Summer 2013
PMH STORY by Robert Kelly MD FACP
The patient was at home. Her husband had died some years ago. Her family lived out of state.
She noticed a strange feeling in her chest. Heart attack was far from her mind – there was no prior problem with heart disease. Simple remedies like yawning and deep breathing did not resolve the sense of oppression across the chest. She called her Premium Medical Home doctor’s office at approximately 9:00 a.m. and was immediately speaking with the PMH nurse so well known to her. Within minutes, her PMH doctor had reviewed her chart and her problem, and recommendations were given to go to the hospital for care. The doctor called and alerted the hospital staff to the patient’s needs.
A cardiologist, whom the patient had not previously met, was waiting when the ambulance arrived. By noon, cardiac catheterization and intervention was done. The problem was identified, a solution provided, and she was soon recovering in the intensive care unit.
Lying on a bed in the ICU, surrounded by strangers, there was a certain feeling of anxiety and anonymity. At 2:00 p.m., the patient’s PMH physician came to see her. On his arrival, the patient exclaimed, “Oh, Dr. Kelly, I can’t tell you how good it is to see you.” Discharge was made several days later, with a continued healthful life at home.
This is a Premium Medical Home story, not because of a favorable medical outcome, an outcome which would have likely been achieved with prudent care. What is different is that, in the midst of this illness, in the midst of all the new people, and in the midst of the intensive care unit, members of a Premium Medical Home can count on seeing the physician whom they have learned to trust and whose manner and methods they have become accustomed to. They are seen by a physician who knows them and their family, who knows what has been important to them over the months or years prior to their acute illness and who knows the consultants and the hospital staff. This was why the patient was so happy to see her doctor. This is another reason we created Premium Medical Home.
A DOCTOR’S OFFICE VISIT IS NOT ALWAYS NECESSARY by Robert H. Kelly MD FACP
Recent issues in the abortion debate may unexpectedly shed light on efficiency that could improve medical care. The doctor’s office is not always the best place to get the medical care we need. Certainly, many treatments are now available without prescription, such as over the counter medications, even the Plan B contraceptive that can be sold to any girl regardless of age. It seems reasonable to ask, if regulators believe a 12 year-old girl has adequate judgment to buy Plan B, why should not a 42 year-old mother of three have the ability to buy antibiotics for her children? This issue of patient directed care deserves attention in less controversial areas.
PHOTOGRAPHS by Allan R. Kelly MD FACP
A helpful communication is taking and sending photos by cell phone. Recently a middle-aged woman noticed a spot on her finger and wondered whether it was the sort of thing that she should check with the doctor. She had hurt it, it was tender, and she thought it was infected. She called my office late in the afternoon. She asked whether or not she should go to the emergency room.
SHELF LIFE: BETTER THAN YOU MIGHT THINK by Robert H. Kelly, MD FACP
The question often arises: how long after the expiration date can the medication still be safely used? From the safety perspective, the answer may be that there is little safety concern, but from a potency or effectiveness perspective some medications do lose their effectiveness. A study was done last year that looked at medications that were held in a federal program of strategic reserve. These medications had expired between 28 and 40 years before testing. Capsules or tablets from each medication were tested looking for the presence and concentration of the active ingredients.
REFLUX MEDICINES AND FRACTURES by Allan R. Kelly MD FACP
The longer medicines are on the market the more we learn about their benefits and their risks. Learning about the risks of medicines can clarify how best to use them safely. Newly reported problems with proton pump inhibitors (PPI’s) have come to light after twenty years of experience. Examples of PPI’s are Nexium, Prilosec, omeprazole, Protonix, and Prevacid, among others. They often relieve symptoms of reflux and protect from complications such as ulcers, perforation and bleeding. They do a great job. It appears that prolonged use of PPI’s increases the risk of fracture. This is important as fractures are associated with serious health problems, surgery and functional loss.
DEMENTIA: MEMORY OR BEHAVIOR? by Allan R. Kelly MD FACP
We all know that smoking causes suffering from stroke, heart attack, and cancers. There are other risks worth being aware of, as we counsel family and friends who smoke.Tobacco use correlates with psychiatric illness, complicates its treatment and contributes to early mortality and morbidity in those with mental illness. This is a perspective that many may be unaware of.
PMH QUOTATIONS SUMMER 2013
“”Once with his patient, he must, in word and thought, attend to nothing but his patient’s case and what concerns it.”
” – Oath of the Hindu Physician, circa 1500 B.C.
“Under the present system of supervision it is unlikely that many of the successful surgical innovations we have witnessed would have been achieved “
– Allen B. Weisse, M.D.; Proceedings; Baylor University Medical Center; July 2013, Volume 26, No. 3, Page 310
“”. . . the importance that professionals ascribe to patients’ deep experience and such enduring moral practices of caring, as the laying on of hands, the expression of kindness, the enactment of decency, and the commitment to presence – being there for those who need them. This is the embodied wisdom medical students need to learn and we all must remember.”
– Arthur Kleinan, M.D.; New England Journal of Medicine; April 2013