Spring 2021
PMH STORY
A member who lives out in the country had been on vacation with her family. She had just not felt well. After vacation, she called the office, and was invited to come right over.
She did seem uncomfortable and was not in good spirits. Vital signs were normal. Abdominal examination was slightly abnormal but nothing specific. A couple of calls found a radiology office that could do a CT scan of her abdomen right away. Laboratory was obtained and the patient went a few blocks away for the x-ray. After the x-ray was completed, the radiologist immediately called Dr. Kelly to advise about the finding of a ruptured appendix with abscess. She returned to the office. A call to Harris was met with good coordination by the admissions office and she went directly to the hospital where consultation and plans were made for care of the appendicitis.
We were not too busy. We are well aware of the resources in the community. We care for patients across different levels of care, and the patient was admitted to the hospital within an hour and a half of coming to the office. She did well with treatment and recovered.
This would not have been possible for that patient if there was no PMH. At times PMH doctors will see their patients at the emergency room, for that is a good way of getting immediate care, rapid laboratory turnaround, and admission to the hospital. But with PMH it is good to know that there are alternatives, and it is good to know who will be taking care of you in the hospital. We think PMH helps both doctors and patients.
Robert H. Kelly, MD, FACP
VIRTUAL VISITS WORK WELL
Continuing attention to the benefit of virtual visits, JAMA Surgery reported on virtual versus in office post operative visits. Typically, after surgery a person will go in to see their surgeon for an in-office post-operative follow up. But now, visits can be done either virtually or in person. Would that be as good? This was looked at in the research.
Robert H. Kelly, MD, FACP
VACCINES: SUCCESS & FAILURE
We have cared for patients with life-threatening viral infections since going into medicine. The danger was dramatized in the 1980’s with the emergence of the HIV epidemic, and then in the 90’s the hepatitis C virus epidemic. Both of these epidemics have continued to kill many thousands of Americans every year. Fortunately, we have developed excellent antiviral therapies so that if diagnosed, the infected persons can be protected by medical therapies.
Allan R. Kelly, MD, FACP
OBESITY AND THE PREVENTION OF DIABETES MELLITUS
Dr. Joslin of Massachusetts was a great leader in understanding and treating diabetes. In JAMA in 1921, he wrote about his peaceful New England village where he had cared for seven persons who had severe diabetes. He noted in his article that six of the seven had died during the course of treatment, but one had survived. He went on to say that six of the seven suffered with obesity, and those were the six that died.
Allan R. Kelly, MD, FACP
EGGS: BETTER THAN WE EXPECTED
The authors studied approximately 500 articles about egg consumption published 1966 through 2020. During the same interval, there had been changing opinions about egg and cholesterol intake. For example, in 2000, the American Heart Association recommended that less than 1 egg per day be eaten, but when the guidelines were re-written during the interval 2015 to 2020, there were no specified limits on egg consumption. There had been no placebo-controlled trials. Prior studies had been inconclusive. This study combined all the data: median follow-up 12 years, 1.5 million cases and 150,000 cardiovascular events. The authors compared 3 levels of daily egg consumption: 0, 1, >1.
Robert H. Kelly, MD, FACP
DIABETES AND DEMENTIA
Dementia is a major problem for the elderly. Diabetes is an increasing problem for the country. Authors from the University of Paris writing in JAMA explored the association between diabetes and the risk for dementia.
Allan R. Kelly, MD, FACP
QUOTES
“The economic disruption caused by COVID-19 obliges clinicians to protect people from the financial stresses of needlessly being turned into a patient.”
Gilbert Welch, M.D., 2021
“Medicine was never intended to be like this. With all the political hand-waving and jargon about taking care of patients, the expansion of government and private insurance companies into healthcare has put all of our best intentions in jeopardy.”
-Marc Siegel, M.D., 2020
“Cultivate equally well your hearts and your heads…doctors are given over now days to science.”
William Osler, M.D., 1899
“If it were not for the great variability among individuals, medicine might as well be a science and not an art.”
William Osler, M.D., 1892
“That is the core of our job, to pull out a person’s humanity and let that light the way.”
Jessi Humphreys, M.D., 2021