Winter 2015
PMH STORY by Allan R. Kelly, MD FACP
Premium Medical Home has many components, including direct communication by telephone and cell phone between the doctor, the patient, and the patient’s family. A recent example of the value of direct communication involved an elderly lady whose husband could no longer care for her at home. He spent some time choosing an excellent assisted living facility. He chose one that was close to his home and that offered much of what he wanted. He moved his wife to the facility on a Wednesday. All seemed well, but five days later on Monday, the husband called the doctor with bad news. The facility could no longer care for his wife, and he would have to take her home the next day. He was told her needs were beyond the capacity of the facility because of behaviors the facility could not handle. The PMH doctor asked who had told him that his wife would have to leave and then set up a conference call between the husband, the facility charge nurse, and the physician. In this 3-way conference call, the specific concerns of the charge nurse were explored and discussed. The problem was amenable to medical treatment, and the doctor made recommendations for changes in medication and behavioral modifications. The nurse, the husband, and the doctor agreed on a plan of care over the next several days, and the facility agreed to keep the wife in their facility. Psychiatric consultation was also arranged.
The next day, the charge nurse reported that the behaviors had improved.
Later, the doctor’s office received a thank you note from the husband saying he had given up hope that his wife could stay in the facility and was surprised by the quick conference call. He further added that the nurses at the facility much appreciated the prompt assistance.
A doctor’s schedule can often be busy or hectic, but less so in a PMH office. PMH emphasizes the comfort and convenience of patients and their families. Comfort and convenience are not trivial, and enhance the experience of patients and families in their medical care.
SLEEP AND WAKEFULNESS by Robert H. Kelly, MD FACP
A recent report showed that of nearly 1000 patients referred to the Mayo Clinic for insomnia, 91% were found to be suffering from obstructive sleep apnea, not from simple insomnia. In such cases, treatment with standard sleeping pills would worsen the sleep apnea problem, the disease which was driving the patient’s insomnia: why is this so?
IMPROVING PRIMARY CARE by Allan R. Kelly, MD FACP
Continuous improvement is an important goal. We want to do a better job. One of the great interests in medicine today is to improve the outpatient care of patients with serious chronic illnesses. A recent study looked at how to improve care for high risk and chronically ill children. The study called the process “enhanced medical home.” I have reviewed many studies of how organizations can improve care: the results have been so-so. Some added more healthcare practitioners, nutritionists, social workers and consultants. But this study proposed “comprehensive care.” The goal was to have the clinic open 40 hours per week and staffed by a physician and nurses. Another big element was: “All patients had the cell phone number to directly reach one of the primary care clinicians at all hours.” There were direct conferences with ER doctors about emergency care. These are the same types of interventions that we emphasize in Premium Medical Home.
AMERICAN HEART ASSOCIATION, STATIN USE, AND EXERCISE by Allan R. Kelly, MD FACP
In 2013, the American Heart Association changed guidelines for the use of statins, doubling the number of Americans falling into the “treatment recommended” group.
HAND WASHING by Robert H. Kelly, MD FACP
There are at least two key elements to hand washing: the cleansing agent and the method of drying. The most important disease control for the doctor to do in the clinic, and for patients to do in their everyday lives, is to keep their hands washed at appropriate intervals. This is true for all of us prior to mealtime and after being in the restroom or public places. With adequate hand washing, significant reductions in infectious disease have been reported in hospitals, schools, and elsewhere.
PMH QUOTATIONS Winter 2015
“Most important of all, your patients may not see [things] the same way that you [physicians] do. We [patients] are the experts on what we value.”
J.McDonagh, JAMA Internal Medicine, 2014; 174 (12): 1889.
“Walking is man’s best medicine.”
Hippocrates
“The best preventive approach in frail older adults may sometimes involve doing less rather than more.”
M.Clarfield, JAGS 2010; 58: 2019.