Winter 2018
PMH STORY
Premium Medical Home doctors remain active in the medical community.
Recently, I was asked to care for a hospice patient (whom I had never met) admitted to a nursing home. The resident was totally dependent upon her daughter and was in for a short respite stay. After visiting the patient and the nurses, I called the daughter.
On identifying myself to the daughter, the daughter was confused. She said, “Had there been an emergency?” I advised that there had not. She said that in the years she had been providing the care for her mother, including in and out of hospitals and nursing homes, a physician had never called her on the phone.
This is not the first, nor will it be the last, time that a family member expresses surprise and, naturally, appreciation for a doctor’s personal attention to their loved one. I shared with the daughter my own personal experience serving as my father’s physician. In his last months while in hospice, he had a problem and I was unsure how to proceed.
I called one of the specialists here in town and left a message on their answering service: I was just another patient’s family member asking for help. Within minutes, the doctor called me back. We reviewed the issue and he stated that it sounded like I was doing the right thing. He offered to come over or see my father, or have us visit the next morning in his clinic. With the phone call, I had the information I needed and a visit was not necessary. But like the daughter of this hospice respite patient at the nursing home, like any of us when we are sick and do not know for sure what is wrong and what to do, I felt deep appreciation for this doctor who was able, willing and available to help, and willing to talk to me on the phone. We have experienced both sides of the relationship. We want our patients and families to have that support and relationship always at hand.
Robert H. Kelly, MD, FACP
WHAT IS BEST FOR PAIN?
People have been using narcotic analgesics for thousands of years. But are the narcotics any better than new drugs, such as ibuprofen and acetaminophen?
NEW BLOOD PRESSURE GUIDELINES
The American College of Cardiology and the American Heart Association issued new guidelines for the diagnosis and treatment of hypertension. For most of our patients, there will be little change. There are two groups that will notice a significant change.
DO ANTIDEPRESSANTS REDUCE DEPRESSION IN PATIENTS WITH COMPLEX CHRONIC ILLNESS?
Major depression is frequently experienced as a lack of interest in anything that would generally bring pleasure and as an unexplained sense of persistent blueness and depression. Treatment of depression is important. But randomized controlled trials of depression exclude patients with chronic and serious illnesses: cancer, heart disease, kidney disease, and others. Facing such serious illness, patients and their families commonly ask about treatment of depression symptoms.
COFFEE – STILL OUR FRIEND
In a randomized controlled trial, heart patients in Brazil were off coffee for 7 days. Then each person took five doses in 5 hours of 100 mg of caffeine as coffee. This is about the same as five 8-ounce cups of coffee. The placebo group drank coffee. Blood tests, electrocardiogram and stress tests were done. The results showed no adverse or positive effect of coffee on skipped beats, duration of exercise, heart rate, or blood pressure. People like coffee, and it appears that coffee is not dangerous, even in the face of heart failure and arrhythmia.
OSTEOPOROSIS
Long term prednisone use causes a 60% – 100% increase in fracture risk. An experiment was done with 3600 patients in Sweden who were taking prednisone. Fosamax or placebo was started 1-3 months after the initiation of prednisone. Over the 1.3 years, there was a hip fracture rate of 9/1000 in the Fosamax group versus 27/1000 in the placebo group.
PMH QUOTES
“I have come to believe that patient trust in the physician is one of the most important therapeutic elements in our armamentarium. Such trust can be built only when a lasting relationship is forged between the patient and the physician.”
William Mayo, M.D.
“Many chronically ill elderly patients should be spared from spending their last hours in the grip of medical technology.”
Michael Gordon, M.D., 1985.
“There is building resentment against the shackles of the present EHR; every additional click inflicts a nick on physicians’ morale.”
Donna Zulman, M.D., 2016.