Does More Care Do More Good?

When we are sick, how much health care is good health care? These days when we call an ambulance, the medics rush in with all sorts of equipment and medications — called advanced life support, which replaces the basic life support that many of us learned in CPR classes.

Doing More for Patients Often Does No Good, a January 12, 2015 article appearing in the New York Times, makes the point that more advanced therapies and medical care do not guarantee higher quality or better outcomes. Written by Aaron E. Carroll, M.D., the piece shares a study in the journal JAMA Internal Medicine that compared the outcomes for patients who had received life support — basic or advanced — before being admitted to the hospital. He also writes about other studies that appear to show how the most advanced emergency care does not necessarily mean longer survival.

Dr. Carroll, a professor of pediatrics at Indiana University Medical School, further reinforces this “more may be less” point of view by describing studies that show how women with breast cancer receive complex and also more expensive breast surgical cancer treatments that are no more effective than outcomes with a more standard breast conservation therapy.

This article requires readers to process fairly complex explanations about medical care, and it may be necessary to read some paragraphs more than once. Yet, it’s worth taking the time to understand that doing more medical care in many cases will not give us extra quality or a better outcome.

Aging Parent Hospitalizations and Observation Status

Just when you think that you have settled the most significant adult child-aging parent issues — when you and your parents have spoken about medical care support, finances, and the range of their end-of-life wishes — along comes another concern to worry about, and it’s one that may be completely out of our control.

Medicare ObservationWe now need to be concerned about the possibility of a parent entering a hospital and assigned to observation status for several days. Observation means that, rather than being officially admitted as a patient, the person is there to be watched, sort of like an out-patient, but not really an out-patient. The problem is, it’s difficult to discover what status a hospital assigns a patient  — the two look almost alike with nurses, doctors, hospital rooms, blood pressure checks, etc.  Admission and observation do not look that different to the patient and family, and apparently many hospitals are not especially  forthcoming with the information.

Why is patient status significant? It’s simple, really. If your parent needs to enter a skilled nursing facility or nursing home after three days of observation status, Medicare will not pay and the family will be required to pay all of the bills, including the hospital costs. For Medicare to pay the bills, a family member must be admitted as a patient for at least three days and not assigned observation status.

Over the past year newspapers and medical or health journals have carried stories about elders and observation, and I share them here so that you can learn as much as you can.

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Detached Retina: Another Vitrectomy Treating My PVR

I’ve just returned to the hospital for another surgery on my right eye. My retina condition has a name — proliferative vitreoretinopathy (PVR) — which basically means that, so far, my retina keeps detaching. When I last reported on my detached retina issues, I explained how oil was placed into my eye to hold the retina in place.


Click to read about epiretinal membranes @ the Mayo Clinic.

The oil went in four months ago, and since that surgery I’ve been reporting to my retina specialist on a regular basis, and he has been monitoring my condition. He is watching the development of epiretinal membranes (read about them at the Mayo Clinic site — 4th paragraph down), studying them through the oil at each visit. These membranes needed to be removed, because extra tissue puts pressure on my retina.

So today my surgeon performed a vitrectomy, going in through the oil and removing the scar tissue but leaving the oil in place. The plan is to watch the retina for another two or three months, let it continue to heal, and then remove the oil and see how my retina fares (yes, I’m crossing my fingers and toes, just in case it helps).              Continue reading

Pets and Patients: Can Pets Help With Healing?

Our family’s dog is ready for the Red Sox celebration parade.

Our family’s dog is ready for the Red Sox celebration parade.

Ever so often a blogger, in this case me, discovers a piece of news that’s old, but so interesting and relevant. When Best Friends Can Visit, appearing in the New York Times New Old Age blog, is just such an article.

This report, written by Judith Graham, describes how some hospitals and medical centers have decided to allow pets — as opposed to trained therapy dogs — to visit sick patients. One of these programs, at the University of Maryland Medical Center, has been in place since 2008. The report is filled with patient and family testimonials, explaining the positive differences that visiting pets can make.

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Detached Retina – I’ve Got Oil in My Eye

The light shading in this image represents the oil. The macula is in the middle.

The shading in this image represents the oil.

This post is not a substitute for talking with your physician.

Since oil was put into my right eye to hold my retina in place for several months, I’ve been humming an old Sunday School song, “Give Me Oil in My Lamp,” last sung, by me anyway, some time ago. The only difference is that I’ve changed the words. (Listen to the original song here.)

I’ve got oil in my eye, keep me healing.
I’ve got oil in my eye, I pray.
I’ve got oil in my eye, keep me healing.
Keep me healing ’til the break of day.

In early August my surgeon put silicon oil in my right eye after the retina kept detaching due to a condition called proliferative vitreoretinopathy. The oil holds the retina in place for a longer period than any bubble can — right now it looks like the oil will remain for about four months — holding my retina firm and promoting the healing process.                Continue reading

Grandfather First Refused Medicare Because of Scare Tactics and Misinformation

Affordable Care

If the system is too busy or too slow, do exactly what you do with online banking or at other online sites — wait a while and try again.

It’s funny how changes in health care policy seem to generate anxiety, anger, and all sorts of misinformation in the United States. Well, actually it’s not so funny.

How is it that so few people can scare so many others when it comes to keeping many more people healthy? But that describes what has happened with the Affordable Care Act. A small number of fear mongers have frightened many others — often citizens who can benefit from better access to health care.

My husband’s grandfather, a small-town merchant, refused Medicare for years, because of the anxiety, anger, and misinformation associated with the passage of the laws. He would have benefitted if he had signed up in a timely manner for the Medicare coverage that he was entitled to receive. In those days he would have needed to get the forms, probably lengthy ones, fill in the information, mail them, and wait around for several weeks — not like today when, once the IT experts tweak the computer systems, people will be able to sign up in a day or two.

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