Summer 2014
PREMIUM MEDICAL HOME STORY by Allan R. Kelly, MD FACP
Mr. Doe had excellent health most of his life, but had recently been having abdominal symptoms. Workup showed an unusual malignancy.
We made arrangements for consultation in Fort Worth. The patient was satisfied with the oncologic consultant, and we began a plan of treatment. But the patient was uncertain whether or not more should be done. The oncologist was a new doctor for Mr. Doe who didn’t know entirely how to “read” the doctor’s manner.
This led to repeat telephone consultation with his PMH doctor. The patient was trying to develop insight into the consultant’s style. The PMH doctor had known this consultant for decades, understood these issues, reassured the patient, and went over the details. Though helpful, the patient wanted more. Fifteen years earlier, for a malignancy that had been cured, he had ended up going to M.D. Anderson hospital. He wondered if he should go back.
The patient was getting ready to go on vacation, was anxious, and faced a potentially life-threatening illness with important decisions to be made. After hanging up from Mr. Doe, Dr. Kelly called M.D. Anderson and found the names of two doctors there who treated this specific malignancy. One of the doctors kindly and promptly called back. Dr. Kelly was able to review what M.D. Anderson could do for Mr. Doe. The M.D. Anderson doctor offered to see Mr. Doe at a time of convenience.
Dr. Kelly called back Mr. Doe. Dr. Kelly outlined what he had learned about what M.D. Anderson had to offer. Mr. Doe listened carefully, considering his options. He said that he would think about it some more, that he appreciated Dr. Kelly’s work, and it sounded to him like he would probably decide simply to stay right here in Fort Worth and work with his new oncologist.
When patients face severe issues, such as cancer, there are going to be a lot of questions. Many of those questions should be answered and should be resolved by the oncologist. But there will be issues of personality, manner, and judgment calls where an open, friendly, and professional relationship with a physician can make a big difference. But also, does the primary care doctor have time to search out answers and options for his patient? In many practices, driven by volume, short appointments, and insulation of the physician from telephone contact with patients, there may not be enough time. In the PMH practice, it is our commitment to make that time available to you at times of stress such as an important diagnosis, injury, or hospitalization.
THE IPHONE PANCREAS by Allan R. Kelly, MD, FACP
Diabetes is a major cause of illness and expense in the United States. Its complications include amputation, end-stage renal disease, stroke, and blindness. Diabetes for centuries was treated with dietary modification, weight loss, and calorie restriction. Since 1928, the development of insulin and the ability to easily measure blood glucose have transformed the lives of diabetics for the better.
OSTEOARTHRITIS PHYSICAL THERAPY by Robert H. Kelly, MD, FACP
A series of recent publications have examined the safety of “hypnotic” drugs, drugs like Ambien, Xanax and Ativan. This class of drugs is derived from Valium. They have been helpful in medical practice. Ativan, for example, has been used to treat anxiety, seizures, sleep disorder, and psychosis.
OBESITY by Robert H. Kelly, MD, FACP
Nutrition is good but too much food, eating more than we should, can cause obesity. Obesity leads to diseases such as sleep apnea and liver dysfunction, and it makes other diseases worse, like hypertension and diabetes mellitus. Obesity increases weakness, sickness, and risk.
ADVERSE EFFECTS OF MARIJUANA USE by Robert H. Kelly, MD, FACP
Though Colorado has made marijuana purchase and possession legal, there is debate about whether or not marijuana is harmful. It’s a safe bet that it is: medicines which adversely affect judgement and health, create dependency and habituation, and do not improve health are bad and should not be used.
PMH QUOTATIONS Summer 2014
“Above all, physician do no harm must be first and foremost, just in front of humility.”
Peter Weiss, MD, FACOG, UCLA School of Medicine, 2014
“For a generally healthy 85-year-old, the physical exam could reasonably be limited to blood pressure measurement and assessment of the body mass index.”
Michael Rothberg, MD
“The opportunity for doing wrong by careless talk to sick people and their families seems almost limitless.”
Sol Pepper, Doing Right, p.26