Punxsutawney Polamalu sees his shadow!
Tuesday, February 9, 2010
Tuesday, February 2, 2010
Groundhog Day
In 1978, my United States Marine father was assigned a 13 month tour of duty in Okinawa. Family was not going to accompany him on this detail. So Mom had to find a place to live with her six children until he came back. The logical solution was to move back to Pennsylvania, so we could be close to mom's side of the family. Her relatives mostly lived in Indiana County, Pennsylvania. Letting the housing market and common sense prevail -"live close, but not too close"; we ended up living in Punxsutawney (Jefferson County). Punxsutawney was the epitome of a western Pennsylvania borough. Punxsutawney was settled by that usual western PA settler mix of English and German that came for the land and stayed because of the mines. Lumbering was another big industry, but those laborers (several of my ancestors among them) followed the work and migrated from county to county. Mining, farming and lumbering, the genetic stock was hardy and tough. In 1979, common entertainment in Punxsutawney was getting drunk, fighting and racing your vehicle at breakneck speeds until somebody lost it all against a railroad overpass abutment. My father said that Punxsy reminded him of the '50s. I think he liked that.
The name Punxsutawney derives from the Delaware Indians. Ponksaduteney translates to "town of the sand flies." According to legend an evil Indian sorcerer was defeated in battle there by a hero chief. To eradicate his black magic, the body was consumed by fire. Instead of ashes rising out of the pyre, glowing sand flies arose and drove out the local inhabitants with burning bites. In 1978, the public pool and the outdoor basketball and tennis courts were located along the creek and in the evening we would sit on the dike along Mahoning Creek and swat the swarms of gnats or "ponks" as we called them. It wasn't hard to see how the legend sprang up.
The Indians also left the legend of the grandfather who first inhabited the area. He was the wuchak. According to the creation legends, the first people were created in the form of animals and later became the people of the land. The wuchak was the original father of those who lived there. The wuchak was a groundhog. This legend gave rise to the common usage of the word "woodchuck." In Gaelic folklore, the Cailleach — a divine ancestral being — rules the winter months. Brighde (Brigit) is her counterpart who rules the summer. When the Cailleach wants to extend her rule for a longer time period she makes February 1st (Imbolc) a bright and sunny day so she can gather firewood for the rest of the winter. Gaelic people could rest easy if Imbolc was foul weather day. It meant that the Cailleach had no intention of extending winter and therefore spring would soon be here. Conversely, if the sun is out and you can see your shadow on Imbolc enjoy it, but keep the heavy cloak handy; you're going to need it for six more weeks.
Somehow, Imbolc and Candlemas (the day the infant Jesus was presented as a firstborn and Mary purified herself at the temple 40 days after the birth) got rolled into one. Imbolc is called the Feast of St. Brigit. Yes, that is the same Brighde mentioned above. Brighde is summer and life, Cailleach gets the bad rep as she is winter and death. St. Brigit is the patron saint of midwives. She represents birth, spring, new life, all that nice kind of stuff. Folklore, pagan and Christian, mixed into a celebration of spring and new beginning. Weather prognostication was a big part of that celebration and the people had their own natural almanacs to determine the long-term forecast. Italians watched wolves' hibernation patterns, the Scottish watched for snakes in snow, the French looked for prosperity in flipped crepes, and the Germanic people watched ground squirrels.
How natural then, that the Pennsylvania Dutch who settled the area brought the Imbolc/Candlemas groundhog legend with them when they settled in Ponksaduteney. Of course, they didn't honor the groundhog himself as the great grandfather of Indian lore. The pesky rodent tore up crops, got into supplies, and over reproduced himself. So the people of Punxsutawney hunted him just like any other game animal.
It is said that in the summer of 1887 a group of local hunters and gourmets held a groundhog hunt and picnic and celebrated the event by barbequing their game and washing it down with locally brewed beer. The city editor of the Punxsutawney Spirit newspaper was a man named Clymer Freas. Inspired by the hunt, the fellowship or the beer, he dubbed the picnickers the "Punxsutawney Groundhog Club". He recalled the Pennsylvania Dutch legend of the groundhog as a weather prophet and claimed for the Punxsutawney Groundhog all weather rights. He created a home for him on Gobbler's Knob and a fame that is now worldwide.
(Marc Weimer, History of Punxsutawney, http://users.penn.com/~mweimer/history.html)
William Orlando Smith, congressman and editor of the Spirit, promoted Freas' tongue-in-cheek editorial. An event grew, it was publicized, and it became a local holiday. Smith's successors carried on the tradition – adding top hats and cutaway coats and using flowery language as they proclaimed the forecasts of Punxsutawney Phil, Seer of Seers, Sage of Sages, Prognosticator of Prognosticators and Weather Prophet Extraordinary. People came from far and wide to observe the event. The locals attended too. It was an excuse to get drunk, fight and drive really fast.
The famous location of the proclamation is Gobbler's Knob. Known to locals as The Knob, it quaintly sits on a parcel of land close to where Woodland Avenue and Elderberry Hill Road meet. Again, I know this location well. The LDS Chapel where we attended was built on Gobbler's Knob. The whole ceremony of February 2nd took place on the church grounds. The local bishop said that when they were looking for a place to construct the church they were approached by Sam Light, then President of the Punxsutawney Groundhog Club. Light said that he knew the Mormons were looking for a place to build, he had seen other Mormon structures including some of the temples, and he would be pleased if the Latter-day Saints would consider Gobbler's Knob as a suitable location. Light was sure that the church would do justice to that piece of land, the only caveat being that the Punxsutawney Groundhog Club and the Groundhog Day festivities continue as they always had. This was a win-win for the church; a prime location AND lots of non-members coming to their chapel. The chapel was built, the landscape was cleared and beautified, and for years the people of the world showed up at a Mormon church to see a groundhog continue a pagan practice on a Christian holiday. Who says America isn't the Great Melting-Pot? The morning of February 2nd saw the parking lot fill up fast. Buses shuttled people up from Front Street and the big parking lot at the Buffalo & Pittsburgh railroad yard. Hot chocolate and donuts were served in the church; coffee was served in the parking lot, and people brought coolers of beer or mugs of Irish coffee. The aftermath would be a bunch of tee-totaling Mormons cleaning up beer cans and liquor bottles for hours. But in the early morning light, it was a party. People shifted from foot to foot to stay warm while meeting up with old friends. The inner circle of the Club showed up with pomp and fanfare, speeches were made; a sleepy groundhog was pulled out of a cage in a hollow stump. The President of the Club called the assembly to silence as he let Phil whisper the forecast in his ear. 2010 went like this:
Hear Ye, Hear Ye, Hear Ye:
On Gobbler's Knob on this glorious Groundhog Day, February 2nd, 2010, Punxsutawney Phil, Seer of Seers, Prognosticator of all Prognosticators awoke to the call of President Bill Deeley and greeted his handlers, John Griffiths and Ben Hughes.
After casting a joyful eye towards thousands of his faithful followers, Phil proclaimed, "If you want to know next, you must read my text. As the sky shines bright above me, my shadow I see beside me. So six more weeks of winter it will be."
Just like in 1979, the people gathered in that place suspend disbelief as they react to the news. The crowd cheers or moans depending on the forecast of winter yet to come. And then fireworks go off and music plays. There is no use wasting the occasion even if the news isn't what it was hoped to be. Kids get the day off from school. Businesses in town open only after the party is over. The record of winter vs early spring now stands (since 1887) at:Shadow 99
NO Shadow 15
no record 9
The rest of the time Punxsutawney Phil lives in the Public Library with his wife, Phyllis. All the local kids know his exhibit/home well. It is right down in the children's book section and there are certain times when Phil's handler will take him out and let the patrons pet the famous rodent. When we lived in Punxsy, I spent a lot of time at the library. We happened to live there when there were a number of baby groundhogs wandering around the various transparent tunnels that made up the burrow. I have no idea how many Phils there have been over the years, but I can assure anybody that the 1978 version of Punxsutawney Phil loved people. He would come right up to the glass or snuggle under your hand. People meant attention, affection and food; filling all the needs in the hierarchy to make a nice little self-actualized hedgehog.
I lived for 14 months in Punxsutawney. I'm not planning to move back, but it was fun while we lived there. Childhood still had magic and the small-town feel contributed to the angst and excitement typical of coming of age that passes in the early high school years. I can remember the Punxsy streets well as I recall my life stories from those days; even if the movie Groundhog Day was filmed… in Illinois.
Thursday, January 28, 2010
Birthday Ramblings: A Place for My Stuff?
I have determined that I am not among the mental elite of our species. Not that there were any allusions to the contrary. But the evidence is stacking up quite convincingly. I lack the necessary skills and abilities. In fact, I may be subpar. I can't find things. Sure, I can't find my hair, my feet, my breath – I expect that with age. It's the other stuff that eludes me. My family hides stuff from me all the time. I can't find it. I know there are little stashes of goodies all over the house. I see the wrappings left behind. I never get any. Halloween candy vanishes on November 1st. Easter candy leaves behind a few strands of plastic grass. Christmas stockings are mysteriously empty. I'm missing out. Where are they hiding their good stuff?I also can't find car keys, hairbrushes, my wallet, my tools, peace. Even when people tell me where stuff is I can't find it. Case in point, I submit the following little exchange. I'm at home. Phone rings. I answer.
"Hello."
"Hi honey," Gailyn's cheerful voice greets me. "I am going over to pay for the cell phones now. Can you grab the Verizon bill and tell me how much Jessica went over last month and how much it is?" To ascribe cheerful as an adjective to Gailyn's voice is redundant. But to be cheerful when going to pay the cell phone bill is just not natural.
"OK. Where is it?" I ask.
"It's right there on the counter, by the phone."
"I don't see it."
"It's right there on top of the pile of bills – I put it there before I left."
"I'm looking but I don't see it…I've gone through the pile here…twice now. I don't think it is here."
"Did Stephanie clean up before you got home?" Stephanie's idea of cleaning is to create stacks of stuff. She clears 98% of a room area by condensing any matter down into about 2% of the cubic square feet. It's like coming across those giant termite hills you see in the desert. You have miles and miles of wasteland, then boom, you come across this huge tower rising out of nowhere. That would be Stephanie's modus operandi if she were straightening up the desert.
I say, "I don't think so – there are a bunch of dishes around, but they aren't stacked to the ceiling. Look baby girl, I just can't find it."
"It has to be there. I just looked at it when I grabbed the checkbook. Is it over by the microwave?"
"That's where I'm looking now, but there aren't any bills at all over here – wait, did we pay our auto insurance premium? Never mind, this is for 2005. We don't even own these cars anymore - why do we still have this? Here are all the paystubs for 2002. And we have something about a Thomas Kinkade Christmas Village – dated 2008. Why do we have Arby's coupons that expired last summer? Publisher's Clearinghouse - 2007? Did we win? They probably came when we weren't home. Hmm…and I don't even know what this is. Why are we being charged for a destroyed science textbook? Do you know about all this?"
"Yes. Those are all mine. Don't mess up my order. Did you check against the wall in the dining room?" (This is our default junk overflow location)
"I'm over here on my knees right now…but…no…unless it is under the kids' report cards for last year. Do you think it would be mixed in with the ten years of editions of Family Fun Magazine?"
"All right, never mind, just forget it. I don't know how the bill would have gotten in there anyway. I'll just ask the store clerk to pull up the amount at the counter. See you when I get home."
So, you can guess what happens when she gets home. She walks in. Puts her purse on the counter and picks up a nice little envelope with a Verizon logo that just happens to be sitting right there on the corner. I can see the lips tighten and her eyebrows pull down on the sides. She waves it at me. I'm confused. Am I supposed to take the envelope from her? She says, "Here. Here is the cell phone bill. It's right here." This is not so much a statement of fact as it is an accusation of incompetence or carelessness. In response I swear that it wasn't there earlier - yada, yada, yada. And she sighs and gives me one of those uh-huh noises that lets me know she is convinced that I would lose my head if it wasn't screwed on.
I admit it. I can't find stuff. I'm excellent at the find-the-hidden-figures-in-this-picture puzzles, or choose the dinner plate which has a long strand of hair hidden in the food. But real life seems to evade me. Now, I can pretty much live with this flaw. It gets me out of having to do a lot of stuff. My soul mate just sighs and says "never mind" and she takes care of things for me. It is just easier on her that way. It does bother me some when I can't find the stuff I need. But what really bothers me is that I can't seem to hide stuff either.
If you've ever read a Dan Brown novel you know that there have been geniuses throughout history who were able to conceal the greatest secrets of mankind in plain sight. You could tour Rome, Paris or Washington D.C. and never be aware that the keys to enlightenment and apotheosis are close enough to touch. The great thinkers, scientists and artists of the last 1000 years have carefully preserved the ancient secrets of mankind against the suppression and tyranny of the church, government, and common ignorant masses. Only a Robert Langdon type has the mental wherewithal to uncover the mystery. And he does it all in just a few short hours, all the while running from the police, the bad guys and the secret societies.
I'm either an incompetent hider or my children are all little Robert Langdons. I can't secret anything away. All my stuff is quickly found and consumed. Sometimes I get there just a little too late. The only stuff left is like those little pieces of chum left in the water after the sharks feed. I bought one of those 10 packs of razors. I took one out and hid the rest in my dresser. I come back a few days later and there is one left. Just one. I bought a box of Little Debbie Devil Dogs and hid the box on the top shelf of my dresser – under a pile of sweaters. I come back and there are little cellophane wrappers all over the bedroom floor. I don't even know who to blame.
This happens constantly. I can't keep any of my stuff. Sometimes I know who takes it, i.e. my razors (daughters use for legs), my shampoo (son uses in morning), any comb (?), candy (Michael has paranormal abilities), etc. The kids are bad enough but even my wife takes my stuff. Gailyn has a 24 hour rule on chocolate I might bring home. If I don't eat it in 24 hours then it is hers by default. This applies to desserts left in the fridge as well. Back when I was working for Dow Jones and gone in the evenings I would come home late at night to find a cheese cake pie pan in the sink. There might be, I stress, might be one little piece left in the refrigerator. If I didn't eat it then, well, let's just say that by the next day there would not be a piece in the fridge. Guess who ate it? Yeah, the one with all the willpower in the world except when it comes to staying out of my yummy stuff.
I tested her though. It happened on my birthday. I got Banana Cream Pie. That is my favorite dessert. This year she asked me if I would like her to prepare a couple of those instead of a cake. I said yes. And to ensure that I would get some I asked her to make one that would be just mine. She did. I enjoyed a big slice and left 2/3 of it in the refrigerator. And you know what, she didn't eat it; didn't take a single piece. Neither did the kids. She may have had to threaten them with a slow and agonizing death if they did, but they all left it alone. After about 48 hours I ended up splitting the rest of the pie with her and we lived in decadent pleasure for a happy hour. This is about as decadent as we can manage these days. I did mention it was my 45th birthday, right? (JK, Hon.)So that's the secret. I have no stuff because I have no power. It all resides in the perky little inamorata that I married. I have stuff if she mandates I have stuff. And sometimes she even has willpower - when she wants to. And it seems she wants to about once a year.
Wednesday, January 20, 2010
Dems Begin Their Decline
Scott Brown wins. I'm surprised that Coakley didn't win, indications of the polls aside, voters normally return to the safety of their party candidate when they pull the lever, regardless of what they say in a survey. Ted Kennedy is to blame for the loss of the seat. To be sure the arrogance and the "we're ramming this down your throat" approach of the democrats since last January made the voters of Mass angry - but Uncle Ted is the reason Scott Brown is even a public name. The Democrats want you to think that Coakley was a horrible campaigner, that Massachusetts is racist, that Massachusetts is sexist, that the American public is just dissatisfied and ready to vote out any incumbent. Bull. This was a referendum on Washington and a big slam on the Big O himself. The margin between Brown and Coakley actually widened after the President took off his tie and robo-called the good people of the Bay State.
This is all true. But it would have been a non-factor if Theodore Kennedy (D) who served for 46 years - longer than I've been alive - had not tenaciously held onto his seat even when he knew he had a fatal condition and would die in office.
The question is - just who, really, is Scott Brown?
This is all true. But it would have been a non-factor if Theodore Kennedy (D) who served for 46 years - longer than I've been alive - had not tenaciously held onto his seat even when he knew he had a fatal condition and would die in office.
The question is - just who, really, is Scott Brown?
Friday, January 15, 2010
My Completely Useless, But Fun, Best Foods Ever List
Nov. 7, 2007 - The Frrrozen Haute Chocolate is unveiled at the Serendipity-3 restaurant in New York City. Guinness World Records determined the $25,000 frozen hot chocolate was the most expensive dessert in the world.
January 15, 2010 – I still haven't gotten any. Nor do I understand any idiot who would pay $25,000 for a dessert item. How do these people keep their money?
More down to earth, these are some of my favorite things to pick up at specific locations (and none of them cost over $25):
#1 - Wegman's brand Chocolate Milk. Cream O' Weber in Utah was my favorite, but 15 years out I don't remember exactly how the two brands stack up. But Wegmans is good. I don't know what the mix is or how creamy the starting product but it puts other brands and mixes to shame. This is a brand to hide from the kids. They can drink the Nestle and the Ovaltine. Leave my Wegmans Chocolate Milk alone!
#2 - Shearers Baked Cheese Curls (Giant Eagle). I am not a cheesy poof lover. They make you have orange sticky fingers that can be traced through 3 counties and they gum up your teeth. Not worth the trouble. Most of them are pretty tasteless or nasty anyway. Not Shearers. I actually will put up with discoloration just to down a half bag (or more) of these.
#3 - Goya Brand Guarana (Tops). Guarana: the official soft drink of Brazil. Delicious. Wish they sold Antarctica brand here but... enough said.
#1 - Wegman's brand Chocolate Milk. Cream O' Weber in Utah was my favorite, but 15 years out I don't remember exactly how the two brands stack up. But Wegmans is good. I don't know what the mix is or how creamy the starting product but it puts other brands and mixes to shame. This is a brand to hide from the kids. They can drink the Nestle and the Ovaltine. Leave my Wegmans Chocolate Milk alone!
#2 - Shearers Baked Cheese Curls (Giant Eagle). I am not a cheesy poof lover. They make you have orange sticky fingers that can be traced through 3 counties and they gum up your teeth. Not worth the trouble. Most of them are pretty tasteless or nasty anyway. Not Shearers. I actually will put up with discoloration just to down a half bag (or more) of these.
#3 - Goya Brand Guarana (Tops). Guarana: the official soft drink of Brazil. Delicious. Wish they sold Antarctica brand here but... enough said.
#4 - Mighty Fine Donuts (Erie PA). Krispy Kreme - sugary dough. Winchell's - kid stuff. Dunkin Donuts - maybe worth the trip for the coffee, but for real melt-in-your-mouth donuts, head for Parade Street and Mighty Fine Donuts. Show up early to get your fresh pick. Some varieties go fast.#5 - Graeter's Ice Cream (Ohio locations). Best ice cream since Nellie Thames' homemade ice cream for the church picnic in Beaufort South Carolina.
Thursday, January 14, 2010
Isabelle Nelson
Lived Well, Loved Much. Isabelle Fickenworth Nelson, age 87, of Erie, passed away Friday, January 8, 2010 at Sunrise Assisted Living. She was born in Erie on June 15, 1922, daughter of the late George and Anna Depner Fickenworth. She was a lifelong Erie resident. Isabelle's life was centered around her home and family. Her home personified her skills of cleaning, cooking and gardening. Family and friends always felt the peace and love that abounded there. Family gatherings were very special to all and each new addition was lovingly welcomed. Isabelle was a devoted member of the Church of Jesus Christ of Latter Day Saints. She served many years with the children and youth as a leader and teacher, as well as holding many other church callings. She and her husband, Earl, also served a one year mission in Texas in 1984. She had previously worked at the Boston Store and then Blue Cross/Blue Shield prior to retirement. She was preceded in death by her husband, Earl A. Nelson; her 11 brothers and sisters; and one step-grandson. Survivors include her daughter, Marjorie Nielson (Deon) of Erie; her son, Terrence Nelson (Patty) of Girard; nine grandchildren; one step-grandson; 21 great-grandchildren; several nieces and nephews. Friends may call at the Dusckas Funeral Home, Inc., East, 2607 Buffalo Road on Tuesday from 6 to 8 p.m. and Wednesday from 9 to 10:30 a.m. at the Church of Jesus Christ of Latter Day Saints, 1101 South Hill Road, where the Funeral Service will take place at 11 a.m. conducted by Bishop James Moore. Interment, Erie Cemetery. Memorial contributions may be made to Alzheimer's Association . Greater PA Chapter, 1128 State St., Suite 301, Erie, PA 16501. Special thanks are extended to all her caregivers at Sunrise where her last years were spent. To send condolences visit http://www.dusckasfuneralhome.com/.Published in the Erie Times-News on Jan 10, 2010.
Thursday, January 7, 2010
Mental Issues and Treatment - Dementia Brief
by Rick Doray*
In the field of medicine there are three categories of diagnostic errors to which a doctor or clinician can fall prey. First, there are lack of data errors. A health condition may present silently or atypically. It may be a new disorder. Sometimes health care providers just do not have enough data to make an accurate diagnosis. This type of error is very difficult to eliminate. Hopefully, these errors will be reduced and committed less often as medical/health knowledge advances. Type 2 errors are healthcare system errors. These errors can be caused by specialty competition for resources in a health facility or by system redesign changes. Health systems can be overtaxed and errors can result due to a lack of available resources.
Type 3 errors are cognitive errors and are committed by the provider. These types of errors are caused by insufficient data collection; data misinterpretation; a lack of system-level checks, such as second opinions, specialist consultations and laboratory results; or even carelessness (Graber, Gordon, Franklin, 2002). Clinical personnel should be careful to not make rushed analysis or avoid using system level checks to ensure their diagnosis. Residents and Physician Assistants need second opinion approval from qualified supervising providers to enter a diagnosis on a patient's chart; it might be well if all chronic condition diagnoses were peer reviewed to ensure consensus and accuracy.
There are more than 70 conditions which can cause dementia. Clinicians may fall into the "trap of commonality" to diagnose a condition as dementia when it may be something else. Clinicians may also misclassify a temporary dementia condition as permanent. This misdiagnosis can haunt a patient even after the condition causing the dementia has been ameliorated or cured. It is important that health service providers be alert for reversible dementia conditions so timely treatment can follow. If not, permanent damage can be done to the patient's nervous system. Clinicians should not be in such a rush that delirium is diagnosed as dementia.
Apparent Dementia may be due to other conditions. Polypharmacy, the interaction between multiple drugs that the patient may be taking, should be watched for. The mix of different medications may produce temporary conditions in a patient that mimic the onset of dementia. The patient improves as the drugs are secreted from the body. This process normally takes longer to happen in the elderly as opposed to younger people.
Normal Pressure Hydrocephalus, or NPH, causes the ventricles of the brain to fill with fluid. Sufferers of NPH begin to have cognitive and motor complications that present as dementia. NPH is treatable and the patient can return to precondition functionality, but only if caught before permanent damage has been done to the brain. Depression may be another condition which can be misdiagnosed as dementia. A patient under assessment may give a multitude of lack of response or I don't know answers which may be seen as a mild onset of dementia. In reality they are suffering from severe depression. This pseudodementia may show considerable improvement as the patient is successfully treated for depression.
Clinical assessment should take a multifaceted approach. A clinician needs to take into account the patient's physiological and social state as well as their psychological one. Clinicians should be just as careful to rule out all possible diagnoses as they are to code one. Assessment needs to take into account the particular needs of the patient, both cognitive and physical. For example, a slowed motor response may be due to arthritis and not to reflex inhibition. Difficulty in answering written questions may be due to poor eyesight or lower education achievement.
The clinician needs to be sensitive to the particular cultural differences of the patient and how that difference may affect the interaction between provider and patient. These differences can be particularly pronounced between male providers and women of certain cultures. For example, Muslim women may be reluctant to fully engage younger male staff members. Older Veterans with PTSD may not wish to interact with clinicians who are perceived to be of the nationality of an opposing force in a previous military engagement*. Clinicians need to be familiar with the 2003 APA approved guidelines for clinical work with older adults. These guidelines will help providers become proficient working with older adult populations.
1. Graber, M., Gordon, R., & Franklin, N. (2002). Reducing diagnostic errors in medicine: What's the goal? Academic Medicine, 77, 35-46.
* Note: Aug 31, 2010 - This is my brief. I didn't originally put a byline on it since I figured it was being posted on my blog. But I have found this article posted without attribution around the web. Which it is fine to post it if you want - but I want to maintain my rights as the author, so please make sure you add the byline as well. Thanks.
In the field of medicine there are three categories of diagnostic errors to which a doctor or clinician can fall prey. First, there are lack of data errors. A health condition may present silently or atypically. It may be a new disorder. Sometimes health care providers just do not have enough data to make an accurate diagnosis. This type of error is very difficult to eliminate. Hopefully, these errors will be reduced and committed less often as medical/health knowledge advances. Type 2 errors are healthcare system errors. These errors can be caused by specialty competition for resources in a health facility or by system redesign changes. Health systems can be overtaxed and errors can result due to a lack of available resources.
Type 3 errors are cognitive errors and are committed by the provider. These types of errors are caused by insufficient data collection; data misinterpretation; a lack of system-level checks, such as second opinions, specialist consultations and laboratory results; or even carelessness (Graber, Gordon, Franklin, 2002). Clinical personnel should be careful to not make rushed analysis or avoid using system level checks to ensure their diagnosis. Residents and Physician Assistants need second opinion approval from qualified supervising providers to enter a diagnosis on a patient's chart; it might be well if all chronic condition diagnoses were peer reviewed to ensure consensus and accuracy.
There are more than 70 conditions which can cause dementia. Clinicians may fall into the "trap of commonality" to diagnose a condition as dementia when it may be something else. Clinicians may also misclassify a temporary dementia condition as permanent. This misdiagnosis can haunt a patient even after the condition causing the dementia has been ameliorated or cured. It is important that health service providers be alert for reversible dementia conditions so timely treatment can follow. If not, permanent damage can be done to the patient's nervous system. Clinicians should not be in such a rush that delirium is diagnosed as dementia.
Apparent Dementia may be due to other conditions. Polypharmacy, the interaction between multiple drugs that the patient may be taking, should be watched for. The mix of different medications may produce temporary conditions in a patient that mimic the onset of dementia. The patient improves as the drugs are secreted from the body. This process normally takes longer to happen in the elderly as opposed to younger people.
Normal Pressure Hydrocephalus, or NPH, causes the ventricles of the brain to fill with fluid. Sufferers of NPH begin to have cognitive and motor complications that present as dementia. NPH is treatable and the patient can return to precondition functionality, but only if caught before permanent damage has been done to the brain. Depression may be another condition which can be misdiagnosed as dementia. A patient under assessment may give a multitude of lack of response or I don't know answers which may be seen as a mild onset of dementia. In reality they are suffering from severe depression. This pseudodementia may show considerable improvement as the patient is successfully treated for depression.
Clinical assessment should take a multifaceted approach. A clinician needs to take into account the patient's physiological and social state as well as their psychological one. Clinicians should be just as careful to rule out all possible diagnoses as they are to code one. Assessment needs to take into account the particular needs of the patient, both cognitive and physical. For example, a slowed motor response may be due to arthritis and not to reflex inhibition. Difficulty in answering written questions may be due to poor eyesight or lower education achievement. The clinician needs to be sensitive to the particular cultural differences of the patient and how that difference may affect the interaction between provider and patient. These differences can be particularly pronounced between male providers and women of certain cultures. For example, Muslim women may be reluctant to fully engage younger male staff members. Older Veterans with PTSD may not wish to interact with clinicians who are perceived to be of the nationality of an opposing force in a previous military engagement*. Clinicians need to be familiar with the 2003 APA approved guidelines for clinical work with older adults. These guidelines will help providers become proficient working with older adult populations.
1. Graber, M., Gordon, R., & Franklin, N. (2002). Reducing diagnostic errors in medicine: What's the goal? Academic Medicine, 77, 35-46.
* Note: Aug 31, 2010 - This is my brief. I didn't originally put a byline on it since I figured it was being posted on my blog. But I have found this article posted without attribution around the web. Which it is fine to post it if you want - but I want to maintain my rights as the author, so please make sure you add the byline as well. Thanks.
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