Fall 2016

PMH STORY

PMH is about continuity and knowledge.

The patient was in his early 90’s. The PMH doctor cared for the man and his wife for over 20 years. The wife died 15 years ago. Family always thought the PMH doctor took good care of mom, even though she died, and always had confidence in the doctor’s care of their father.

A gradual downhill course eventually pointed to approaching end of life for the father. His illnesses were severe. He was comfortable and surrounded by his family in the hospital room. But it was time to confront that there was nothing else that the doctors could do to get him back on his feet and to recover his strength.

In a meeting with the family, the doctor was able to recall the patient’s history dating back decades, to reflect upon the spouse’s death, and to talk about the future and how to take good care of a good man, even at the end of life. The doctor had cared for the patient in the office, at the nursing home, and was sitting at the patient’s bedside in the hospital. With transition to hospice, the doctor would again be by his patient’s side.

The trusted and longtime physician at the patient’s bedside is valuable, a good thing. Regardless of what may be happening elsewhere in hospitals and nursing homes, at PMH we are committed to this continuity of care over time. We believe continuity of care is good for the patient, the family, the doctor, and those who support the patient, even at the end of life.

Allan R. Kelly, MD FACP

ANNOUNCEMENT

Dr. Robert Kelly’s Subscription Fees will be increasing as of January 1, 2017. The new fees are posted on our web site, www.PremiumMedicalHome.com and are also available by calling the office. As your PMH renewal becomes effective, you will be billed for the new 2017 fees.

BLOOD TRANSFUSIONS: IS BLOOD FROM MEN AND WOMEN DIFFERENT?

In the popular media there is all this talk about gender, malehood, femalehood, etc. Doctors have always known the truth: There is a difference.

But even we were surprised when JAMA 2016 presented data on male and female blood donors. The advent of big data has allowed for tracking outcomes in new and comprehensive ways.

ANTIBIOTIC TREATMENT: SHORTER CAN BE BETTER

We all remember the doctor’s instruction when we had strep throat infections: Take the antibiotics for ten days until they were all gone. Children and young parents became accustomed to the idea of taking antibiotics for one to two weeks, even after we got better.

But times have changed. Over the past fifteen years, multiple studies have compared shorter versus longer courses of antibiotics. Dr. Brad Spellberg recently reported experiments of shorter versus longer duration therapy. For example, in community-acquired pneumonia, stopping antibiotics after five days was superior to continuing antibiotics for 7 to 10 days. Other studies included pyelonephritis (7 versus 14 days), intraabdominal infection (4 versus 10 days), sinusitis (5 versus 10 days), and cellulitis (6 versus 10 days). According to Dr. Spellberg, shorter duration beats longer duration in these clinical syndromes. I believe these new studies will lead to a change in clinical practice.

PAREGORIC, OPIUM, MORPHINE: PAST AND PRESENT

Paregoric represented an ancient tradition of care, its components in use for thousands of years. The active ingredient is a natural product from poppies, and used by people of all social statuses, all incomes, and all educations in every country since the time of Marco Polo.

Older people may remember paregoric, used for many purposes in the home. It was used for a teething child who was restless or uncomfortable with colic. It was used for people with diarrhea and stomach cramps and pain. It was available without a doctor’s prescription at every drugstore. Mr. Bill Whitten, a pharmacist who built up Whitten’s Pharmacy chain in Fort Worth, said he always had paregoric available over the counter. He would keep an eye on it, and if he thought that a person was buying too much, he would turn them away.

INFECTION – WARNING SIGNS

Paying attention to a worsening infection before it requires hospital care is important. One key to transition between infection that can be treated at home and infection that requires hospital care is when infection changes to a syndrome called sepsis. Sepsis is a serious problem with a mortality rate of 15-30%.

REDUCING COLON CANCER RISK

Prudently reducing the risk of colon cancer and colon polyps is important. Cancer tends to develop in a polyp, so reducing polyp formation is desirable. Though the frequency of colon cancer is relatively low for any individual, colon cancer ranks third after breast and lung cancer as a cause of death from cancer in the United States.

Americans are open to medical treatment that reduces risk. Examples are low-dose aspirin and statin drugs for those at risk for coronary disease, tobacco cessation, and bisphosphonates for osteoporosis. And now, maybe metformin for colon polyps. A recent experiment in Japan recruited persons with high risk of forming colon polyps and randomly assigned them to two groups. One group was given metformin 250 mg daily (lower than used for diabetes) and the other given placebo. Colonoscopies were performed after one year. The number and prevalence of adenomas and polyps was then measured and found to be significantly lower in the metformin group. In the metformin group, only 38% of persons had some form of polyp or adenoma on the follow-up colonoscopy, whereas nearly 60% in the placebo group. The risk of colon polyp or adenoma was reduced by almost half.

PMH QUOTATIONS FALL 2016 

“The true core of good medicine is not an institution but a relationship, a relationship between two human beings. The better those two human beings know one another, the greater the potential that their relationship will prove effective and fulfilling for both.”

Richard Gunderman, M.D., 2016

“He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.”

William Osler, M.D., Aequanimitas, 1904