Winter 2013
PMH STORY by Robert H. Kelly, MD FACP
The patient woke up Friday morning with poor appetite, weakness, diarrhea and vomiting. He spoke on the telephone with his PMH doctor, who suspected a GI virus and prescribed medicines to help with the nausea. In a follow-up phone call the patient was not improved. The doctor recommended admission to the hospital for testing, IV fluids and better symptom control.
The doctor called the hospital and reserved a room for the patient. Initial orders for care were given. The PMH nurse called the patient back with room number and explanation of the admission process. An ambulance was called for transportation.
The paramedics took him to the hospital. The Emergency room was crowded, full of influenza cases and Friday Emergencies. The patient reported that patients were lined up two deep in the hallway, and some family had prepared pallets on the floor to sit or rest.
The paramedics told the ER desk clerk that the patient had been directly admitted to the hospital by Dr. Kelly, and was not to be seen in the ER. The clerk confirmed the bed assignment and the patient went upstairs for continued care. The stay in the emergency room was less than five minutes.
Upon leaving the ER, the paramedic told the patient, “You must have some kind of doctor.” His partner added, “Yeah, most of the time when people tell us that admission was arranged by the doctor, no one in the ER knows anything about it so they stay in the ER.”
Sometimes emergency room care is necessary and cannot be prudently bypassed. Sometimes the patient’s needs are better met in a regular hospital room, not in the Emergency Room. When that is the case, it is good to have a doctor that you can call directly and who will arrange direct admission to the hospital without an unneeded visit to the ER. This is one value of a PMH subscription.
LABORATORY TESTS: TO FAST OR NOT TO FAST by Allan R Kelly MD FACP
In the 20th century, the diagnoses of diabetes and cholesterol abnormalities were based upon fasting blood work. Fasting blood work dates back to the 1930’s and 1940’s when treatment for diabetes with insulin first became available. A fasting oral glucose tolerance test was the gold standard. Subsequently, fasting was thought to be the appropriate time to test other metabolic parameters. Our patients who were born prior to 1960 are accustomed to the idea that blood work should be taken prior to the first meal of the day.
URINARY TRACT INFECTIONS: OVER-TREATMENT CAUSES PROBLEMS By Allan R. Kelly, MD FACP
Urinary tract infections are a common problem in both the healthy and the frail populations. Traditionally, a urinary tract infection is diagnosed when people have bladder symptoms and laboratory testing shows inflammation of urine, as well as a positive culture. Many are familiar with this scenario in ourselves and our family. We know that a few days of antibiotics will generally take care of the problem.
FLU VACCINATION by Allan R. Kelly, MD FACP
We have all gotten used to the idea that the flu vaccine is good. Most medical organizations recommend routine annual flu vaccine for certain groups. However, past recommendations have generally not included the healthy adult between the ages of 20 and 50.
GERIATRIC ISSUES by Robert H. Kelly, MD FACP
Aspirin keeps attracting attention, some of it negative, some positive. For example, in persons suffering adult ‘wet’ macular degeneration, aspirin use may increase bleeding complications. If you have adult “wet” macular degeneration, ask your eye doctor if aspirin should be stopped or continued. On the positive side, in persons with heart disease or who have suffered stroke, the benefit of aspirin is well proven.
SLEEPING, VITAMINS AND FRESH AIR by Robert H. Kelly, MD FAC
Sleeping pills for insomnia are coming under increasing scrutiny and regulation. Each person deserves careful consideration of the causes and possible treatments for sleep disorder. There is some information that may be generally useful.
PMH QUOTATIONS WINTER 2013
“I hope physicians will avoid words like health care provider and consumer. We are physicians and we care for patients. Let the cost accountants provide and consume.”
– Sol Papper, Doing Right: Everyday Medical Ethics, 1983, p. 66
“[Patient] Autonomy is not threatened by hearing the thoughtful opinion of experts about what they claim is the best course of action.”
– Arthur Caplan, Mayo Clinic Proceedings, November 2012, p.1041