PMH @ Home Newsletter

PMH STORY by Allan R. Kelly, MD, FACP

An elderly patient suffered aortic stenosis, a type of heart disease which can lead to poor heart function. Ten years earlier he had coronary artery bypass grafting on two occasions without complications and the aortic valve did not warrant repair.

As the patient entered his 80’s, the aortic stenosis became more of a problem: he would need surgical treatment or suffer heart failure and premature death. But in the setting of two prior heart surgeries in an 80 year old, the feasibility of aortic valve replacement seemed virtually impossible.

The patient’s cardiologist referred him to a surgeon in Dallas doing a research study of percutaneous aortic valve replacement. The PMH internal medicine doctor was not part of this referral. The patient and his family asked the PMH doctor to review the protocols, talk to the doctors in Dallas and Tarrant County and share his opinions about the options. The patient benefited by talking about his problem with his PMH physician.

The PMH doctor also discussed the case with the surgeon in Dallas and made sure the surgeon had all the information he needed for enrolling the patient in the research study.

The implantation of the experimental valve went well, relieving the patient of his heart failure symptoms and resolving the problems of heart weakness. Upon leaving the hospital, the surgeon commented to the family, “Your primary doctor really cared.”

Your PMH doctor is available to help you with difficult questions. Your private doctor, though no substitute for skilled sub-specialists and surgeons, is likely to have information and insight to help understand options. This direct availability and counseling is not described in CPT codes. We believe that this type of availability helps define a Premium Medical Home experience, like having a doctor in the family.

TO FORGET IS HUMAN by Robert H. Kelly MD FACP

Memory problems are common. But when do memory problems become an illness: Dementia or Alzheimer’s disease? There are other reasons why memory may seem impaired………

EXERCISE PROTECTS AGAINST COGNITIVE DECLINE by Allan R. Kelly MD FACP

As reported elsewhere in PMH@ Home, cognitive decline is a common problem. We all know that memory changes as we get older, and many of us find it increasingly handy to keep a list in our pockets to help us remember………..

COUGH: OFTEN MORE BARK THAN BITE by Robert H. Kelly MD FACP

Cough is a common symptom. An acute cough is one described as lasting one to two weeks; subacute cough lasting three to eight weeks; and chronic cough more than eight weeks…………

OVARIAN CANCER SCREENING by Allan R. Kelly MD FACP

Ovarian cancer is an uncommon but often lethal form of cancer. While we have reasonable screening for cervical, colon, and breast cancers, the benefits of screening for ovarian cancer is unproven. In fact, the United States Prevention Services Task Force recommends against screening for ovarian cancer.

PMH STORY by Allan R. Kelly MD FACP

An elderly patient suffered aortic stenosis, a type of heart disease which can lead to poor heart function. Ten years earlier He had coronary artery bypass grafting on two occasions without complications and the aortic value did not warrant repair…..

Medical Quotes:

“Reducing medicine to economics makes a mockery of the bond between the healer and the sick.
” - Pamela and Jerome Groopman MD

“When we ourselves are ill, we want someone to care about us as people, not as paying customers, and individualize our treatment according to our values. ” - Pamela and Jerome Goodman MD

PMH STORY by Allan R. Kelly, MD, FACP

A Premium Medical Home subscriber was traveling to visit family. While in New York City on Saturday morning, she noticed pain and discomfort in the hip. Shortly thereafter, she noticed a rash and was uncertain of the cause, but it was both painful and visible. She called her Premium Medical Home doctor for advice.

Talking with the patient, the diagnosis was not immediately clear. The doctor knew that an examination of the rash would probably settle the diagnosis. He asked the patient to use her cell phone to take a picture of the rash and send it to him.

The picture was duly sent within two to three minutes. The photo demonstrated a rash consistent with shingles.

The doctor called the subscriber back and reviewed her symptoms and medical history again. The doctor asked her to look out the window of her hotel and see if she saw a pharmacy. There was one right across the street. The doctor called the pharmacy and ordered medication for shingles.

On returning to Fort Worth two days later, the patient had a consultation with a dermatologist, who confirmed the diagnosis that was made over the weekend. Medications were continued. Early treatment reduces the pain and suffering of shingles in mature patients. This patient got treatment quickly and conveniently.

Premium Medical Home encourages patients and doctors to work together in a way that is comfortable and convenient. We believe that this focus is not only valuable itself, but improves medical care, improves outcomes, and improves satisfaction. The patient would have received the same treatment, perhaps, in an emergency room or urgent care clinic. But ready availability of her doctor allowed for more comfortable, convenient, and timely evaluation. Such options are a benefit of your PMH subscription.

This is why we have changed our practice to the Premium Medical Home model. We believe that by focusing on the Premium Medical Home model, we can find better ways to help our patients.

ELECTRONIC HEALTH RECORDS by Allan Kelly MD FACP

There is a lot of interest in using electronic health records. Recent legislation from Washington awards doctors incentives of up to $55,000 over three to four years if they will convert their offices from paper records to an electronic record.......

PREVENTING DIABETES by Robert Kelly MD FACP

Pre-diabetes is common. It predicts a high probability that in the person’s future, diabetes mellitus will develop.In the last 20 years there have been significant changes in the average American’s diet and activity. One measure of this was that in about 1990 only one of the 50 states had…..

SMOKERS SUFFER by Allan Kelly MD FACP

We all know that smoking is bad for our health, but did you know that current smokers suffer poorer outcomes of other illnesses, even when those illnesses are unrelated to smoking? A smoker may philosophically accept the fact that ……

CHANGES IN DIET/LIFESTYLE AND LONG TERM WEIGHT GAIN by Robert Kelly MD FACP

A recent study from the National Institutes of Health (this is not an article on wasteful government research!) looked at food habits associated with weight change. Four items were each associated with significant weight gain…….

Medical Quotes:

“Although scientific knowledge is available to all, there is a vast difference between the best and worst of doctors, that difference representing the art of medicine.” - D. J. Weatherall, M.D., 2011

“While medicine is a science, in many particulars it cannot be exact, so baffling are the varying conditions of human life. ” - Charles Mayo, 1909

PMH STORY by Robert Kelly, MD FACP

“My direct access to you and your attention to the details of my care is worth a million.”

A gentleman’s pain had begun unexpectedly. There were questions whether or not the pain was caused by a disease which would require surgical intervention. He had undergone cervical spine surgery in the past for a painful condition and had done well, so the possibility of another surgery was considered.

After seeing the patient in the office he was admitted directly to the hospital. Over two days, he was seen by subspecialty caregivers to assess why this pain in the lower back was occurring. Unfortunately, an emergency at home prompted him to have to leave the hospital unexpectedly before definitive care.

At home, after addressing his emergency, pain, nausea and vomiting persisted. He called his PMH doctor and reported that the pain was not improving and he was having recalcitrant nausea and vomiting. He was again directly admitted to Harris Hospital for further care.

In the hospital, a team from neurosurgery, urology, and palliative medicine, including an anesthesiologist, saw the patient. After five days in the hospital with attention to pain relief he showed no need for surgical intervention, and the pain began to abate. He was able to eat, and the nausea and vomiting resolved.

The patient was pleased by the way, at each step, he had been able to reach his doctor and describe his complaints. This led to prompt effective intervention. His quote appears above.

Subscribing to Premium Medical Home and being a patient in a Premium Medical Home benefits subscribers and patients. It allows direct access. It provides attention to interdisciplinary care and the attention, when appropriate, of a subspecialty team coordinated by a trained expert physician who knows the patient well. This is a great value to patients and family.

DO STERIOIDS HELP JOINT PROBLEMS by Allan Kelly, MD FACP

Common joint and tendon problems can improve with exercise and weight loss. Pain relief can be achieved with drugs like Tylenol, and elastic supports can be helpful at the wrist and the ankle and the elbow. Other interventions are less certain......

THE RISK OF BLOOD CLOTS FROM LONG FLIGHTS by Robert Kelly, MD FACP

The risk of blood clots goes up after a long airplane ride, The absolute risk is low, less than 1%. In an average group of 400 passengers on a flight lasting for 12 hours, it is probable that one person may have an episode of blood clot from the flight.....

FATIGUE by Allan Kelly, MD FACP

Fatigue is a common symptom for patients making a doctor appointment. Fatigue is something that we all experience: It can be a part of our daily life, even in people who are healthy and strong. Fatigue is also a common manifestation of illness. Infection, malignancy, metabolic diseases, diabetes, and others will, in the natural history of the illness, cause fatigue........

NEW CANCER STATISTICS by Robert Kelly, MD FACP

The March issue of CA, a cancer journal for physicians, included a review of cancer incidence. Worldwide, approximately one third of cancer deaths were potentially avoidable through reducing major risk factor, including tobacco use, unhealthy diet, physical inactivity, infection, unsafe sex and alchol use.........

Medical Quotes:

“Medicine, at its fundamental, is still about suffering, healing, and comforting; it is about individuals; it is about relationships and trust; it is about stories…… Concern of coding, billing, documenting, administration, computers, surveys, rules, regulations, and politics have increasingly occupied my mind and space like an intracranial tumor.”- Michael Monroe, JAMA, Volume 305, No. 12, Page 1176 to 1177

VACCINATIONS AGAINST CANCER by Allan R. Kelly, MD FACP

Vaccinations have been a great gift to mankind. Some were called miracles. The development of the first vaccination for smallpox saved hundreds of millions of lives. The benefits can hardly be exaggerated, and now we see that the disease smallpox is effectively eradicated.

FULL BODY AIRPORT SCANNERS by Allan R. Kelly, MD FACP

Are full body airport scanner safe? The Transportation Security Administration (TSA) uses backscatter x-ray to screen travelers. We know that many of our Premium Medical Home members will be going through airport security, and we want to let you know what we know about the new back scanner machines.

NUTRITIONAL SUPPLEMENTS: Less May Be More by Robert H. Kelly, MD FACP

Nutritional supplements continue to receive a lot of attention. Shelves of stores are loaded with different supplements. Within a single class, such as vitamin D, there multiple different preparations, origins, strengths, and promised benefits.

PREVENTIVE CARE: Prostate Cancer Screening by Robert H. Kelly, MD FACP

The United States Preventive Services Task Force (USPSTF), a national organization that looks at clinical effectiveness of screening and prevention methods, examined the records of nearly 400,000 asymptomatic men 45 to 80 years old. Screening with digital rectal examination and PSA was done.

Medical Quotes:

“All patients are interesting, but not all doctors are interested.” - Herb Fred, M.D., Houston, Texas

“First I will define what I consider medicine to be. In general terms, it is to do away with the suffering of the sick, to lessen the violence of their diseases …” - Hippocrates

FITNESS AS PREVENTION-A SCIENTIFIC FACT by Robert Kelly, MD FACP

“Doctors work to base their recommendations on science, and on treatments that when tested objectively, in unbiased fashions, are known to deliver benefits. This is as true for behavior recommendations as it is for medical treatments….”

PREVENTION OF HEART ATTACH, STROKE AND DEATH IN DIABETICS by Allan Kelly, MD FACP

“Diabetics and all adults are at risk for vascular complications. Hopefully, your doctor can help you to prevent and delay such problems…..”

CANCER DEATHS DECREASING by Allan Kelly, MD FACP

“Recent reports from the American Cancer Society indicate decreasing rates of cancer over the past ten years. Overall, cancer diagnoses have been declining approximately 1% per year over the 8 years and deaths have declined 1.6% per year over the past six years…”

A PMH STORY – DIRECT CONTACT YIELDS DIRECT RESULTS by Robert Kelly, MD FACP

An elderly woman was discharged from the hospital after a difficult illness and transferred to a long-term care facility or nursing center. She and her husband were early subscribers to the Premium Medical Home.

It was not a long term care facility that Dr. Kelly visits so she was assigned to the care of the facility medical director. The patient and her husband preferred this facility because it was more convenient for him to visits.

After she was discharged from the hospital in the afternoon, her husband accompanied her to the nursing center. When he left he saw the security system at the front door. He did not understand how it worked, but saw it would be locked in the evening. When he left for home that evening, her medicines had not yet arrived. Arriving home, finishing supper, he tried to call the facility to see if she had been given her evening medicines.

After calling many times, he realized no one was answering the phone. Alarmed, he called Dr. Kelly on his cell phone. The call was directly answered. Dr. Kelly listened to the story and recognized that the phone number the husband was dialing was not the best number to reach the nurses’ station. In a 3-way conversation, Dr. Kelly called an alternate number and got the nurse on the phone. The husband’s intuition was correct – the needed medicines had not arrived and delivery was not certain.

The nurse provided the simple code for the front door lock so that the husband could come and go as he wished. Speaking with Dr. Kelly, she also agreed that if the husband were to bring the medicines from home, the nurse would see that they were promptly given to the resident and avoid any further delay or anxiety. This was a great relief to the husband and a great comfort to the wife because of her painful symptoms.

Such is the usefulness of direct contact with your PMH doctor. Knowledge and understanding about how long-term care facilities, hospitals, and other parts of healthcare systems operate was immediately available to the subscriber. This kind of enhanced access solved this problem and also relieved alarm, worry, and uncertainty. In a standard medical office, a phone call expressing concern about an inability to complete a phone call to a nursing home or getting a combination to a security door would generally not be met with direct help and intervention. At a Premium Medical Home, we are available to help with the medical needs that are important to you.

“It’s a poor government that does not realize that the prolonged life, health and happiness of its people are its greatest asset.” – Charles Horace Mayo

PMH STORY by Allan R. Kelly, MD FACP

On Sunday morning a young man wakes up and discovers a rash. What should he do? Rashes can be serious – the patient needs to see a doctor soon, but the doctor’s office is closed on the weekend. The young man started a new and vital medication two weeks ago, and this could be an allergic reaction.

As a PMH Subscriber, the young man has access to his doctor 24/7, so he is able to get in touch with his doctor immediately via cell phone, even on Sunday morning. In this case, the doctor is on his way to the hospital to make rounds when he receives the call. He meets the young man at the hospital, allowing him to bypass the ER. The doctor quickly assesses the problem, determines that the rash is a reaction to the new medication, recommends care, and schedules a follow-up visit, all within an hour.

For a patient who is not a PMH Subscriber, emergency care necessitates visiting the emergency room or an urgent care clinic. These options are time-consuming, expensive, and require the patient to be treated by an unfamiliar doctor who has no prior knowledge of the patient’s medical history, conditions, or medications.

For PMH Subscribers, enhanced communications options enabled the young man to see his primary care doctor without delay, eliminating hurdles and expenses. As the patient’s primary care provider, the PMH doctor is familiar with the patient and can recall critical medical information from prior visits. And importantly, the follow-up visit will be with the same doctor who examined and treated the patient on Sunday.

We believe that such availability and responsiveness improves care while simultaneously reducing costs. In this scenario, the patient had a better experience at a lower cost, and he can be confident in the doctor’s ongoing attention and care. We call this a Premium Medical Home experience.

RISK ASSOCIATED WITH CT SCAN FREQUENCY by Allan Kelly, MD FACP

“Healthcare topics are receiving significant coverage in the media, and one issue that has received considerable public attention concerns testing and screening procedures. Medical institutions are changing their recommendations for frequency of screenings like mammography, and physicians have to balance these recommendations with what is appropriate for their patients…….”

DISCUSSION ABOUT A FORT WORTH MEDICAL SCHOOL by Robert Kelly, MD FACP

“Fort Worth is the largest city in the country that does not have an MD-granting medical school, but that may change soon. The University of North Texas has proposed to open an MD-granting, or allopathic, medical school in Fort Worth……”

CAUSES OF CANCER IN THE UNITED STATES by Robert Kelly, MD FACP

“The four most common cancers in the United States are cervical/prostate cancer, gastrointestinal cancer, lung cancer and breast cancer. The most common cause of cancer death is lung cancer, followed by cancer of the colon…..”

A PMH STORY – SUNDAY MORNING MEETING by Allan Kelly, MD FACP

“Rashes can be serious – the patient needs to see the doctor soon, but the doctor’s office is closed on the weekend. The young man started a vital medication two weeks ago, and this could be an allergic reaction…”

“The practice of medicine is predominantly a humanistic act. Physicians must care about their patients, and they must constantly improve their scientific knowledge about disease. To care and not know is dangerous. To know and not care is even worse. Caring and knowing must be combined to succeed in doctoring.” – J. Willis Hurst, MD