As a 24-hour-a-day, seven days a week, on-call nurse practitioner serving elderly and frail patients, my work day is anything but typical. I start my day not at a hospital or clinic, but at my dining room table. There, I document patient visits from the day before, write up my notes and place an average of 10 or more calls—ranging from setting up appointments to calling my patient’s family members ...
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An 85-year-old woman with moderate Alzheimer’s disease who enjoys walking in her nursing home's garden with her walker has fallen and broken her hip. An advance directive signed by the patient states a preference for “comfort measures only,” and specifically states that she does not want to be transferred to the hospital. The physician believes that surgery would provide long-term pain relief and the chance to maintain some mobility.
What do ...
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I've been interested in apps for the caregivers of elders, but like many physicians, I've been too busy to seriously research them or try them out.
Time to change that. No, I'm not going to exhaustively research and review all caregiver apps on the market.
But, as I've been invited to give a technology talk to a local group of family caregivers later this summer, I would like to see if I ...
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old woman living in a nursing home is evaluated for incontinence. Over the past year, she has had progressive decline in her cognitive status and now spends most of the day in bed. She requires coaxing to join the other residents in their communal meals and requires assistance for eating and bathing. When ...
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I made a big decision recently: I decided to give up my Blackberry smartphone.
Why? Like a good geriatrician, I considered the benefits and the burdens of sticking with the Blackberry. And since the burdens seem to outweigh the benefits, bye-bye Blackberry.
This was a difficult decision for me, however. To begin with, becoming comfortable with a new device for one's daily work takes time. During the transition phase, one is slower ...
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“J.T.” is 92 and clearly a soul who lives to the beat of a different drummer. She has no children and her closest relative is a niece who she despises. Despite this the niece oversees her care, sending in a full time aide and her personnel assistant to run the household. J.T. will not come to the office for a visit. If I call and make an appointment to see ...
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How to effectively keep tabs on a patient’s multiple medical problems? And how to do so without losing sight of the whole person?
The first question is the one I wrote about in a recent blog post. The second was the theme of many of the responses and also LinkedIn.
I love this second question; it’s an issue that’s always been of interest to me. Plus it’s especially ...
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A little over a year ago, I found myself burning out and realized that my worklife was unsustainable.
I’d been working at an FQHC clinic, and had become the site’s medical director a few months before. I was practicing as a primary care doc, trying to improve our clinical workflows, problem-solving around the new e-prescribing system, helping plan the agency’s transition from paper charts to electronic charts, and working on our ...
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Brought to you by MedPage Today.
1. Teach Health Info to Teens? Use Electronic Media. Electronic media may be an effective health intervention for teens, but better-quality studies are needed to confirm this association.
2. Annual Pap Tests a Hard Habit for Docs to Break. Most physicians wanted female patients to undergo cervical cancer screening more frequently than recommended under published guidelines.
3.
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"Hey doctor, what do you think about this product/solution/service?"
These days, I look at a lot of websites describing some kind of product or solution related to the healthcare of older adults. Sometimes it's because I have a clinical problem I'm trying to solve. (Can any of these sleep gadgets provide data -- sleep latency, nighttime awakenings, total sleep time -- on my elderly patient's sleep complaints?)
In other cases, it's because ...
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"A comprehensive and extremely useful roadmap for doctors."
-Eric Topol, MD, author of The Creative Destruction of Medicine
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