Fall 2018

PMH AND HOSPICE – A PMH STORY

One PMH principal is continuity of care by direct relationship with patients and their families. This is especially important during a long and complex illness. It is also important at the end of life.

A PMH couple were ill. The wife had dementia and the husband was the caregiver. But the husband developed pancreatic cancer. The wife was moved to a memory care unit so that the husband could meet with doctors to begin treatment. But treatment failed, and there was no hope for further intervention to prolong his life or to cure the cancer. In time he would lose his ability to care for his wife as he dealt with his own terminal illness. Hospice would be a help to him and the family endorsed this. The family asked, “Dr. Kelly, you will take care of our father when he goes on hospice, won’t you?”

That Saturday, Dr. Kelly sent a brief text message to a hematology colleague about the patient and asked if he would be able to see the patient early in the coming week. Records were faxed to the hematologist’s office.

Almost all primary care doctors have given up following their patients on hospice. Often they simply don’t have enough experience, never having served as a hospice medical director nor the time. We have talked to many hospice representatives who tell us it is rare to find a doctor who will follow a patient on hospice.

When the husband transitioned to hospice, the PMH doctor made rounds and talked to him at each visit about his much beloved wife, whom the doctor visited regularly at the memory care unit. When the family came to be with their dying father, they could also talk to the PMH doctor about their mother. This helped them care for their mother and father. They knew that the doctor was there for their mother and father. And the dying husband had confidence that his wife would be cared for.

The father died. The mother lives on with Alzheimer’s, still cared for by the same physician who knew her at a better time, who is able to talk to her about her husband whenever her thoughts turn that way. At times, she still recognizes her doctor.

PMH is about continuity, directness, and willingness to follow the patient even on hospice, which is good for the patient, and the family. PMH gives preeminent importance to the feelings and wishes of the patient and the patient’s family.

Allan R. Kelly, MD, FACP

A VACCINE THAT PREVENTS CANCER

Cervical cancer is a common cause of cancer and cancer death in women. The American Cancer Society for decades recommended annual pelvic exams and every three year Pap smears for women. Cervical cancer deaths in the United States were markedly reduced by screening, but cervical cancer remained one of the top 5 causes of female cancer death despite this effort.

Allan R. Kelly, MD, FACP

 

UNEXPECTED BENEFITS FROM AN ANTIVIRAL DRUG

In 2013, the first anti-hepatitis C virus antibiotics were approved. These antiviral antibiotics are highly effective with success rates of 98% to 100%. Many people with chronic hepatitis-C are cured within weeks of taking antibiotics. A recent report reveals an additional benefit. There is a shortage of organs for transplantation. Many of the people who die and have organs that would be good for others cannot donate because they have hepatitis C infection. These people died before they were treated and since hepatitis C was present, these organs could not ethically be used for transplantation.

Allan R. Kelly, MD, FACP

 

NARCOTIC TREATMENT OF PAIN CONTROL

A recent study looked at the effectiveness of narcotic medications for the treatment of musculoskeletal complaints. Patients were randomized to two groups: either treatment with narcotics or non-narcotics for 1 year. Outcomes studied were pain and function.

Robert H. Kelly, MD, FACP

 

INCREASED RISK CAN MEAN BETTER OUTCOMES:A HIDDEN COST OF FREE CARE.

There are a large number of patients waiting for a transplantable kidney. Donors are rigorously screened for infectious and cancer risk in order to reduce risk: IV drug users, men who have sex with men, and people with certain habits are excluded from the donor pool because of the risk of occult viral infection (HIV and Hepatitis C specifically). Donors with these habits are called increased risk donors. These viruses may be transmissible but not detectable by blood tests. Fundamentally, accepting a transplant from an increased risk donor means to take on a burden of risk or uncertainty about getting Hepatitis C or HIV. This risk could be avoided by waiting for a safer donor. The risk is measurable from these increased risk donors: 1/1,000 risk of hepatitis C and 1/10,000 for HIV infection after transplant. Risk is like a cost the patient has to pay with the coin of uncertainty, anxiety, and possible medical treatment, even though no dollars are paid.

Robert H. Kelly, MD, FACP

PMH QUOTATIONS

“He taught by example, the best of all methods, rather than precept. His associates were deeply impressed by his habits of thought and work; his enthusiasm, his painstaking accuracy, his close observation and his never failing interest in studying problems…”

J.M.T. Finney, M.D., 1940, regarding Halsted, the great surgeon.

“We must be careful too not to lose sight of the fact that we are dealing with human beings, whose individual feelings and interests must ever be respected and guarded. It is axiomatic that the doctor shall be well trained scientifically, but in the treatment of disease, the human element is sometimes of even more importance than the scientific.””

J.M.T. Finney, M.D., 1940

“Teach thy tongue to say, ‘I don’t know.”

Maimonides, a physician, born 1135

“Every patient, even the most degraded…should be treated with the same care and regard as though he were the Prince of Wales himself.””

Joseph Lister MD, 1864

“But the essence of medical ethics, the Golden Rule, has been largely overlooked.”

Michael DeBakey, MD, 1968

“Let it be remembered that the true physician takes care of his patient without claiming to control the diseases in all cases.”

James Jackson, MD, (1856)

PMH FEES

Dr. Robert Kelly’s new PMH fees will go into effect
on January 1, 2019 as posted on
www.premiummedicalhome.com
You will be billed for the new rate on your annual PMH renewal date

PMH@Home is for information purposes only.
Consult your doctor for more information