Summer 2012
PMH STORY by Allan Kelly, MD FACP and Robert Kelly MD FACP
Our father, Gordon Kelly, started a practice in Fort Worth in 1953. Over the next 40 years, he served the citizens of our community, the hospitals, and his colleagues in caring for the sick and providing good advice to the healthy.
Gordon’s practice was devoted to private and one-on-one care of the individual. This represents an ancient and honorable tradition dating back to the days of Hippocrates. Over time, this basic relationship between a physician and a patient, a unique and personal relationship, has been the basis of medical and surgical care into the modern era.
Up to this point, it has not been demonstrated that there is something better than this traditional relationship. We hope that the development of medical teams, managed care, and diffusion of responsibility will be helpful and beneficial to our fellow citizens and our colleagues, but the benefit is uncertain.
Gordon died on June 29, 2012. His career is the basis of Premium Medical Home. His practice of medicine illustrates the ancient, honorable, and enduring human relationship between the sick and their physician. This is a tradition we treasure and promote at PMH.
CANCER SCREENING AND CONTROVERSIES by Allan R. Kelly MD FACP and Robert H. Kelly MD FACP
There are controversies in the areas of cancer screening. Two controversies emphasize reducing the frequency and intensity of cancer screening in otherwise healthy and vigorous people.
First, the annual visit for women for cervical cancer screening is changing. Years ago the American Cancer Society and the United States Preventative Services Task Force (USPSTF) recommended reducing pap smears to every three years. The recommendations changed as of 2012 to as little as every five years for women over 30.
RETHINKING THE ASSOCIATION OF HIGH BLOOD PRESSURE AND MORTALITY IN ELDERLY ADULTS by Allan R. Kelly MD FACP
Identifying and treating hypertension is a cornerstone of care for many adults. Over the past 20 years, mortality rates from cardiovascular disease have declined in part because of the power of antihypertensive therapy.
But later in life, the meaning of hypertension becomes more complicatd.
CONTINUITY OF CARE IS GOOD by Allan R. Kelly MD FACP
Patients like having the same doctor for a long time, a doctor who knows their medical history well. But does this actually improve outcomes; does it improve efficiency, cost, or morbidity?
The Mayo Clinic has used hospitalists for its inpatients for some time. A recent study, published in April 2012 by Chandra et al., looked at continuity of care among hospitalists and how it affected length of stay, healthcare costs and other outcomes. In one group, the same doctor remained in charge for the patient’s hospital stay. In the other group, the attending changed with every shift.
TELE-MONITORING OR PERSONAL COMMUNICATION? by Allan R. Kelly MD FACP
The scientific method involves creating hypotheses and then doing experiments to test the hypotheses. An example of this simply involves the question of how we take care of people as they get older and suffer complex illness. A study in the Archives of Internal Medicine looked at patients over the age of 60 who are at high risk for re-hospitalization because of chronic medical illness. Does increased screening or monitoring improve health?
NOT ALL SYMPTOMS ARE WARNINGS OF DISEASE by Robert H. Kelly MD FACP
Some symptoms are common in healthy people. Hunger, thirst, sleepiness are universal experiences. Symptoms found in more than 30% include nausea, muscle pains and aches, and anger. Fifteen percent of normal persons report difficulty sleeping, headache and head pains, tiredness or lack of energy, nervousness, feeling of tension, worry and dizziness.
SMOKING by Robert H. 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 2012
“The physician must have two special objects in view with regard to disease, mainly, to do good or to do no harm
” – Hippocrates Epidemics
“I love technology, but I think we are discovering that the physician-patient relationship is timeless. It cannot be abandoned . . “
– Andrew Verghese, MD, New England Journal of Medicine, May 17, 2012
“On a lot of patients, we cannot make the correct diagnosis. Some we diagnose, we cannot cure. But there is never a time in the practice of medicine that you can’t be kind to a sick man.”
– Tate Miller, MD; BUMC Proceedings, Volume 25, No. 3, July 2012, Page 256