March 3rd, 2011 by StevenWilkinsMPH in Opinion, True Stories
Tags: Aging Parents, Anticipatory Care, Elder care, Elderly People, Family Practice, General Medicine, Geriatrics, Internal Medicine, Older Adults, Post-Fall Syndrome, Predictable Health Issues, Predictions In Medicine, Preventing Falls and Fractures, Preventive Health, Preventive Medicine, Primary Care, Prone To Falls, Quality of Life, Seniors Health, Steven Wilkins MPH, Unnecessary Medical Care
No Comments »
We hear about stories like this all time: An elderly person falls and breaks something — a hip, a wrist, or an arm. Soon what once was a healthy, independent senior begins an inexorable downhill slide. Such is the case of my 89-year-old mother who recently fell and broke her wrist.
Turns out that 30 percent of people age 65 and older fall each year. Predictably, seniors with the following risk factors are more prone to falls:
- Using sedatives
- Cognitive impairment
- Problems walking
- Urinary tract infection
- Eye problems
- Balance issues
Similarly, when a person does fall, a cascading series of predictable clinical events occurs. It even has a name: “Post-fall syndrome.” This syndrome is characterized by things like fear of falling again, increased immobility, loss of muscle and control, lack of sleep, nutritional deficits, and so on. Seniors susceptible to falls also have higher rates of hospitalization and institutionalization.
What strikes me about falls among the elderly is that they are seemingly predictable events. And once a fall does occur, the consequences seem pretty predictable as well — enter post-fall syndrome. So if falls and their consequences are so predictable, why aren’t primary care physicians more proactive in terms of:
- Preventing falls?
- Treating post-fall syndrome?
In the case of my mother, her primary care physician and orthopedist were both very diligent at treating her episodic needs (i.e. her pain and broken bones). But little attention, if any, was given to assessing her long-term needs, such as nutrition, inability to do anything with her left hand (she’s left-handed), sensitivity to new medications (she never took drugs because they make her loopy), gait analysis, and depression counseling. Read more »
*This blog post was originally published at Mind The Gap*
February 28th, 2011 by EvanFalchukJD in Health Policy, Opinion, True Stories
Tags: A Third Place In Healthcare, Best Doctors, Better Healthcare, Doctor Patient Relationship, Evan Falchuk, General Medicine, Healthcare reform, Incorrect Diagnoses, Making Patients' Lives Better, Medical Errors, Misdiagnosis, More Healthcare Options, Overworked Doctors, Quality Care, See First Blog, Starbucks, Wrong Treatment
No Comments »
Media reports on misdiagnosis continue to mount. A recent study on patients with Alzheimer’s found that half had been misdiagnosed. Half.
Another headline blared “4 out of 10 patients being misdiagnosed.” The article encouraged patients to “see another doctor” if they are worried about their diagnosis.
You know what it makes me think about? Starbucks. Why? Because the way Starbucks revolutionized coffee drinking shows a way forward for healthcare.
Starbucks realized that since our lives focus on two places — home and work — most of us don’t have a “third place” to go. A place where we can be free of everyday distractions and take care of ourselves. Starbucks set out to create that “third place” by making its shops comfortable, inviting places. It works. “Third place” makes customers’ lives better — and Starbucks has almost 20,000 shops to prove it.
It’s time for a kind of “third place” in healthcare. Healthcare focuses on two places, too: The doctor’s office and the hospital. Both places are difficult for patients. Patients complain of not getting enough time from their overworked doctors, and studies of things that go wrong in hospitals are equally disturbing.
There really isn’t a “third place” to go to in healthcare. Somewhere that you can step outside of the difficult process of being sick. Somewhere you can get a quiet, clear perspective of what is going on.
Now, some people are lucky and can turn to relatives or friends who are doctors to provide some of that “third place” experience. But most people can’t. At Best Doctors, we’re creating the experience of a healthcare “third place.” We do it by taking the time to review each case, have doctors think about what’s happening, consult with experts, and share advice. Read more »
*This blog post was originally published at See First Blog*
February 26th, 2011 by AndrewSchorr in Better Health Network, True Stories
Tags: Abnormal Test Results, Afraid Of Bad News, Andrew Schorr, Cancer Survivors, Cancer Survivorship, Chronic Lymphocytic Leukemia, CLL, Emotional Component, Fear, Fear Of Recurrence, Nervous About Seeing The Doctor, Normal Vs. Abnormal, Oncology, Patient Power, Stress and Anxiety, Test Anxiety
No Comments »
I had breakfast this morning in Las Vegas with my friend, Dave Garcia. Dave is a pit boss on the graveyard shift at the Belagio Hotel where they made the modern-day “Ocean’s 11” buddy movie from 1960. Dave is also a 52-year-old chronic lymphocytic leukemia survivor. He reached out to me online and we have been friends since soon after his diagnosis in 2002.
Dave is a father of two young kids. He dreams of seeing them grow up. But, understandably, he worries. Some days more than others. Today was his day to see his oncologist and get the latest blood test results. Would his white blood count (WBC) be in the normal range? If so, his third round of treatment was still working. If not, he might be headed to a stem cell transplant, short-term disability, and living in another city for weeks or months.
As you can imagine, Dave was on pins and needles today. He would be against more chemo because he worries about the toxic drugs killing cancer cells but weakening him in the long run. Dave admits his blood pressure goes up on these days.
Dave is not alone in his fear. For millions of cancer survivors, while each day is special, some days are anxiety producing. For me it’s when I have a strange ache or pain. I rarely tell Esther, but I worry. For almost everyone it’s on days when we are having a “checkup.” The worry is, is this the day another shoe will drop? Fortunately, that hasn’t come for me yet and I hope it never will. I am happy to say Dave just texted me. His worry today was unfounded. The WBC was normal. He was given a pass at least for a few more months. We hope forever!
At another meeting today in Las Vegas there was a discussion about information for cancer patients. Nurses ticking off all sorts of facts and admonishments to patients. The nurses feel they are doing their job of education quite well. Some patients would say maybe not so well. How come? Fear. For us it is not clinical routine. It is our lives on the line at diagnosis or at a checkup. We often don’t hear so well in those moments. Dave may not have heard so well today. Only one word counted: “Normal.” Read more »
*This blog post was originally published at Andrew's Blog*
February 25th, 2011 by admin in Book Reviews, True Stories
Tags: 365 Thank Yous, ACP Internist, American College Of Physicians, Appreciation, Daily Gratitude, Dr. John Schumann, Family Medicine, General Medicine, GlassHospital, Inner Turmoil, Internal Medicine, John Kralik, Personal Change, Personal Perspective, Primary Care, Self-Awareness, Self-Improvement, Self-Motivation, Thank-You Note, Thankfulness, University of Chicago, Work-Life Balance
No Comments »
This is a guest post by Dr. John Schumann.
**********
I just read the book “365 Thank Yous” by John Kralik. I heard an interview with the author on NPR and it caught my attention.
Kralik had been down on his luck in 2007: Divorced twice, overweight, with a struggling law firm that he’d started, he was also failing in a new romantic relationship. He was worried about losing his seven-year-old daughter, too, in a custody dispute.
He made a momentous decision: Instead of feeling sorry for himself (easy to do given his predicaments), he decided to be grateful for what he had. To show it, he vowed to write a thank-you note every day for the next year. What do you think happened?
His life changed for the better. His relationship improved. His clients started paying their bills and his firm’s financial footing solidified. His health improved. He eventually achieved his lifelong dream of becoming a judge. To top it off, he turned his personal quest into a writing project. Within minutes of writing a book proposal, he received responses from agents who hoped to shepherd his project. Every writer’s dream.
I’ll grant you that it sounds hokey. But there are a couple of things the book demonstrated to me. Read more »
*This blog post was originally published at ACP Internist*
February 25th, 2011 by Peggy Polaneczky, M.D. in Opinion, True Stories
Tags: Accuracy in Diagnosis, Diagnostic Tool, Dr. Gizabeth Shyner, Dr. Peggy Polaneczky, Electronic Medical Records, EMR, Healthcare Outcomes, Medical Diagnosis, Methodical Madness, Mothers in Medicine, Pathology, Quality Improvement, TBTAM, The Blog That Ate Manhattan
No Comments »
A pathologist uses the EMR to find out just a little more about the patient whose cerebro-spinal fluid she has under her microscope — and changes her diagnosis:
This patient had a diagnosis of plasma cell myeloma with recent acute mental status changes. So the lone plasma cell or two I was seeing, among the lymphs and monos, could indicate leptomeningeal spread of the patient’s disease process. I reversed the tech diagnosis to atypical and added a lengthy comment – unfortunately there weren’t enough cells to attempt flow cytometry to assess for clonality of the plasma cells to cinch the diagnosis. But with the information in the EMR I was able to get a more holistic picture on a couple of cells and provide better care for the patient. I cringe to wonder if I might have blown them off as lymphs without my crutch.
The much-hoped-for improvement in quality due to the adoption of EMRs has been elusive to date, so anecdotal experiences like this will be important evidence to consider in judging the impact of the EMR on healthcare outcomes.
Kudos to pathologist Gizabeth Shyner, who writes over at Mothers in Medicine and her own blog, Methodical Madness, for “thinking outside the box.”
*This blog post was originally published at The Blog That Ate Manhattan*
