with another physician regarding the care of the patient I'm seeing during that block of time.

I let people talk on the phone or text or deal with their families or clients. No one has done it repeatedly or in a way that notably distracts from therapy. I'm a bit surprised when anyone wants to pay my fee to talk on the phone, or even when anyone runs late, but hey. If I weren't "rented out" in blocks of time, so to speak, I'd be exiting with Dr. Jill-of-all-trades whenever the phone rang.
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And on a completely different note, I noticed that Jill of All Trades has a link on her sidebar to "Shrink Rapping"....I clicked on it thinking it would be us. But, no....There's another Shrink Rapping doc out there-- Dr. Gregory Smith from Georgia and he's been at it a while. How'd we miss that?

What Do You Want To Know About Psychiatry?

When you work in any setting, your view of it becomes distorted. Your vision becomes tunneled, and the world looks small. My husband came home one day upset because a client had burst into tears while they were talking. "Why does that bother you?" I asked. Apparently it's not something that happens a few times a day for him. And when I was a medical student on an oncology ward, one of the doctors came in for rounds late---on her to way to work she'd seen a young man get knocked off his bicycle by a automobile. She'd stopped to help, and her first question to the young man was, "Are you a smoker?" She quickly realized that it was not a particularly relevant question in that setting.

So do people in the real world have questions about psychiatry? What are they? What a time to ask: just as our book goes for it's final draft. I should have asked before-- What do you want to know? Maybe we're wrong about what we thought people want to know. Maybe we need to write a second book.

The good news is that after several requests, the jacket designer has agreed to add a duck. Bless our editor for asking--- no clue how she explained that one.

Why do I feel like we've been working on this book forever? Clink will tell you, "because we have."

So what questions do you think the general public has about psychiatry? Go for it.

Quadruple Amputee Swimmer Successfuly Swims English Channel

Video of Man Whose Arms and Legs Were Amputated after Electrical Accident Swims English Channel with Prosthetic Legs

I don't understand why the news doesn't cover this story more

This is one of those hard to believe but true inspirational stories about Man versus Life, a quadruple amputee with prosthetic legs swims the English Channel. But wait there's more! This guy has also parachuted out of an airplane. I wonder if Hollywood has contacted him yet about a movie based on his life.. Croizon had his arms and legs amputated when a surge of electrical current traversed his body. According to the report while he was in hospital, Mr. Croizon saw a tv report about a channel swimmer and the idea began to roll around in his head. This isn't even the quadriplegic hero's first long swim. Previously, he swam a 12 hour course.

Quadruple amputee swims the Channel :Philippe Croizon, who lost his limbs in an electrical accident, uses flippers to make crossing in 13 and a half hours

Texas University Student Severe Meningitis Partly Treated with Viagra and Oxygen Helps Foment Change in Texas Bacterial Meningitis Law

Story of Texas Student Who Had Meningitis Trauma Partly Treated with Viagra and Oxygen Pushes Texas to Join 12 Other American States in Mandating Bacterial Meningitis Vaccine

The heart breaking experience of a Texas sophomore, Jamie Schanbaum who contracted bacterial meningitis, helped push the Texas Legislature into enacting mandatory Meningitis vaccination for university students. Her experience was so severe that doctors tried using oxygen and Viagra to improve the circulation of oxygen to her limbs.




Bacterial Meningitis can fall upon it's victims with a sudden savage fury.It can be especially devastating when what seems like a sore throat morphs over night into deadly meningitis. The brain and the spinal cord, the nervous system, are sheathed in layers of tissue. When these layers get an "inflammation", mostly an infection..that's meningitis. The usual suspects in infection elsewhere are also the culprits here, i.e. viruses, bacteria and even fungus.

What are Some Symptoms of Meningitis and Meningococcemia

According to the National Meningitis Association (see below):

Meningitis starts out looking like the flu or a migraine and progresses quickly. Some, but not all of the symptoms may be present. Here is a list of symptoms:

Headache - May seem like the worst headache you have ever had.

Fever - Can get very high. Doesn't respond to tepid bath or aspirin.

Vomiting

Numbness / cold extremities / loss of feeling

Stiff neck

Avoiding light

Disoriented / confused

Seizures

Purple spots or rash - This means blood poisoning is underway. Pressing a clear glass on the spots does not cause them to turn white.

Why is Bacterial Meningitis Dangerous and Requires Prompt Medical Attention?

Why Are College Students More Susceptible to Meningitis?

The meningitis one generally reads about in college outbreaks is meningococcal meningitis. It is caused by a bacteria, Neisseria Meningitidis. (for you Biology majors,nicknamed the Meningiococcus, it's a gram negative diplococcus)..College students tend to live in dorms and cramped apartments with multiple students. Sanitation and hygeine are not always foremost on some students' agenda. The meninigitis microbe, Neisseria meningitidis, is spread via close contact such as sharing drinking cups, kissing and sharing cigarettes. Many people are natural carriers and can walk around with the bacteria with no ill effects.



Bacteria can be organized by subtypes into so called serogroups..by what is in the capsule that surrounds them. six serogroups of Meningococcus are mostly to blame for the meningitis caused by this particular bacteria. (remember meningitis is also caused by other bacteria as well as viruses and even fungi)...the serogroups X,Y,A,B,C and W-135 are the main culprits with the meningococcus. The vaccines available now don't work on serogroup B.

What Are the Types and Treatments of Meningitis







"Neisseria meningitidis are bacteria that can cause illness in people of any age. At any time, about 5-15% of people have these bacteria in their throats or noses without getting sick. The meningitis bacteria are spread through saliva (spit) during kissing, sharing of food, drinks or cigarettes, and by close contact with infected people who are sneezing or coughing. People who have come in close contact with the saliva of a person with meningitis from this type of bacteria may have to get antibiotics (medicine) for protection. Meningitis caused by these bacteria is called “meningococcal.” There are vaccines, which can be used to help prevent this kind of meningitis.


Haemophilus influenzae type b bacteria, called Hib, can also cause meningitis. There is a vaccine called “Hib vaccine” that prevents infants and young children from getting Hib disease. Most adults are resistant to this type of meningitis, and thanks to the vaccine, most children under 5 years of age are protected. Certain
people who have come in close contact with the saliva of a person with meningitis from this type of bacteria may have to get an antibiotic for protection.


Streptococcus pneumoniae are bacteria that cause lung and ear infections but can also cause “pneumococcal” meningitis. These bacteria are usually found in the throat. Most people who have these bacteria in their throats stay healthy. However, people with chronic medical problems or with weakened immune systems, and those who are very young or very old, are at higher risk for getting pneumococcal meningitis".

Jamie Schanbaum Support and Medical Update Blog

Freshmen Required to Get Vaccine

Viagra Used to Treat Rare Meningitis Attack, Student Fights for Her Life


You can read the transcript of a NOVA television program on meningitis at KILLER DISEASE ON CAMPUS.


Why doesn't everyone, especially college students get vaccinated? There is a vaccine that covers four of the five most common "serotypes" of meningococcal meningitis. Per the CDC, " Vaccination does not eliminate risk because:

the vaccine confers no protection against serogroup B disease and

although the vaccine is highly effective against serogroups C, Y, W-135, and A, efficacy is less than 100%."


Nevertheless, it still seems that getting vaccinated will lower the chances of this especially nasty form of bacterial meningitis. It's certainly worth discussing with your doctor.

Meningococcal Vaccination

WHO HAS LESS HEART PROBLEM RISK ? TEATOTALERS THOSE WHO DRINK MODERATE RED WINE OR DRUNKS

Which of these groups has the least cardiovascular risk? (other things being equal)

1. People who binge drink red wine

2. People who never drink red wine

3. People who drink moderate amounts of red wine?
According to some medical analysis the answer is people who drink MODERATE amounts of red wine

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Can 50 Million Frenchmen be wrong? Frenchmen allegedly have less heart disease, also allegedly due to their red wine consumption...(enough with the allegedly already, I'm starting to sound like a TV lawyer). Still, the link between MODERATE red wine drinking and less heart problems like heart attacks has been floating around for a while now.



An article in the July 2010 Journal of Family Practice says "moderate daily red wine consumption decreases cardiovascular risk compared with either abstinence or heavy and binge drinking". It also points out that HEAVY DRINKING IS ASSOCIATED WITH INCREASED RISK OF STROKE.









healty medical Blog has previously examined the association between red wine and heart risk factors and maybe even slowing down aging. Other articles have pointed to the possibility that a compound in red wine called resveratrol may be implicated in a slowing down of the aging process.

RED WINE SHOULD YOU OR SHOULDN'T YOU LATEST REPORT IN THE SAGA OF RESVERATROL DOES A CHEMICAL IN RED WINE RED GRAPES SLOW DOWN AGING

Newest Old Idea a Long Time Coming MAYBE New IPHONE Will Finally Kick Start the Age of Video Phones

Videophones,the concept, has been around for a long time..People at the 1965 New York World's Fair saw an example of a videophone on which you could SEE and SPEAK to people at Disneyland.. It seems obvious to me that videophones are a great idea..Think about it. Your Aunt Tilly in Cedar Rapids and your Mom and Dad in Ohio want to see and watch the baby play at home in Chicago. Skype has already proven that many people want video phones but it's still not quite there for ease of use and image quality.



Videophones need to be a no brainer to use. As easy as making a phone call to anyone anywhere. When THAT happens you will see the concept take off like a rocket.. Personally I have always thought that Iphones while having a nice interface are over hyped but MAYBE the new Iphone may open the doors to the Videophone Era IF... The new Iphone has the ability to do videophone calls. BUT apparently you can only make the video calls over WI FI which is still a stumbling block..IF they fix it so that you can make video calls from anywhere to anywhere we may be on the CUSP of the VIDEOPHONE REVOLUTION.

Ticket to Trouble Dizziness Needs Immediate Medical Evaluation in Old and Young People New Study Implicates Heart Disease in More Than Half of Dizzy E

Ticket to Trouble Dizziness Needs Immediate Medical Evaluation in Old and Young People New Study Implicates Heart Disease in More Than Half of Dizzy Elderly

Sometimes people just take an anti-vertigo pill without a deep search for the cause of the dizziness. This turns out to be an even worse idea than it seems. According to a recent study OVER HALF of the elderly people who had DIZZINESS had it caused by HEART PROBLEMS.






The study which appeared in the Annals of Family Medicine, concluded "Contrary to most previous studies, cardiovascular disease was found to be the most common major cause of dizziness in elderly patients in primary care. In one-quarter of all patients an adverse drug effect was considered to be a contributory cause of dizziness, which is much higher than reported in previous studies". A number of heart related problem can make a person feel dizzy such as atrial fibrillation, other irregular heart beats and high or low blood pressure. Of course some other causes can be high or low blood sugar, inner ear problems and fluid loss.



No matter how you parse it, dizziness is NOT something to sneeze at and just taking a medication to cover up the symptom without a complete medical evaluation is a ticket to trouble.

Causes of Persistent Dizziness in Elderly Patients in Primary Care