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"Treating You Well"

Medical Causes of Behavioral Symptoms


An example of the importance of reviewing medical as well as psychological issues when patients present behavioral changes is seen in the case of Susannah Cahalan who was admitted to New York University’s Medical Center in 2008 with mood swings, seizures and hallucinations, and was initially diagnosed with psychological disorders.  Neurologist Dr. Souhel Najjar recognized that the numbness started before she became psychotic, and a brain biopsy identified inflammation on the right side of Ms. Cahalan's brain.  This resulted in a diagnosis of autoimmune encephalitis, which is a rare but treatable disorder which can present psychotic symptoms.  Ms. Cahalan returned to work seven months later and was treated with a course of steroids for a year. 

For more information see: https://vimeo.com/99048483

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Who is that Doctor in My Room?


Most individuals don't even think about the doctor (called the "attending physician") who will oversee their care if they have to go to hospital for non-elective treatment/care.  Most are feeling too sick or frightened to worry about it (initially at least), and assume their PCP will follow them.  Or they trust that a competent doctor will come along as an employee of the Hospital.   Do you know who would, and should, care for you?


Let's consider it.  Should you be unfortunate enough to find yourself in one of those chilly hospital beds, when that doctor pops up beside your bed with a clipboard and a stethoscope - where will s/he come from?   


It may be your Primary Care Physician (PCP).  But that's unlikely.  There's a reason they're a PCP!  And those who do take care of their hospitalized patients are few and far between - primarily because of the time involved in traveling to and from the hospital, let alone time needed to address an illness serious enough to require hospitalization.  It's not just financially disadvantageous for the PCP, but impacts waiting times and schedules of patients in their busy clinics. 


Most probable is that the doctor will be an 'Internal Medicine' Physician; the systematic "generalist" of the medical field who does the work of a PCP (but with more critical problems to solve and much less time to do it) when patients are hospitalized.  These physicians, aptly named "Hospitalists", not only rapidly assess and begin working on the patient's overall condition, situation and needs, but orchestrate specialists (pulmonologists, infectious disease doctors, nephrologists, etc) as needed.  Traditionally independent local physicians (or groups of physicians working together) these doctors have built the trust and relationships with local PCPs to take care of their patients if those patients are admitted to an inpatient facility.  Those relationships are formalized by agreements by which hospitals know who to call whenever a patient of the PCP is admitted. 


In recent years however, Hospitals have seen financial and control benefits of contracting large third party companies to provide Hospitalist teams.  Not only has this reduced the opportunity for the traditional Hospitalist to service local facilities and patients, but more importantly, it reduces the ability of local PCPs to choose who will care for their patients while hospitalized.  Indeed, in most cases where these contracted Hospitalists are used, the PCPs have not even met the Hospitalists to whom their patients are assigned for care.  The patient is simply allocated to a doctor on call, who remains their attending physician throughout their treatment and recovery at the hospital.


What does this mean?  As a PCP, you should check to ensure that your agreements with your Hospitalist providers are being honored at hospitals where your patients are or may be admitted.  While hospitals do not have to honor your request for specific Hospitalists, they may be more inclined to if you restate your expectations.  As a patient, ask your PCP to which hospital(s) (if you have a choice) you should seek admission, and if s/he will not care for you there, which Hospitalist physician to specifically ask for.   Your choice of attending physician is one of the most important ones you will make during and after your recovery.


And if you don't get a choice, you just may want to take the next ambulance out of Dodge.

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Links between Mental and Physician Health Conditions


There is more than an intuitive link between your physical and your mental health.  They are very much tied together, and more importantly, their influence on each other goes both ways.  This suggests 3 things:

1. Individuals should care about and seek help for their mental wellbeing as much as they do their physical health and bodies.  While the stigma of mental illness has reduced in recent years, many patients are reticent to seek help, impacting not only their mental but physical health.
2. Healthcare facilities need to better integrate - and simultaneously service - both aspects.
3. Healthcare Insurance plans need to support their customers by providing seamless coverage for easy interaction between the insured and the providers they need for both physical and mental help.


While general hospitals frequently boast behavioral health professionals on staff or facilities and wards as part of their infrastructure, many psychiatric facilities are lagging behind in providing the equivalent quality of medical care that would accelerate patient progress and reduce relapse and recidivism.
According to Mental Disorders and Medical Comorbidity issued by the Robert Wood Johnson Foundation (2011), "Comorbidity is the rule rather than the exception. When mental and medical conditions co-occur, the combination is associated with elevated symptom burden, functional impairment, decreased length and quality of life, and increased costs."

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Washington DC, March 2014:  NAPHS Conference


The National Association of Psychiatric Heath Systems (NAPHS) Annual Meeting was in the capital city again this year.  Conferences can be a dry affair, with presentations to audiences of varying levels of interest, commitment, and decision-making responsibilities.  Vendors are usually stretched in corridors in hopeful lines to catch delegates at the worst times - on trips from the auditorium to either the restroom or lunch. 


But not so with NAPHS.   An impressive attendee list and interactive delegate forum was helped by a carefully planned format with the participants, speakers and vendors in the same room.  This facilitated (literally) continuous dialogue, but also the opportunity for delegates to have relevant and timely connections to solutions for the issues being presented.  Add to that well some organized (and provisioned) social forums - timed to enable enjoyment of the capitol or dinner meetings on the same evening - and you have a recipe for an excellent combination of networking, business, and pleasure in one of the best cities in the country.


Premier Inpatient Management Services was proud to be a sponsor at the 2014 conference.

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