I was a first-year medical student, starting my first afternoon at an outpatient clinic as part of an introductory course in clinical medicine. My white coat was freshly washed; I had a rainbow of pens in one coat pocket, and my shiny name tag dangled from the other. I only hoped that I was as prepared as I looked. I entered Mrs. Carr’s room. A fifty-five-year-old woman, she sat gingerly at ...

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Loss is something all humans face in their everyday lives.  As a physician, the effects are often magnified.  People die, they move away, they graduate from your services, or occasionally they pursue care elsewhere.  Parting can sometimes bring relief, and others a deep sense of failure.  But with Clara, I'm not sure we actually parted.  Mostly, I was left with confusion. Clara came to me by way of the nursing home.  ...

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medpagetodayFrom MedPage Today:

  1. U.S. Seniors Losing Grip on Muscle Strength. The first national survey on grip strength in older adults found that 5% of those over 60 had weak muscle strength, and 13% had intermediate strength.
  2. Low MI Risk in Patients With Non-MI Chest Pain. Patients treated in emergency departments (EDs) for ...

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Flossie Marks used to complain now and then about shortness of breath on exertion. She never had chest pain and, after all, she carried firewood from the basement to feed the wood stoves and fireplaces in her large Victorian house. At 81, who wouldn’t be a little short of breath doing that? Last summer, she finally sold the house where she and Eli had raised four children and hosted nine grandchildren ...

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It was a rather unlikely place to begin my clinical career. Shortly after starting medical school, I signed up to volunteer in the hospice unit of my academic medical center.   The first few visits I relegated myself to fairly banal activities.  I shredded old medical records, or I might do a load of laundry for a family member who had been waiting tentatively by their loved one's side and was ...

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Home health care is in many ways a fantastic service, especially for those Medicare beneficiaries who are essentially homebound due to frailty or illness. But it often feels surprisingly hard to synergize with home health care. The main problem, as I see it, is that home health care agencies have set themselves up to provide only administratively required communication with the ordering doc. (There are rules governing home health care, you know!) Now, ...

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Check. The administrator's voice wavered as I picked up the phone.  He was calling about the nursing home patient that I admitted the day before.  While normally forthright, I could feel the discomfort in his tone as he danced around the issue.  The patient's insurer had called.  Apparently they made an "arrangement" with the mega-ACO owned by the latest consolidation of Goliath health systems.  They wanted my patient transferred to another ...

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Ruth was problematic.  Well into her seventies, her body may have dulled but her tongue was sharper than ever.  And she used it to lash me with complaint after complaint.  If it wasn't her knees, it was her ankles.  If it wasn't her ankles, it was her hips.  I battled the impossible month after month, year after year.  Our interactions left a bitter taste in my mouth.  Nothing makes a ...

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the_good__the_bad_and_the_ugly_by_kwad_rat-d5id914 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 ...

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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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