Winter 2017
PMH STORY – THANK YOU
A big and heartfelt thank you to all of our patients and their families.
For many years, we have invited medical students to work in our offices. We want medical students to have the opportunity to work with internists who are active in their community, office, nursing home, hospital, and other facilities where our patients receive care. This is a voluntary effort on the part of the doctors. No reimbursement or payment is sought or expected, and the experience contributes to education and training of doctors for the future. Our work is endorsed by UNT Health Science Center (we are both adjunct clinical assistant professors) and by The American College of Physicians where Dr. Allan Kelly received the Texas Chapter Emerald Award for service in education.
It is your choice whether to allow the student to be part of your care. We believe that having a student involved does not distract from good care and at times has positively contributed. There will be times when a patient doesn’t want a student involved, when they don’t want to meet a new person, when they just want to work with the doctor with whom they are familiar. When a student is introduced to participate in your care, please don’t hesitate to say you would rather see the nurse or doctor. At times when you are open to working with these young people, we thank you very much. We aim to limit student participation to just two or three months out of the year.
Premium Medical Home is about running an office in a way that is good for our patients, their families, and the community. Helping young doctors and encouraging them to work in our city is good for everyone.
Allan R. Kelly, MD FACP and Robert H. Kelly, MD FACP
FALLS
When you are young, falls are embarrassing, and sometimes may be dangerous. At any age, no one wants to fall and all of us want to avoid injury.
As we age, falls are more likely to be dangerous and should be reported to your doctor. Your doctor will then likely consider what may have played a role in the fall and what measures can be taken to avoid future falls. At any age, medications should be reviewed. Strength and balance training may help.
READY FOR DISCHARGE?
When a person is admitted to the hospital, there may be uncertainty whether they are ready to go home when discharge arrives. The doctor and the nurses may all feel good about that discharge, but from time to time the patient or the family is not so sure and wonders if they are being sent home too soon. A recent report in The American Journal of Medicine looked at all discharges from hospitals in Edmonton, Alberta from October 2013 until November 2014. Patients discharged were questioned about whether or not they were ready for discharge. Twenty-three percent of patients discharged reported “being unready for discharge.” Being unready for discharge was associated with disability, cognitive impairment, dementia, poor education, and multiple hospital admissions. But the risk for hospital readmission and the risk for death did not differ between the two groups over the course of the next 30 days. Specifically, only 15% of those who felt unready for discharge were readmitted, versus 18% of those who felt ready for discharge.
OVARIAN CANCER SCREENING DOES NOT WORK
Doctors recommend cancer screening in order to reduce death rates and disability from cancer. We have found that cancer screening is successful for some cancers, but not for others. One of the most important lessons of the past 20 years is the failure of ovarian cancer screening. An American study published in 2011 randomized 68,000 women between ages 55 and 74 to screen for ovarian cancer with combined blood testing and pelvic sonography. There was no difference in death rates, nor was there any difference in stage of cancer upon diagnosis. The screening failed to save lives.
METFORMIN AND COLON POLYP PREVENTION
It looks like a common medication, metformin, may reduce colon cancer risk with medical treatment. In a recent experiment, people who had had polyps removed at colonoscopy were told to come back in one year. One-half of these persons were randomly assigned to take metformin 750mg daily; the other one-half were given placebo.
NARCOTICS AND CHRONIC PAIN
In persons suffering chronic back pain, hydrocodone (an opioid narcotic) was compared with placebo to see if it was effective for chronic pain control. Pain was measured on a 100-point scale: a change in pain score of 20 points was considered significant. Nearly 50% of patients treated with hydrocodone, compared to placebo, withdrew because of side effects. Moreover, those continuing to use hydrocodone did not receive significant pain relief. Opioids, compared to placebo, reduced pain insignificantly for those patients with back pain. Other research shows that long acting opiates appear to increase the relative risk of death more than 50% compared to persons whose back pain is treated with antidepressants or medications such as gabapentin.
PMH QUOTATIONS WINTER 2017
“Clinical excellence remains the best medicine.”
Burke Cunha, M.D., 2017
“I now see that the medical system is layered to shield the doctor from direct contact with the patient (except for the appointment time).”
Carl Norden, M.D., 2016
“The computer has taken over our offices. This rise of the machines…has led to more and more angst and physician burnout…we work harder, with longer hours, and more time doing meaningless, useless tasks. The physician patient relationship has been eroded almost irreparably because we so often spend too much time staring at computer screens and not enough time actually connecting with those we serve.”
Hujefa Vora, M.D., 2017