Winter 2012
PMH STORY by Robert H. Kelly MD FACP
I walked into my first medical care class. For two years, I had been studying medical science. Now it was time to learn about medical care: the clinical rotations. Surgery, Medicine, Pediatrics, all the sub-specialties: I had been waiting for this day.
A respected physician was at the front of the lecture room. There were 200 eager and intelligent medical students sitting in rapt attention. This was their first clinical lecture.
The gray-haired and thoughtful physician stood before us. He began his talk, and he said that he was there to tell us what the most important job was for a physician. We students leaned further forward. Newspapers were put down. Pens stopped clicking. Conversations were hushed. Four hundred eyes and 400 ears were tuned in to what the esteemed professor was about to say.
Many of us thought that he would say that cardiopulmonary resuscitation was the most important job that we would have, bringing those who had nearly slipped from our world back into life. Others thought that perhaps it would be the delivery, not only of a single birth, but perhaps twins or triplets. Others reasonably believed that the key issue would be the public health services of vaccination and prevention. Maybe research: the discovery of the next polio vaccination. Saving life. Preventing death. We all waited, knowing that our dreams of greatness would be confirmed by what our teacher was about to say.
“The first and most important job of a physician is to identify who is sick and who is well.” He let that thought sink in. The room remained silent. Clearly this could not be our most important job. It had to be something bigger. The doctor went on to explain.
Doctors are needed to identify those who are sick and who are well. If they fail to identify those who are well, then people who are not sick will be treated, subjected to examinations and procedures that are not necessary, that are associated with cost and risk. At the same time, to fail to identify those who are sick leaves those suffering without the treatment that could give them comfort. In the world today, a common belief is that our problems are caused by some illness; there is disease that accounts for what is wrong. However, that is not always the case. Often, a person is well, and the problems they experience do not arise from disease, but arise from living, the normal function of the body, and the challenges that we all face.
At the very start of helping another person as a physician, the first job, the job this professor told me about 31 years ago, is to identify who is sick and who is well. Assistance, care, treatments, advice, and counseling can follow.
CANCER SCREENING GUIDELINES by Allan R. Kelly MD FACP
The American Cancer Society is a helpful source of information about cancer and cancer screening. In our offices we use the American Cancer Society (ACS) Screening Guidelines or the United States Preventive Services Task Force (USPSTF) to help give our patients good advice. Though The American Cancer Society is reliable, it is not above criticism.
NARCOTICS OVERDOSE AND DEATH by Allan R. Kelly MD FACP
The Center for Disease Control in JAMA, December 14, 2011, reported on troubling increases in death rates from prescription pain medications.
Over the past 10 years, the sale of prescription narcotics has increased 400%.This is an extraordinary increase. But the increase is not consistent. For example, non-Hispanic whites and American Indians are three times more likely to have narcotic prescriptions than Hispanics and Blacks.
CARDIOVASCULAR DISEASE by Robert H. Kelly MD FACP
For the last 40 years, knowledge of risk factors for lifetime risk of cardiovascular disease has been accumulating. This work was first studied in a town in Massachusetts, Framingham, where the earliest evidence of risk factors was identified. There is now a Framingham Risk Calculator, for example, which uses standard risk factors to calculate the risk of heart attack and stroke.
LOWER BACK PAIN AND YOGA by Robert H. Kelly MD FACP
Back pain is common. The best approach to a strained back or common backache is to continue with usual activities and try to resume a program of non-strenuous walking. Back exercises and simple over-the-counter remedies are useful adjuncts. Extensive evaluations or dangerous treatments are usually not helpful and, if research is correct, are counterproductive.
PMH QUOTATIONS WINTER 2012
The number of medical students who choose to train for a career in primary care internal medicine has been falling for decades and has now reached a critical point. If the trend is not reversed, many patients in the US will be left without access to a primary care internist “
– Joseph S. Alpert, M.D. , Editor in Chief American Journal of Medicine, 2011
“The treatment of a disease may be entirely impersonal; the care of a patient must be completely personal.”
– Francis Peabody, M.D.(1881–1927) The Care of the Patient