Spring 2013
PMH STORY by Robert R. Kelly, MD FACP
Around 2 PM one weekday afternoon, a long time patient e-mailed Dr. Kelly with concerns about depression and anxiety. An hour or so later, looking at e-mails while between patient appointments, Dr. Kelly noted the message. The chart was pulled for Dr. Kelly, who sent the patient a quick e-mail that discussed some principal treatment options to consider, including a change in medication, visits, consultation, and further testing. Within minutes, an opportunity arose to call the subscriber on the phone; discuss symptoms; review the e-mail notes; and establish reasonably that there was no suicidal risk. Options were discussed.Based on the patient’s preferences, a referral was made to a counselor. The Premium Medical Home nurse called the subscriber back that afternoon with contact information for the counseling.
Though happy to visit with the subscriber at an office visit, the needs, in this case, were well met by a consideration of the patient’s symptoms; review and modification of treatment; and referral to an appropriate source for psychological counseling.
Subscribers can avoid long waits for a return call when they are in a Premium Medical Home. They do not need to first talk to a nurse or a nurse practitioner. There is no need or expectation that they visit at the office to receive information about options or alternatives, as some of the most important care given to patients occurs on the phone and when they are at home.
Your Premium Medical Home subscription recognizes this fact and creates avenues for you to contact your doctor directly for advice, counsel, treatment, and referral where needed. This leads to more efficient care and better satisfaction.
HOSPITAL ACQUIRED INFECTIONS: NOT ALL SOAPS ARE THE SAME by Dr. Allan R. Kelly, MD FACP
Everyone knows that antibiotics can have side effects, and one of the side effects can be diarrhea. Many have heard about Clostridium difficile or C. diff. A disease that is a complication of antibiotic therapy, C. diff can be dangerous, and even a cause of death. The treatment is only partially successful: many patients relapse, some die, and many may face months or years of recurrent illness.
FALLING by Dr. Allan R. Kelly, MD FACP
Falls are embarrassing and can be dangerous. It is important for doctors, patients, and families to work together to reduce falls. After age 70, the most common causes of accidental death are injuries sustained in a fall. Most falls do not result in injury, and it is estimated that people over age 85 will have two to three falls per year.
QUALITY OF CARE by Dr. Robert Kelly, MD FACP
One pernicious element of centrally planned medical and surgical care is an assumption that normal people are not capable of making judgments about what is best for themselves. Can a federal agency better identify what is best? The problem with this assumption was recently demonstrated in a study of weight loss surgery, also called bariatric surgery. The best approach to weight loss in the obese is life style change.
BLOOD PRESSURE by Dr. Robert Kelly, MD FACP
For blood pressure, the doctor should treat the person, not the number. In the younger elderly, those below 80 years of age, treatment of hypertension helps reduce the problem of heart failure, dementia, and stroke. New research on high blood pressure in those older than 80 is yielding surprising conclusions. A recent report from the Netherlands published in The Journal of the American Geriatric Society explores high blood pressure in the over 85 group.
PMH QUOTATIONS
“What is allegedly true and useful today may be shown to be worthless tomorrow.”
– Joseph Alpert, MD, The American Journal of Medicine, February 2013
“We medical people really have no idea what we put patients through.”
– Edward Viner, MD: The Physician as Patient, 1985
“May there never arise in me the notion that I know enough, but give me the strength and leisure and zeal to enlarge my knowledge. Our work is great and the mind of man presses forward forever.”
– Maimonides, physician (1135 – 1204)