Spring 2015
PMH STORY by Robert H. Kelly, MD FACP
Shoulder and arm pain had troubled a PMH subscriber for a couple of months. With an upcoming special event on Saturday, the problem had become a distraction. She called the office and a referral was made to a specialist for the week after the special event but the pain persisted.
On Friday afternoon, she called for more help. There had not been a visit in many months. Obviously having severe pain, some evaluation was in order. A request was made to meet Dr. Kelly in the Emergency Room the next day. The subscriber did not want to do this because of the amount of trouble sometimes associated with an Emergency Room visit. Dr. Kelly recommended instead that they just meet at the Emergency Room waiting area and then make a decision on whether or not checking into the Emergency Room for further evaluation would be needed.
The new Marion Emergency Care Center at Harris Hospital downtown makes a great place to visit and make a decision about needs. At 8:30, Dr. Kelly met the subscriber and a proper evaluation and examination was done. The problem did not seem to be dangerous at all, and a decision was made to plan x-rays at a later time and begin treatment for what was likely an inflammatory musculoskeletal condition. She did not “check in” to the Emergency Room, saving hours of time and great expense.
Premium Medical Home makes such visits possible. As a PMH patient you are able to see the same physician at the hospital, who will also then see you at his office, the same physician with whom you have spoken on the telephone, whether it is a weekend or a weekday. Because there are fewer patients in Premium Medical Home, there is more time to try to understand the patient’s needs and circumstances and try to match the visit or treatment more carefully with these matters of convenience and comfort.
SURGICAL VERSUS NONSURGICAL TREATMENT OF A SHOULDER FRACTURE by Allan R. Kelly, MD FACP
As we get older, fractures become more common and often require surgery. Generally, we are going to leave the decision to have surgery to the orthopedic surgeon. A recent study in the Journal of the American Medical Association (March 2015) by authors from Europe, compared shoulder (humerus) fracture outcomes at six months, 12 months, and 24 months after treatment. These were serious fractures of the proximal humerus with displacement (separation) of the bone fragments. Patients were randomized to non-surgical treatment (sling immobilization) or surgery (fracture fixation or shoulder replacement).
STATINS by Robert H. Kelly, MD FACP
CMedical treatment of disease is meant to promote better health, reduce need for medical care, and allow fuller enjoyment of life. Medical treatment should not promote harmful or high-risk behavior. Statins are used to reduce the problem of disease and death caused by hardening of the arteries. Most importantly, statin drugs, in the appropriate population, significantly reduce the risk of heart attack, stroke, and premature death.
CLOSTRIDIUM DIFFICILE by Robert H. Kelly, MD FACP
C. difficile is a difficult problem in medical care today. C. diff infection can cause diarrhea, severe illness, and even death. Diagnosis is based on testing for the presence of C. difficile organisms in a stool specimen. There are novel treatment ideas out there. A previous PMH@Home article mentioned doing a stool transplant to treat C. difficile. Another idea is to improve identification and diagnosis of disease.
SMART WALKING by Robert H. Kelly, MD FACP
An article in JAMA (Accuracy of Smart Phone Applications, 2/10/2015, Vol. 313, #6, pg. 625), looked at the accuracy of some of the devices used to measure activities or steps. The devices were compared against a standard 500 and 1500 step trial. A treadmill was used set at 3 miles per hour and 10 different devices were worn. Step count from the devices was measured after each trial.
PEANUT ALLERGIES by Allan R. Kelly, MD FACP
Peanut allergies are a problem in the pediatric age group, but I thought PMH members would be interested in a report from the New England Journal of Medicine on how to prevent peanut allergy from developing.
PMH QUOTATIONS Spring 2015
“They who are accustomed to daily labor, although even weak or old, endure labor more easily than the robust or young who are unaccustomed to it.”
Hippocrates
“I tell all my patients that frequent exercise is just as important as their medication in controlling their cardiovascular disease.”
Joseph S. Alpert, MD
“At day’s end, after we have stripped away the science, medicine consists of one person helping another, and the visceral desire to assuage another’s hurt, to provide hope even when we have lost it ourselves.”
Samir K. Shah, MD