Fall 2017
PMH STORY
HOSPICE
By now, all older adults know that hospice is a choice they may consider for themselves or their loved ones as illness progresses and goals change.
The PMH patient was an elderly gentleman with progressive neurological disease causing paralysis. His wife had worked for years to care for him at home even as he became bedfast. The spouse took beautiful and effective care of her husband.
As he worsened, he could no longer breathe adequately. Should he transfer to the hospital for usual, aggressive care, or remain at home? The PMH doctor met with the family and the patient in the emergency room. Respiratory failure was impending. At the ER, we could quickly assess that this was nota reversible disease. The patient and his wife were asked, “Do you want to be cared for at home or do you want to be cared for in the hospital?” Both firmly expressed they wanted him to be cared for at home. A daughter, in the room, also wanted his care at the home. With this decision, hospice was offered and a referral completed.
His PMH doctor talked to the hospice team before he left, and also talked to the familyabout his condition and family goals and wishes. The family returned home but delayed starting hospice; “it didn’t feel quite right.” She wanted to think about it another day or two.
Two days later, she called and said she wanted to talk to a different hospice company and the PMH doctor made that referral. The following day, the hospice referral was completed and the family had signed up with the hospice company. Thankfully, the family had the time at home that they treasured.
The patient’s wife and children needed time, conversation, and the options to explore their own best choice and their own feelings and decisions. The time required to explore and understand is important and worth taking.
We believe that where there is good communication between patient, doctor and family, the decisions will be more gentle, more careful, and better for all concerned. This is why we have created PMH. We want the patients and families to have time, attention, and thought appropriate for the difficulty and magnitude of the decisions they face.
Allan R. Kelly, MD, FACP
PMH FEES
A REMINDER – Dr. Allan Kelly’s new PMH fees went into effect on October 1, 2017. They are posted on our web site, PremiumMedicalHome.com and are also available by calling the office. You will be billed for the new rate on your annual PMH renewal date.
Allan R. Kelly, MD, FACP
EXERCISE, COGNITION AND FALLS IN OLDER ADULTS
Falling is a big problem for the elderly. Falling can cause injury and loss of independence,and force a move out of the home and into assisted living.
Allan R. Kelly, MD, FACP
REDUCING NURSING HOME HOSPITALIZATIONS
Medicare wants to reduce the hospital admissions of nursing home residents. Currently, admissions are based on judgment by nurses and physicians depending on patient needs.
Allan R. Kelly, MD, FACP
CORTICOSTEROIDS FOR IRRITATING COUGH
Patients with asthma predictably respond well to steroid therapy along with antibiotic treatment for acute bronchitis. About 15% of adults without asthma who have a lower respiratory tract infection (like bronchitis or a cold) are treated with corticosteroids. But after the acute infection, some are often left with lingering cough. The role for antibiotic treatment is negligible in reducing symptoms. Would steroids help reduce these symptoms in the person without asthma?
Robert H. Kelly, MD, FACP
OSTEOARTHRITIS
The National Institute of Health and Duke University studied whether intensive and complex intervention for the treatment of osteoarthritis, (a universal, degenerative condition)can make a difference
Robert H. Kelly, MD, FACP
PMH QUOTATIONS FALL 2017
“The experience in that tiny hut [in Africa] was a reminder to stop talking, be still, and focus on the patient. The patients will tell us what’s wrong with them if we listen.” Ann Elise Kutzler, second year medical student, 2017.
“Listening and thinking are still what patients expect from their physicians.”
Frank Sparandero, M.D., September 2017
“No disease that can be treated with diet should be treated by any other means.”
Maimonides. A Physician, 1135-1204 AD