I had a recent conversation with an old friend about her elderly father that encapsulates a lot of what is both great and terribly wrong with health care in America today. Here are the basic facts: the man is in his mid-80s, retired from teaching school, and is active and vigorous, living in the community; he is cognitively intact. He has a history of coronary disease and had an intracoronary stent ...

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All health care professionals must be skilled at effectively communicating with patients who have dementia.  Some professionals may erroneously assume that only those employed in long-term care, assisted living facility and other similar places need these skills.  However, patients with dementia visit medical practices, acute care hospitals and other health care centers.  This article will provide a framework to effectively interact with patients who have dementia. Go along to get along This ...

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Outpatient anesthesia in elderly patients: What to watch forA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. More than 75 percent of operations in the U.S. occur in an outpatient setting. Outpatient, or ambulatory care, can take place in a number of different settings, including physician offices, outpatient surgery centers, or hospital or non-hospital-based outpatient clinics. With more and more elderly patients undergoing outpatient ...

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There is much to deplore in our medical system.  Atrocities abound in the dark recesses of hospital wards, the overpacked waiting rooms of outpatient offices, and the algorithmic hum of insurance claim denials.  Yet time and again, the most vile of of insults are hurled at one setting in particular.  I'm talking of the place cursed by emergency room physicians when admitting yet another poor soul with a sacral ulcer, ...

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American health care has become a gigantic game board with players of all sorts strategizing to win. Winning, of course, means getting more money from payers: government or private. It turns out this medical marketplace game is not all that new. It's just become wilier, as I have shared in a couple of posts over the summer. An obituary last week for Dr. Rashi Fein, an influential economist with a progressive stripe ...

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She was sick.  Not sick like a high fever, body aches and a runny nose.  Sick like she had spent the last half a decade in nursing homes as most of her internal organs failed.  There was oxygen, and dialysis, and a colostomy.  She propelled herself vigorously through the crowded halls in the custodial wing of the nursing home, her wheelchair a natural extension of her body thoroughly unhampered by ...

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She was nearing the end of a long and interesting life. Her birth was announced on the party line in her rural community’s first telephone system. Her death, which would come soon, would be shared on Facebook and via cell phone. She had graduated with a degree in home economics from the University of Minnesota in 1938 and had worked for a meat packing company during and after World War ...

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Mrs. D was my last patient. I retired several months ago, and for some time prior I informed my patients so as to give them time to decide where they would like their follow-up care. Mrs. D was an elderly lady who I first met in the ER several years prior after a fall resulting in a displaced ankle fracture. She was pleasant and alert, understanding everything I was explaining after ...

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We were intimate. As intimate as a doctor and patient can become.  He had long outlived his wife and there were no children, no family, just friends.  When he first came to me he was lively and active, but the years took their toll.  Our visits became more regular.  Every six months.  Then every three. His memory started to slip.  Occasionally he would look at me suspiciously when something went wrong.  His ...

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As every physician already knows full well, health care services delivered to the home rather than in an institutional setting are increasing, a trend destined to expand even faster in the decades ahead. This shift is inevitable, thanks to our rapidly growing elderly population and the corresponding prevalence of chronic illness, along with the nationwide push for higher quality care at lower cost and dramatic advances in medical technology such as ...

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