Winter 2014
PREMIUM MEDICAL HOME STORY by Robert H. Kelly, MD, FACP
The patient, a doctor, had been well, but suddenly became ill on a Sunday afternoon. There was no recent travel, and others in her family were well. She suffered marked nausea and repetitive vomiting: nothing would stay down.
When she called, she reported to her doctor that she had tried a dose of nausea medicine: even that would not stay down. She felt as bad as she had ever felt in her life. She told her PMH doctor she was going to the emergency room.
After hearing the story, her PMH doctor asked a few questions. There was no sign of fever or bleeding. She had never been sick like this before. Options were discussed. Recommendations were made to rest and to take a second dose of the anti-vomiting medication, try some clear liquids, call back after half an hour and delay going to the ER.
At the time of her call back, she was resting in bed. She had taken the extra dose of medication and had kept down some sips of clear liquids. She felt better and decided not to go to the emergency room after all. The evening was spent in the peace and quiet of her own home, not at the ER. Her body was able to recover somewhat more naturally, with the help of the medication.
The next morning she reported recovery and decided to go on to work. This was, in short, an episode of food-borne illness with nausea and vomiting which resolved.
An experienced doctor who picks up the phone can give a person, even a fellow health care provider, confidence and prudent advice she can follow. Too often telephone calls to a doctor’s office after hours are handled differently: the answering service, the waiting, the nurse who triages the call and the customary, “If you are suddenly ill, go to the emergency room” are routines that have to be followed. At PMH we think it is better when a knowledgeable, committed physician answers the phone. Familiar with the member’s history, her health, and the tools available, the doctor can make a more defined, personal set of recommendations.
Sometimes patients are sick and have to go to the ER or hospital. But in many cases, knowledge and experience quickly accessed can save a trip to the hospital or emergency room. This is one of the benefits of the Premium Medical Home model.
NUTS AND HEALTH by Robert H. Kelly, MD, FACP
“You are what you eat”, our grandmothers told us. Diet is important. Nut consumption has been of interest to doctors and patients. Are nuts good for your health? This question was addressed in the 2013 New England Journal of Medicine study of 100,000 men and women in the Nurses’ Health Study from 1986 to 2010. That was 3,000,000 years at risk that were assessed! The recent study showed that nut intake correlated with survival. Pooled analysis for death showed a 7% risk reduction for those who ate nuts less than once a week on average, compared to those who did not eat nuts; 11% risk reduction for those eating nuts at least once a week; 20% reduction for those eating nuts 7 or more times per week. Eating nuts at least once per week appeared to reduce overall mortality, and specifically mortality related to cancer, heart disease and respiratory disease.
AROMATHERAPY by Robert H. Kelly, MD, FACP
Falls in the elderly can lead to severe injury, increased risk of death and loss of independence. Efforts at reducing falls have attracted attention for some time in geriatric care, especially in hospitals and nursing homes, where the elderly are at high risk of falling.
TAKE YOUR MEDICINE by Allan R. Kelly, MD, FACP
One of the critical jobs a physician faces is to identify disease and propose treatment that will alleviate suffering and promote health. Oftentimes, medications are an important part of this effort.
SHINGLES VACCINE by Allan R. Kelly, MD, FACP
The shingles vaccine, Zostavax, has markedly reduced the incidence of painful shingles. This is a boon to adults. The vaccine was originally released for the over 60 population, and then later approved for over 50. At a December meeting of the American Advisory Committee on Immunization Practices, the CDC addressed the relative benefits of vaccinating at 50 or at 60.
PMH QUOTATIONS Winter 2014
“The health of my patient will be my first consideration.”
Declaration of Geneva, JAMA, November 27, 2013; Vol. 310, No. 20: p. 2191
“I don’t know what your destiny will be . . . but I know one thing: the only ones among you who will be really happy are those who have sought and found how to serve.”
Albert Schweitze
“The only real change, it seems, is that every year, fewer of us practice medicine and more of us talk about it.”
James H. King, MD, Annals of Internal Medicine, January 7, 2014; Vol.160, No.1: p. 68