Summer 2020
PMH STORY
I met with a young hematologist. He is new to our town with good credentials. I look forward to working with him. He came to the office with an administrator from one of our top hospice groups.
They asked about PMH. I told them that one of the principles of PMH is continuity of care, and we continue to care for our patients who are on hospice. The doctor said, “Oh that is so good. It is so important for our patients. They often feel abandoned when they go onto hospice. It would make such a difference if their doctor continued to follow them.”
Despite this, his group had decided, as a general rule, that they will not follow their patients who transition to hospice care. The hospice administrator confirmed that 99% of doctors stop following their patients who go to hospice. At PMH we think that doctors help patients by providing continuity of care. It is not simply about feelings or personality. It is about quality of life, the care they receive, and the effectiveness of that care. It is about bringing knowledge, understanding and relationships to create something better. As the doctor and the administrator from the company acknowledged, there is something important about continuity of care.
We at PMH are committed to this principle: When our patients go on hospice, we will follow them and care for them and their families as long as we can be of value and service.
In the past month I have had three people die on hospice. We never stopped caring for them. The family never had to introduce themselves to a new doctor as their loved one was dying. Nor did they have to rely on doctors who did not know their loved one. We all know that there will be problems. The doctor will be temporarily unavailable or out of cell phone range. There will be interruptions even at PMH. But we make a commitment to continuity of care. Like patients, our colleagues know that this is good.
Allan R. Kelly, MD, FACP
CPAP: GOOD FOR PEOPLE WITH SYMPTOMS
Obstructive sleep apnea (OSA) has been around a long time. We know that when people fall asleep, their blood pressure, vital signs, and their breathing patterns change.
Allan R. Kelly, MD, FACP
DIET CHANGE CONTINUES TO SHOW PROMISE
We have all been learning how to change our diet to be healthier and avoid illness. The old days of steak and potatoes every night are long gone. The “Mediterranean Diet” has shown a reduction in the risk of cardiovascular events. The DASH, a sodium deprived diet, has shown statistical benefit compared to a controlled diet. A vegetarian diet has shown a reduction in risk, and, of course, low calorie diets have also reduced risk.
Allan R. Kelly, MD, FACP
SIMPLE MEASURES
Sometimes we are reminded that simple elements of healthcare may be as important as are the complex and expensive ways of healthcare.
Robert H. Kelly, MD, FACP
THE PREVALENCE OF VIRAL PATHOGENS VIRUSES IN HEALTHY PEOPLE
A study in 2017 was done at the Statue of Liberty in New York City. Healthy sightseers with no reported illness had viral testing done. The researchers collected nasal swab samples to see how many harbored viruses that can cause illness.
Robert H. Kelly, MD FACP
PMH QUOTATIONS
“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.”
Hippocrates, 301 BC
“Primary care practitioners must wade through EMR auto generated boiler plate pablum to figure out what consultants really thought about their patient.”
H. Gilbert Welch, M.D. 2020
“No greater opportunity or obligation can fall to the lot of a human being than to be a physician. In the care of the suffering, she needs technical skill, scientific knowledge and human understanding.”
Tinsley Harrison, M.D. 1950
“You survive in the new [medical care] system by giving the computer complete attention, the kind of attention we used to reserve for a patient. By default, the patient moves down to second place. As sad and horrifying as this sounds and feels, it is becoming the new reality.”
Elizabeth Toll, M.D. 2020
“Instead, take these patients’ preferences seriously as a way to respect them as persons and to protect their liberty. Physician’s reluctance to treat patients over their objections may therefore reflect a wellfounded moral intuition rather than mere self-interest or pragmatism.”
Mark Navin, Ph.D. 2019
“What we considered to be medical fact today may be medical fiction tomorrow.”
J. Willis Hurst, M.D. 2007