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Are you willing to give your doctor your credit card information to use for subsequent charges?

Posted in Blogfinger Medical Reports, Blogfinger Presents, tagged on April 19, 2017| 3 Comments »


By Paul Goldfinger, MD, Editor @Blogfinger

Do you find flaws that indicate a deterioration in some aspects of our healthcare system? We often do and yesterday we stumbled on another one.

We were at a local medical group for an office visit. When we went to the desk to schedule our next visit, the face behind the glass asked for our credit card information. She assured us that they would only use the card if we had an unpaid balance, for example if there was a copay or a balance after insurance paid.

When we refused the idea that we should give them open access to our checking account  (ie a blank check), she informed us that she could not schedule our next visit without that card. In other words, they were willing to lose two patients who had no history of payment issues over this “policy.”

We were handed a statement in writing which explained that the “insurance industry makes patients responsible for high deductibles, co-payments and non-covered services.” In other words, they didn’t trust their patients to take care of outstanding balances and they hate to wait.

The statement said that if an unpaid balance exists, they would send us an email statement, and if we did not pay within 5 days, they would charge our credit card.   They also worried that we might change our credit card, so they concluded by warning that “you may cancel your credit card, but we will be unable to continue your care without an active credit card on file.”

Although we have been happy with our medical care with this group, this policy, which was willing to let us  leave without a subsequent appointment, casts a dark cloud over that medical provider.  To be honest, we were furious.  They are entitled to establish rules for collections, but this policy has a tinge of abandonment and coercion, something which is unethical among physicians.

For one thing, the policy makes our credit card available to anyone in the office who is interested in getting a new TV, for example.  It also makes it much more difficult to negotiate or discuss a billing issue once they have snatched your cash from your account.  And you need the time to do that because sometimes medical bills contain errors or even fraudulent charges.

Is this legal?  Evidently it is.  (quote below is from Cleveland.com)

“An AMA spokesman said, ‘Employers are offering health plans that require their employees to shoulder a greater share of health care costs. Total cost-sharing for the average patient from deductibles, co-payments and coinsurance has increased from $422 to $747 between 2004 and 2014, according to the Kaiser Family Foundation.’

“He said the cost-sharing trend is accelerating because of the health insurance exchanges opening up. Those often come with high-deductible plan options that people choose to keep their premiums down.

“Meanwhile, overhead for doctors’ offices has soared, he said, in part because of time spent complying with government regulations and health insurer policies.

“To lower overhead costs,” Mills said, “medical practices are focusing more on streamlining patient payment collections. Some practices do take credit card numbers for this purpose.”

“He added that the AMA does not offer guidance to doctors’ offices on this issue, except to say that doctors who do it should get advice from an expert because of the security risk of keeping this type of information on file.

“So the bottom line: If a doctor’s office won’t treat you  because you won’t give the office a credit card number to keep on file, then I’d find a new doctor. Period.”

We are not yet sure what to do, but this feels like blackmail and definitely affects our doctor-patient relationship.  The policy shows disrespect for the group’s patients, and a basic tenet of physician values is to always put the best interest of the patient first.

 

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Wassup? Generic Viagra (sildenafil) is approved.

Posted in Blogfinger Medical Reports, Blogfinger Presents, tagged , on March 11, 2017| Leave a Comment »

This is about the Canadian Supreme Court ruling that made Teva’s sildenafil available there.

 

 

Paul Goldfinger,  MD, Editor @Blogfinger.net and Professor at the Blogfinger Off-shore School of Medicine in Ocean Grove, NJ.

Men who use Pfizer’s Viagra for erectile dysfunction know how expensive that little blue pill is. In 2012, Pfizer made over $2 billion with it.

But the FDA has now approved low cost generic Viagra (sildenafil) to be manufactured by the Israeli company Teva, but that won’t begin until December, 2017 (and maybe sooner.)

The generic version (sildenafil) has been sold in Europe since 2013, so we know that it is a viable generic. It also has been for sale in Canada since 2012.

You can actually buy sildenafil now in the U.S, under the name Revatio, which is a drug approved for a lung/heart problem.  It comes in a dose of 20 mg (unlike Viagra which is in doses of 25 mg, 50 mg, or 100mg). The generic version of Revatio has been approved recently by the FDA.

If you are considering buying that generic, you might want to have a conversation with your pharmacist first.

Or, if you are anxious to get generic Viagra pricing, you can order from a legitimate Canadian company, and there are some, but that will be your responsibility to make that contact, and  you will need a prescription.   Your doctor may or may not cooperate with you for that.  And those Canadian companies often take weeks to get your prescription to you by mail, and sometimes their drugs are made in Turkey or India or other places.  That doesn’t mean that those drugs are a problem, but you need to get all the facts.

Be careful ordering on the Internet. The price will be enticing, but only use sites that you know are legitimate; and only those which require a doctor’s prescription.   There are some fraudsters patrolling the Web.  And don’t buy those non-Viagra supplements.  They are useless.

I also want to remind you of the significant side effects and drug interactions that are part of the story. Do not try any of these forms of sildenafil without discussing your treatment in great detail with your physician.

MARISA MONTE:  (She’s from Brazil where the Viagra patent ran out in 2014)

“I know a man ain’t supposed to cry.”

Well, Marisa’s funky intro means that you need at least 30 minutes for sildenafil to take effect, so if you want to surprise someone, be sure to plan ahead.

Marisa Monte.

 

 

 

 

 

 

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Lowering blood pressure in hypertensive older patients  (ie  those 60 and up.) —a controversial subject even with published guidelines.

Posted in Blogfinger Medical Reports, Blogfinger Presents, tagged , on March 1, 2017| Leave a Comment »

 

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By Paul Goldfinger, MD, FACC

As you may know,  blood pressure measurement consists of a top number (systolic) and a bottom number (diastolic.) Both numbers are important, but recent research trials and guidelines have been focusing on the systolic end points. The exact way to express a BP reading is 120/80 mm Hg. But for this article we will just use the number–e.g. 120/80.

Blood pressures are usually taken in the sitting position.  Some doctors ask their patients to sit for 5 minutes before taking a measurement. This will result in a number that is often about 10 points lower than an immediate office reading and may be different than readings obtained at home.

I recommend that all patients with hypertension (“high blood pressure”)  buy a device and keep track of readings at  home.  I suggest an initial reading and then another after 5 minutes.   Keep a written record for your doctor with the measurements, date, time and circumstances  (eg “just had an argument with my spouse”)   Remember that blood pressure readings do vary, so show your physician all your readings when you go for an office visit.

Experts have been disagreeing lately regarding  the “target” systolic numbers that physicians should aim for when treating older patients  (over age 60) for hypertension  (high blood pressure.)

No one disagrees that treatment should begin for readings over 170, but most physicians will begin therapy for readings averaging over 150/90. Studies show benefits of treatment even for those over age 80.    Doctors will legitimately differ in deciding when to start therapy, depending on the circumstances.   The current treatment  guideline controversies surround the question of how low to go.

The basic concept is that BP control will prevent stroke and cardiac events as well as reduce cardiac mortality rates.  In older individuals, there is a special concern regarding lowering the systolic number too much.

If the BP is caused to be too low, quality of life issues may take center stage including important problems such as fainting, dizziness, cognitive impairment, depression, hip fractures, impotence, and  fatigue.   Sometimes patients will stop their meds due to such reactions. Tell your physician if you suspect side effects.

There are a variety of  drugs that doctors use to treat hypertension and they are often utilized in combination.  If you doctor wants to use beta blockers, keep in mind that this class of drugs may not be as effective for prevention as others and may be associated with significant side effects.*

One recent discovery is that statin drugs, added to anti-hypertensive drug therapy, will improve the prognosis regardless of LDL cholesterol levels.

The JNC 8 (Joint National Committee) guidelines came in 2013,  after not revising the recommendations for over 10 years.   They decided to lighten up on their target systolic reading concluding that up to 150  was OK for “seniors” instead of the prior goal of 140.

But some experts would prefer to see the pressure lowered to below 140,  and even to 130 if tolerated by the patient, especially if the patient is at higher risk, such as diabetics and those with prior stroke, TIA, known heart disease or significant risk factors.

Another recent trial called Sprint advocated a target below 120 for patients 75 and older. The study found that patients with a target of 120 did better than those with 140, but that study was criticized on procedural grounds, and that goal could be risky in older patients who run a significant risk of side effects with such low readings.  Even 130  may be associated with problems. The doctor has to be very careful when aiming for those aggressive targets.

So what is the physician to do given all these disagreements?    The answer is to be knowledgeable regarding research  trials and  official guidelines, but to decide each case individually.

Dr Franz Messerli , a BP specialist and Clinical Professor of Medicine at Columbia U. School of Medicine is quoted on Medscape Cardiology  2/28/17.:    “After JNC 7, it took 11 years to get one more set of guidelines. Now we have six or seven, and they all tell a different story. It has become very confusing to the practicing clinician.

“The patient in front of you never quite conforms to the patient in the trial or to the patients from whom the evidence was derived for the latest guidelines. Despite all the guidelines, you still have to be a doctor, and you have to individualize therapy and continue to learn.”

Dr. Messerli concluded by saying, “Most physicians know that guidelines are more for lawyers than for doctors.”

*Prof. Messerli:  “Despite lowering blood pressure, there is no— and I repeat, no—evidence that beta-blockers reduce heart attack, stroke, or death in hypertensive patients ≥ 60 years. Ironclad evidence has been put forward that beta-blockers are not acceptable antihypertensive drugs in this age group.”  

Here is an important link from our series on treating hypertension. It is from 2013.  You can read our other posts in that series by typing “hypertension” into our search bar (above).

https://blogfinger.net/2013/12/23/confessions-of-a-high-blood-pressure-doctor-part-ii-controversy-emerges-regarding-the-jnc8-practice-guidelines-for-hypertension/

 

 

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Is healthcare broken?

Posted in Blogfinger Medical Reports, Blogfinger Presents, tagged on February 13, 2017| 2 Comments »

'Have a seat, the doctor will be with you in two hours.

“Have a seat, the doctor will be with you in two hours.”      Blogfinger.net photo. February, 2017.  By Paul Goldfinger ©

By Paul Goldfinger, MD, FACC

In many ways, our healthcare system is better than ever, and that is largely due to advances in medicine on the part of physicians partnering with new amazing technologies. More cancer victims are surviving and for longer times —–some are being cured while others are being stabilized.  HIV has become a chronic disease, and our hospitals produce miracles on a daily basis.

There is no question that the ACA  (Affordable Care Act) has resulted in many benefits, including, as we have been reporting, the greater availability of treatment for addicts and guaranteed insurance coverage despite pre-existing illnesses.  There also is the option to keep grown children, up to age 26, on a family’s plan.

The American healthcare system, workers and facilities, often produces remarkable high quality care.

However, despite certain advantages, the ACA is flawed in a variety of ways, including rising costs and inconsistent quality and will likely be replaced or changed in the future.

One important  element in the equation  is that more people than ever before have obtained health insurance, bolstered by government subsidies.  Supposedly the number is 20 million more who have insurance thanks to the ACA. Medicaid has also been expanded across the country, but these rising numbers stress a system which already is over-burdened and short-staffed, and this effect will diminish quality unless the issues are addressed.

The marketplace for insurance availability is too narrow and needs to be widened to bring down runaway costs and increase consumer choices. One factor that increases cost is that the ACA requires too many mandatory clinical elements  (one-size-fits-all), many of which are not necessary in certain instances.

People should be able to design a plan that suits their needs. And they should be able to band together to shop for group prices across state lines.  One idea is to “de-link” insurance coverage from employer mandates. This will create more options for consumers.

From a physician’s point of view, the arm twisting created by the ACA makes life more difficult for doctors and secondarily for their patients. On Blogfinger we have been especially interested in the quality of the doctor-patient relationship.

Here, for example, is a quote from Medscape Cardiology:   

“During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR  (electronic health records)  and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on EHR and desk work.

“The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.

“Two hours of documentation at the office for every hour of face-to-face patient time, plus the additional couple hours at night, are ample fuel to add to the burnout fire which increasingly consumes our profession.”

The huge numbers of additional patients with insurance are causing excessive pressure on physicians who lately often pedal too fast and delegate too much.

Currently,  on a day to day basis, patients often run into sour notes.  For example a person with a problem might have to wait months to see a  specialist or have a particular surgery. If they feel ill, physicians may refuse to see them due to crowded schedules, and patients are then sent to emergency rooms when such an ordeal could  be avoided.

Many doctors have become employees, and managers with no medical training sometimes get in the way of the traditional doctor-patient relationships.

Physician offices are potential  trouble spots where carelessness and poor communication may  cause quality of care to diminish. It is often  difficult to get a doctor on the phone because their offices  have erected barriers to that happening.

Poorly trained desk jockies answer the phone and stumble as they try to deal with medical issues.  This places the patient at risk of serious mistakes.     True medical personnel such as nurses should be manning points of triage for patients.   Evidently the new style of corporate healthcare management is placing  too much emphasis on efficiency and cost cutting, and quality medical care doesn’t always lend itself to such an approach.

As our government tries to sort out the wheat from the chaff, let’s hope that they keep the patient at the top of the priority list and the doctors in charge of medical care.

HAYLEY WESTENRA   from Celtic Treasures

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CDC: This year’s flu season in New Jersey is worse than last, and Monmouth County has been hit especially hard.

Posted in Blogfinger Medical Reports, Blogfinger Presents, tagged on January 9, 2017| 2 Comments »

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3-d portrayal of the H3N2 influenza A virus. CDC

3-d portrayal of the H3N2 influenza A virus. CDC

The NBC Nightly News (1/6, )  briefly reported that the Centers for Disease Control and Prevention “says this [flu] season is worse than last,” with “more than 10,000 cases reported nationwide.” Physicians are saying, however, that the “flu shot is a good match for this year’s dominant strain and it’s not too late to get one.”
USA Today (1/6) reported that federal epidemiologist Lynnette Brammer said “while it’s too early to tell if the annual flu vaccine is effective, it closely matches the strains of flu commonly in circulation, which suggests it will be effective.”
Meanwhile, the Washington Post (1/7) said that according to the recent CDC report, “only 2 out of 5 Americans have received the shot so far this flu season.”

NJ.com :    During the closing week of 2016, Monmouth County had the most number of positive flu tests, followed by Essex, Bergen, and Ocean counties.

Blogfinger medical commentary.  Paul Goldfinger, MD:

Monmouth County has been among the most seriously affected in New Jersey with the flu.  The virus which is responsible, the H2N3 strain of Influenza A ,is the same as the strain which caused many people in 2014 to get so ill.  Now the flu attacks tend to be more severe and more sustained.  The peak season is December through February, and there is still time to get the vaccine.  The most severely affected tend to be the very young and the very old.

The demand for the vaccine is quite high now, and everyone, all ages,  should get it unless there is some specific reason not to (such as egg allergies.)

 

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MEDICAL: The Case of the Hypokalemic High Jumper.

Posted in Blogfinger Medical Reports, Medical topics, tagged on November 29, 2016| 5 Comments »

Getting back to basics…Medicine 101

By Paul Goldfinger, MD, FACC.  Dean of the Blogfinger Off-Shore School of Medicine in Ocean Grove, NJ.

She was a tall, thin blond, 22 years old, from East Germany.  She had long graceful legs and she was a good looker.  But she was more than just that; she was an international elite high jumper and she was exhausted.  Beside muscle weakness, she had leg cramps and she had passed out a few times.

I admitted her to the internal medicine teaching service at Mt. Sinai Hospital, located on the upper east side of Manhattan, facing Central Park. The year was 1967 and I, a first year medical resident, was struggling to come up with a diagnosis.

She seemed perfectly healthy. Her history was unrevealing, and her physical examination was unremarkable. Doctors like to say “unremarkable” for normal,  but she was anything but unremarkable. She denied taking any drugs, being on a crazy diet  or vomiting to lose weight.  We ran tests on her, and there was only one salient abnormality:  her blood potassium level was very low.  In other words, she was hypokalemic.

The second year resident,  the chief resident, and the attending physician could not figure out the cause of her electrolyte disorder.  “Electrolyte” refers to the minerals in the blood such as sodium, potassium, chloride and calcium.  We ruled out kidney disease and metabolic problems.

Dr. Solomon Berson, the Chief of the Department of Medicine, said that he would order an experimental serum insulin level from his lab—a test that would eventually win the Nobel Prize in Medicine.  But that didn’t help either.

Finally I decided to go back to basics and take another history.  It’s like those cop shows when they keep interrogating the suspect until something squeaks out to solve the case. In the 1960’s, a great deal of emphasis was placed on talking to patients, because our testing methods were so primitive compared to today’s.

It seemed that we would have to lower the talking bar for this high jumper. We discussed her life and her habits.  Finally the truth popped out:  she was a secret user of thiazide diuretics.  It wasn’t clear why she was doing that. She didn’t know that diuretics cause your body to be depleted of potassium.  We took away the diuretics, and she was cured.

Next stop was the psychiatry department.  Meanwhile I got a case report out of it in the Mt. Sinai Journal of Medicine plus a bit of notoriety there which lasted about two days.

History taking is becoming a lost art. Electronic medical records encourage doctors to use checklists, and often the history is obtained by a medical assistant or “physician extender.”  There is an old saying in the profession: “Listen to the patient; he is telling you the diagnosis.”  The great Sir William Osler, one of the founders of the Johns Hopkins Hospital, is credited with those words of wisdom.

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Obamacare is forcing the destruction of private practice medicine. (First posted in Dec. 2014)

Posted in Blogfinger editorial, Blogfinger Medical Reports, Blogfinger Presents, tagged on November 10, 2016| 10 Comments »

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By Paul Goldfinger, MD, Editor @Blogfinger.

About two years ago a large and prestigious cardiology group in Morristown, an independent organization which had been in existence for 50 years, was bought out  by Atlantic Health, a mega-medical system akin to Merdian. The doctors in that group, all graduates of the finest training programs in the country, became hospital employees.  They did that because they were forced to, not because they wanted to.

A cardiologist in that group told me that the Medicare reimbursements for office procedures and patient visits had been cut significantly and were much lower than the fees for such services provided at the hospital.  So, because of the financial stresses, the group had to give up and sell out.

Their practice was destroyed by a roaring ill wind that has been rapidly blowing apart the private practice of medicine throughout the country, and that ill wind was created by the government (Obamacare)  through Medicare payment reforms which force doctors out of private practice and favor the growth of corporate healthcare organizations such as Atlantic Health.

At Blogfinger we have been writing about  this theme for the last three years: What will happen to the quality of healthcare and, more specifically, the doctor-patient relationship, as a result of the new government-driven system called Obamacare (aka Affordable Care Act–ACA ?)   For awhile there were no answers, but now the truth is forcing itself out into the open.  Instead of what they say, we are beginning to see what they do.

A decline in quality is already happening, and many of you have experienced either the loss of your regular doctor due to insurance limitations, or the reduced availability of  care, or worrisome changes in how care is delivered.  Some doctors have left or are planning to leave the profession.

In the Wall Street Journal on Dec. 7, an op-ed article by Scott Gottlieb, MD, an expert on health policy, appeared called  “Obamacare’s Threat to Private Practice” *

A survey of 20,000 physicians found that only 35% were in independent practices compared to 62% in 2008. This shows how quickly the private practice of medicine is being dismantled.

Dr. Gottlieb says, “Right now, Medicare is paying much more for many procedures when performed in a hospital outpatient clinic rather than an independently owned medical office. Things as common as heart scans ($749 versus $503), colonoscopies ($876 versus $402) and even a 15-minute doctor visit ($124 versus $70) all pay more when done by a hospital-based doctor than a privately owned medical office. Obama officials know that hospitals are buying doctor practices to take advantage of this difference. But they favor hospital ownership of doctors and see it as a small cost to pay to drive that migration.”

He also says that Congress should remove the pervasive “biases in ObamaCare” that favor hospital ownership of medical practices.

Perhaps you are thinking, “Well, so what if doctors make less money and lose control of their practices?”   There are a number of responses, but I would say that most doctors are, by nature, devoted to providing quality care and placing the welfare of their patients above all concerns.  When they become employees, they lose much of the control over quality and they are disconnected from the feelings of responsibility that doctors in private practice typically have towards their patients.  Most doctors would agree that medicine run by bottom-line oriented hospital corporations will result in reduced quality.

Wait and see what is coming in the future unless this trend is reversed.

Nov. 10, 2016 note:   The situation has worsened since this piece was written in 2014.  Medicare, which has been influenced heavily by Obamacare, is now in serious financial trouble, and ACA premiums are due to rise sharply.

The comments section from 2014 is quite good and can be added to  now; especially in view of the sudden U turn about to happen  in Washington.  —-PG

 

 

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Computer Vision Syndrome—read below and look for some preventive suggestions.

Posted in Blogfinger Medical Reports, Blogfinger Presents, tagged on October 9, 2016| Leave a Comment »

By Paul Rogers, NY Times, May, 2016.

By Paul Rogers, NY Times, May, 2016.

By  Paul Goldfinger, MD   @ Blogfinger Off-Shore School of Medicine in Ocean Grove, NJ   (our motto: “Healthcare are us”)

In May, the NY Times published an article called “Computer Vision Syndrome Affects Millions.”  (Link below)

This fascinating condition causes eye symptoms in people who spend a great deal of time in front of computers—more than  3 hours per day.    The population at risk is “huge” worldwide.   The symptoms include burning in the eyes, double vision, blurry vision, itching, dryness and redness, “all of which can interfere with work performance. ”  Then you have the millions of kids playing computer games.

When you sit in front of a computer, your blinks/minute decrease, promoting dry eyes.

Other symptoms include back and neck pain and tension headaches.

The situation is complicated and involves paying attention to your distance to the screen, the height of the screen, taking breaks from the computer, humidity levels in the room, lighting of the screen, positioning the monitor, and getting special computer glasses for that mid-range distance.

A study from Iran of  642 pre-university students revealed that 71% sat too close to the monitor for comfort, and two thirds were improperly positioned in relation to the monitor above or below.

I use computer glasses that take into account the distance to the monitor and also the need for bifocals to provide for looking down at papers to read when working at a computer. Eye doctors can prescribe computer glasses.

http://well.blogs.nytimes.com/2016/05/30/computer-vision-syndrome-affects-millions/?_r=0

BOBBY SHORT:   “Looking at You.”  from his album Bobby Short on the East Side.

 

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Falls the leading cause of injury among older adults, CDC says.

Posted in Blogfinger Medical Reports, Blogfinger Presents, tagged , on September 25, 2016| 2 Comments »

 

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Good Morning Dr. Paul Goldfinger. Here are today’s top stories. Friday, September 23, 2016.

 

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The CBS News (9/22) website reports that “falls are the number one cause of fatal and nonfatal injuries among adults over 65,” researchers concluded in a report published in the CDC’s Morbidity and Mortality Weekly Report.

The report found that “in 2014, older Americans fell 29 million times, leading to seven million injuries” that sometimes landed people in the emergency department. Unfortunately, “more than 27,000 falls led to death.”

In a press statement, CDC Director Tom Frieden, MD, MPH, said, “Older adult falls are increasing and, sadly, often herald the end of independence.” Dr. Frieden went on to emphasize that falls can be prevented.

Below is the  link to the excellent CBS News article on this subject.

www.cbsnews.com/news/falls-leading-cause-of-injury-and-death-among-older-americans/

Blogfinger medical commentary by Paul Goldfinger, MD, FACC:

These stats are impressive, and the article describes certain elements that we might not ordinarily think of.  Once someone falls, there are a variety of variables that need to be evaluated in order to prevent more falls.   For example, is the patient keeping his falls secret for fear of losing independence? Family members must think of this if, for example, bruises are seen or balance problems noticed.

Falls can be minor or terrifyingly dangerous.  Falling down even a few steps can result in horrible injuries. And that damage can be made worse by coexisting factors such as chronic therapy with blood thinners, causing traumatic bleeding to be worse than expected.

Don’t forget the need to have an “I fell down and can’t get up” button around the patients neck. I had a patient who fell and got wedged between the toilet and the bathtub, and she could not reach a phone; luckily a friend came by to pick her up for her regular card game.   And how about a cell phone to be worn in a holster all the time? There are exercises to improve balance, and make sure to check the lighting in the house.

Head injuries can be deceptive, and, if one occurs, an ER visit and then subsequent observation are essential.

Some of the prevention  factors include safe footwear, regular eye exams,  and getting rid of throw rugs.

If a senior gets in a car accident, don’t allow him/her to just go home and rest.  Always take them to the hospital to be checked. And if they do go home make sure that someone provides oversight to look for emerging signs of trouble.

As we have pointed out in our BF articles, seniors are often on multiple medications, and those may be overdosed, mixed up,causing side effects, or interacting with each other. The end result might be a fall, due to dizziness or a drop in blood pressure. There are other medical issues, such as cardiac rhythm disturbances, that could cause falling, so if someone falls, have them checked even if there is no obvious injury and be sure to have his medication list reviewed—-bring all the meds with you.

We have also reported on drug dependency in seniors, and that might be a factor.

For some seniors, they tend to rush around, and that can cause quick turns and loss of balance.   My mother was like that, so I stuck a big sign on her fridge:  “Slow Down.”  Of course, she gave it back to me by saying, “You talk too fast and not loud enough.”    She used to say, “Stop mumbling.”  At least she didn’t put any signs on our fridge.

The psycho-social issues resulting from falling are very important as well.  Patients sometimes lie about what happened in order to avoid unpleasant consequences such as  neurologic findings which could result in loss of a driving license and thus loss of freedom.  A neurologist might pick up a problem with peripheral vision which could result in a car accident.

Families of elderly patients must be vigilant.

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Evidence mounts linking loneliness to physical illness, functional and cognitive decline

Posted in Blogfinger Medical Reports, Blogfinger Presents, Medical topics by Paul Goldfinger, tagged on September 8, 2016| Leave a Comment »

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Good Morning Dr. Paul Goldfinger. Here are today’s top stories. Wednesday, September 7, 2016:

NY Times by John Krause. Sept. 5, 2016.

NY Times by John Krause. Sept. 5, 2016.

 

Fort Hancock at Sandy Hook. Undated photo by Paul Goldfinger. ©

Fort Hancock at Sandy Hook. Undated photo by Paul Goldfinger. ©

 

“AMA Morning Report:”

On the front of its Science Times section, the New York Times (9/6)  reports in a nearly 1,800-word article on the physical and mental effects of loneliness experienced by the elderly. In the UK and in the US, “roughly one in three people older than 65 live alone.” Investigators “have found mounting evidence linking loneliness to physical illness.”  Loneliness, “as a predictor of early death” even surpasses obesity.

“The profound effects of loneliness on health and independence are a critical public health problem,” said Dr. Carla M. Perissinotto, a geriatrician at the University of California, San Francisco. “It is no longer medically or ethically acceptable to ignore older adults who feel lonely and marginalized.”

Blogfinger Medical Commentary  by Paul Goldfinger, MD, FACC

The mind-body relationship was rarely mentioned when I was in medical school and postgraduate training.  But we were aware of certain things such as how stress might cause a stomach ulcer  or cardiovascular problems;  or how anger and pent-up hostility could aggravate high blood pressure or heart disease. Over the years of practice, my awareness of these issues was growing.  In writing our 2011 book about prevention, we put a spotlight on the depression issue:

“Mental Health: It has been known for some time that stress, anxiety, social isolation and hostility/anger may increase the risk of heart disease. Now there is evidence that depression is also a “potent” risk factor for coronary disease and has been linked to increased risk of stroke, hypertension and carotid artery disease. (Harvard Men’s Health Watch, Nov. 1999). These observations have been made in both men and women.

“Similarly, for those who have had heart attacks, the risk of dying during the 6-12 months after the attack is greater in those with depression, and the adverse risk can extend for years later. Research is trying to determine if psychiatric drugs such as Prozac can make a difference in the risk after a heart attack. It should be noted that not all experts agree regarding the role of psychological factors in causing coronary heart disease. A study from Walter Reed Medical Center found no relationship between depression, anxiety, hostility and stress in promoting coronary artery disease (New England Journal of Medicine. 11/2/2000)”

Now, 5 years later, we see a greater awareness that is summarized in Katie Hafner’s NY Times piece which points out that “loneliness is a quiet devastation” which adversely effects physical well being as well as cognitive and emotional functions.  She points out that loneliness often yields functional and social decline.   People need contact with others–it is “a basic need.”

In the US, Ms. Hafner says that most of us do not know about the relationship of loneliness to health including risk of early death, hypertension, reduced immiune responses and reduced blood flow to vital organs.

I know that the electronic medical records screenings do ask about signs of depression, but a social issue such as loneliness is rarely mentioned in physician offices. In England they are much more active in looking for this problem in their communities and trying to intervene.  But families need to recognize the issue and become proactive with their loved ones.

JOHN DENVER:

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