Summer 2015
PMH STORY by Robert H. Kelly, MD FACP
A subscriber had dementia for many years. Her husband was dedicated to her care and made all her medical decisions. Like to many of us, things such as wills and legal documents seemed not as important as being sure that a loved one’s needs were met in a timely manner.
The husband died leaving the wife still confined by dementia but without her husband to speak for her. A will had been left but an advance directive or health care power of attorney had never been signed.
The PMH member, nearly 90 years old, was found to have a tumor affecting her brain. The prognosis was hopeless but neurosurgery carried a slim chance for temporary relief. There was no one there to speak for her. There were some remote relatives who were not in a position to make decisions for her.
Dr. Kelly was well-aware of the patient’s previous wishes and what her husband had wanted for her. With this in mind, Dr. Kelly asked another physician to consult. Together, the two doctors completed a health directive reflecting the husband’s and wife’s prior wishes. An appropriate Do Not Resuscitate order and referral to Hospice were made.
Because the PMH physician was familiar with both the patient’s and her husband’s wishes and desires over the course of years, there was an informed and respectful referral for care which in no way hastened or accelerated the end of her life, but allowed peace and quiet that might have otherwise been out of reach. At such a time, a well-established relationship with a doctor is important.
APPENDICITIS ALTERNATIVE TO SURGERY by Allan R. Kelly, MD, FACP
In 1886 a disease called typhlitis was theorized to be a consequence of appendiceal inflammation and rupture. Over the next 20 years appendectomy was refined. By the 1920’s, appendicitis was a surgical emergency treated universally with appendectomy.
CARDIAC ARREST AND BYSTANDER ASSISTANCE by Allan R. Kelly, MD, FACP
We’ve become familiar with the scenes from movies and such of trying to resuscitate someone whose heart has stopped. It is a complex process, and seems like something only doctors and nurses can do. But new research shows that simply pressing on the unconscious person’s chest 60 times a minute can make a difference in survival.
CIGARETTE SMOKING AND CHANTIX by Allan R. Kelly, MD, FACP
We have seen the ads on TV for drugs curing serious illness and then comes the long list of side effects, things that might happen if you take the drug. This creates a problem for patients. The doctor may recommend a drug to help them, such as Chantix, but the implied threats in advertisements on TV can overwhelm. Many patients reject use of the drug out of hand based on these intimidating lists of problems. Use is infrequent and there are few friends with experience to share.
DEMENTIA by Robert H. Kelly, MD FACP
In a recent study in the Journal of the American Geriatric Society (August 2014) Joseph, et al show that dementia is not necessarily associated with increased risk of traffic accidents. The author studied 31,000 participants involved in a high blood pressure study. All were community living and not demented. Some had mild cognitive impairment. The results showed a surprising correlation between cognitive impairment and motor vehicle accidents: Motor vehicle accidents decreased with cognitive impairment. No specific measure of driving or accidents per mile driven was made, though those with cognitive impairment were more likely to be infrequent drivers.
SORE THROAT by Robert H. Kelly, MD FACP
Having a sore throat can be uncomfortable. There is risk of bacterial infection, like streptococcus, and antibiotics are appropriate for such disease. Less than 10% of sore throats are caused by streptococcus, so the majority of sore throats do not require antibiotic treatment and are related, principally, to viral infections. Antibiotics can kill strep, and can lessen symptoms of strep throat. But should antibiotics be used for non-streptococcal sore throat? Generally speaking, no.
PMH QUOTATIONS Summer 2015
“Medication and surgery are cornerstones of our efforts to heal patients but honesty and respect…will always be paramount to our success as physicians.”
Jesse Raiten, M.D., JAMA, August 4, 2015
“When the doctor really cares about the patient everything else follows; the hard part is to align oneself to care, especially in the face of the often frenzied pace of medicine today.”
Michael Khan, MD, NEJM, March 2015
“I have sacrificed my ‘physician-hood’ to document nonsense [in the electronic medical record]. This documentation we do does not benefit our patient in any way. In reality, it just ensures that we are properly reimbursed by the insurance companies.”
Hujefa Vora, MD, Tarrant County Physician, July 2015