Spring 2019
PMH STORY
The PMH patient had had recent surgery. He fell and re-fractured his leg. Because of his advanced age, the surgery was complex, involving a rod and wire to hold the badly damaged bone so it could heal around this reinforcement. Recovery was difficult; he stayed in the hospital then went to a rehabilitation facility, and was finally discharged home with home health. Progress was good, but seven weeks later, there was pain back in that same leg, as before. The patient was seen the same day in the PMH office. X-rays showed that the bone was intact: there was no collapse. But the pain was severe, and the PMH doctor made adjustments in the pain medications. At this time, a call was placed to the surgeon.
The next day, x-ray reports and laboratory were back. The patient was calling on the phone, but at the same time, the orthopedic surgeon, whose office was many miles away, returned the call from the day before. The PMH doctor asked that the patient’s call be placed on hold as he talked to the surgeon. He told the surgeon that the patient had developed an unexpected worsening of his pain, and he asked if the surgeon would mind talking to the patient in a conference call. The surgeon agreed, and a conference call occurred between the patient, the surgeon, and the internist. The patient was able to explain his symptoms and what had happened. The internist was able to explain the laboratory results and the x-rays. The surgeon was able to talk to the internist and the patient and make a plan of care. This was a good phone call.
This is a PMH story because of our commitment to directness. Directness includes the desire to use modern tools for better communication between doctors, consultants, nurses, patients, and families. We don’t want there to be barriers. We want to improve communication at the time when it is most valuable.
Experiences like this are good for our patients, good for our consulting physicians, and good for families. Directness is better than indirectness.
Allan R. Kelly, MD, FACP
COGNITIVE FUNCTION AND EXERCISE
There is a great interest in cognitive impairment in the elderly. Researchers at Duke University looked at men and women over 55 years of age who had both cognitive impairment and cardiovascular disease risk factors. They randomized 700 patients equally to four groups: The first group exercised three times weekly for 12 weeks; the second group had dietary counseling roughly once weekly for 12 weeks; the third group had a combination of exercise and diet counseling, and the fourth group simply watched a 30-minute health education video once weekly. The researchers measured executive function and cognitive function. Diet counseling focused on the “DASH” diet (most importantly, a low salt diet).
Allan R. Kelly, MD, FACP
PREVENTING FRACTURES
Women over the age of 65 have a 40% risk of experiencing a serious fracture in their lifetime. There are a lot of common sense things that will help prevent fractures, and there are also medications doctors can prescribe.
Allan R. Kelly, MD, FACP
FRUIT CONSUMPTION VERSUS FRUIT JUICE
Fruits have fructose, not sucrose or glucose as the sugar component. A recent publication in BMJ looked at fruit consumption and the risk of diabetes. Data from three large studies were reviewed, the two largest being nurses health studies done 10 and 15 years ago. Approximately, 12000 patients in these large studies developed diabetes in the course of the study. Three or more servings of fruit per week in the diet were not associated with increased risk for developing diabetes, but there were differences between fruits. There was nearly a 25% diabetes risk reduction in individuals whose fruit consumption was primarily blueberries. Grapes, prunes, apples, pears, bananas, and grapefruit also lowered risk. Peaches, plums, apricots, oranges, and strawberries were neutral. Cantaloupe and melon increased the risk slightly.
Robert H. Kelly, MD, FACP
ATRIAL FIBRILLATION
Recent research from Australia showed abstinence from alcohol in moderate drinkers with atrial fibrillation resulted in a significant reduction in AFib recurrence rate, total AFib burden, and symptom severity. Additional benefits of abstinence included a 12-mm drop in systolic blood pressure and 7-pound average weight loss over the six months trial.
Robert H. Kelly, MD, FACP
VITAMIN E BACK IN THE NEWS
30 years ago, Vitamin E was attracting attention for its anti-inflammatory properties. Benefits were uncertain. As a way to reduce heart disease, it was not helpful. But there is still a role for Vitamin E. A study at the VA about five years ago showed that Vitamin E was as effective as testosterone in relieving symptoms in certain veterans.
Robert H. Kelly, MD, FACP
PMH QUOTATIONS
“Every human being of adult years and sound mind has a right to determine what shall be done with his body.”
Supreme Court Justice Benjamin Cardozo, 1914
“Eating alone will not keep a man well; he must also take exercise. For food and exercise work together to produce health.”
Hippocrates, a physician, 400 BC
“In truth, my failure to meet the local EHR requirements ended my academic practice. The administrative requirements for physicians that are buried in the EHR are now staggering, and the additional requirements inherent in changing reimbursement…are virtually impossible to fulfill.”
Donald Girard, MD, 2019
“Without changes in the values, culture, and environment of care, clinicians in hospitals will increasingly find themselves at odds with patients and family members, who, like us, watch many individuals come and go from their hospital room every day. We can find no one who is ultimately responsible for recovery. Even though I am a physician, I felt like I was standing in front of an express train of technology that I could not stop.”
Lenore Buckley, MD, 2019