Spring 2020
PMH STORY
A patient called. The young PMH member had gotten a tattoo at the base of his neck. He scratched a scab next to the tattoo and there was drainage of pus. He called his PMH doctor for advice on how to proceed.
There was no fever, chills, or vomiting. But the report of pain, redness and drainage was worrisome. It was on a weekend. The PMH office and laboratories were closed.
The description of the drainage was not typical for a common skin infection, likely related to this tattoo. Although a visit would likely have confirmed what the member was saying on the phone, the question in the doctor’s mind was the identity and resistance pattern of the organism causing the infection. It had come about after some instrumentation: the possibility of a health facility acquired infection, or resistant organism, was likely.
The member lived in Fort Worth—it would be easy enough to go to the Emergency Room to check a culture. Trips to the ER carry a burden of time, money, and inconvenience. Dr. Kelly was aware of a nearby Care Now clinic. He called the clinic and spoke with the Nurse Practitioner there. He requested a wound culture and to start antibiotic treatment. The Care Now clinic stated that this would not be a problem. Dr. Kelly’s patient was seen and treated. Empiric antibiotics were provided as recommended by Dr. Kelly. The patient followed up with Dr. Kelly, and the culture results were reviewed.
PMH doctors want to match the patient’s needs with the care given. To improve speed and convenience, visits like this can be handled at urgent care facilities. The outcome was favorable. This is the tailoring of care to a patient’s need which is not always available in large traditional clinic settings where nurses often process inquiries for emergency care. Today, we have many options, and we can make choices based on what is best for each patient.
Robert H. Kelly, MD FACP
LOW BACK PAIN AND OCCUPATIONAL INTERVENTIONS
Low back pain is common. For many patients, who have a normal exam and no neurological loss or impairment, research supports a simple approach based on time, activity, and Tylenol.
Allan R. Kelly, MD, FACP
MORTALITY RATES IN MEN AND WOMEN
Researchers from all over the United States reported on the effect of influenza vaccination on the elderly on hospitalization mortality. A graph was published in the Annals of Internal Medicine (2020:172:445-452), that showed male and female death rates between ages 60 and 70 per 10,000 persons. The study had its strengths and weaknesses, but the data on mortality rates was eye-opening to me. I have cared for men and women in the over 60 age group of course for a long time. But this figure reminded me that we have a problem that we don’t entirely understand.
Allan R. Kelly, MD, FACP
TELEMEDICINE
Dealing with the corona virus has opened our offices to the video conference. From the beginning, directness has been one of the 5 PMH key principles. Having a direct relationship, taking advantage of electronic communication, is important at PMH. We have initiated FaceTime videos and video conferences with patients when we make rounds in nursing homes. But during the COVID epidemic, the role of video conferencing has increased.
Allan R. Kelly, MD, FACP
COVID-19
As of May 12, 2020, in Tarrant County there were 3745 COVID diagnosis and 104 deaths, in a population of 2.08 million. Although not seen by the public, the impact on healthcare is under control! Only one third of the ventilator machines in Tarrant County are in use, half the hospital beds are filled. We are prepared to care for the sick.
Robert H. Kelly, MD FACP
TOO MUCH INFORMATION
For those with non-insulin-treated diabetes, what is the value of home testing of blood sugar or self-monitoring? Home testing imposes cost and inconvenience on the diabetic. Researchers sought to prove whether self-monitoring finger stick glucose makes a difference.
Robert H. Kelly, MD FACP
PMH QUOTATIONS
“So, this is what it means to be a physician – to uphold long traditions of professional obligation and maintain focus on the needs of each individual patient, and to protect the sacred covenant between patient and the physician.”
Thomas L. Schwenk, M.D., 2020
“Three fifths of the practice of medicine depends on commonsense, knowledge of people, and of human relations.”
Harvey Cushing, M.D., 1921
“Between the patient and the guidelines, there needs to be a doctor that is using his/her brain!”
Joseph Alpert, M.D., 2020
“As a physician, you start observing, gathering clues from the moment you enter the door.”
Sharon Inouye, M.D., 2020
“For at first, neither were the physicians able to cure it, through ignorance of what it was, but died fastest themselves, as being the men that most approached the sick.”
Thucydides, physician, 411 B.C.