Fall 2011
PMH STORY by Allan R. Kelly MD FACP
An elderly patient suffered aortic stenosis, a type of heart disease which can lead to poor heart function. Ten years earlier he had coronary artery bypass grafting on two occasions without complications and the aortic valve did not warrant repair. As the patient entered his 80’s, the aortic stenosis became more of a problem: he would need surgical treatment or suffer heart failure and premature death. But in the setting of two prior heart surgeries in an 80 year old, the feasibility of aortic valve replacement seemed virtually impossible.
The patient’s cardiologist referred him to a surgeon in Dallas doing a research study of percutaneous aortic valve replacement. The PMH internal medicine doctor was not part of this referral. The patient and his family asked the PMH doctor to review the protocols, talk to the doctors in Dallas and Tarrant County and share his opinions about the options. The patient benefited by talking about his problem with his PMH physician.
The PMH doctor also discussed the case with the surgeon in Dallas and made sure the surgeon had all the information he needed for enrolling the patient in the research study.
The implantation of the experimental valve went well, relieving the patient of his heart failure symptoms and resolving the problems of heart weakness. Upon leaving the hospital, the surgeon commented to the family, “Your primary doctor really cared.”
Your PMH doctor is available to help you with difficult questions. Your private doctor, though no substitute for skilled sub-specialists and surgeons, is likely to have information and insight to help understand options. This direct availability and counseling is not described in CPT codes. We believe that this type of availability helps define a Premium Medical Home experience, like having a doctor in the family.
EXERCISE PROTECTS AGAINST COGNITIVE DECLINE by Allan R. Kelly MD FACP
Memory problems are common. But when do memory problems become an illness: Dementia or Alzheimer’s disease? There are other reasons why memory may seem impaired………
EXERCISE PROTECTS AGAINST COGNITIVE DECLINE by Allan R. Kelly MD FACP
As reported elsewhere in PMH@ Home, cognitive decline is a common problem. We all know that memory changes as we get older, and many of us find it increasingly handy to keep a list in our pockets to help us remember………..
COUGH: OFTEN MORE BARK THAN BITE by Robert H. Kelly MD FACP
Cough is a common symptom. An acute cough is one described as lasting one to two weeks; subacute cough lasting three to eight weeks; and chronic cough more than eight weeks…………
OVARIAN CANCER SCREENING by Allan R. Kelly MD FACP
Ovarian cancer is an uncommon but often lethal form of cancer. While we have reasonable screening for cervical, colon, and breast cancers, the benefits of screening for ovarian cancer is unproven. In fact, the United States Prevention Services Task Force recommends against screening for ovarian cancer.
Medical Quotes:
“Reducing medicine to economics makes a mockery of the bond between the healer and the sick.”
– Pamela and Jerome Groopman MD
“When we ourselves are ill, we want someone to care about us as people, not as paying customers, and individualize our treatment according to our values. “
– Pamela and Jerome Goodman MD