Sunday, October 28, 2012

Help - I'm falling ......

People fall all the time – and most of the time we brush ourselves off and resolve to be more careful next time. Unfortunately, 20-30% of older adults who fall suffer moderate to severe injuries that reduce mobility and independence and increase the risk of premature death.  But are these falls ‘accidents’ or events that could be prevented?

Falls can be caused by faulty consumer products or products used in a way that was not intended. Chairs are for sitting – not to allow one to reach a high shelf or change a lightbulb. Towel bars and faucets are not designed to be grab bars.

At least one-third of all falls in the elderly involve environmental hazards in the home. The most common hazard for falls is tripping over objects on the floor. Reduce clutter and make sure that electrical and telephone cords are out of the way.

Alcohol is a risk, both alone and combined with medications. Another risk factor is poor vision (including poor lighting). Cataracts and glaucoma alter older people's depth perception, visual acuity, peripheral vision and susceptibility to glare. These limitations hinder their ability to safely negotiate their environment, whether in their own home or in a shopping mall. Young people use visual cues to perceive an imminent fall and take corrective action. Older adults with visual impairments do not have this advantage to the same extent.

A person who has fallen is at great risk to fall again – two-thirds of those who fall will fall again within six months. Don’t wait for the first fall to take action! Failure to exercise regularly results in poor muscle tone, decreased strength, and loss of bone mass and flexibility. Clear out clutter and have grab bars professionally installed. Report side effects of medication and get your eyes checked regularly.
Preventing falls is not just for the elderly. Anyone can be temporarily off her game and not see the electrical cord. Anyone can sprain his ankle and be off balance and trip on the rug. Anyone can lose his mind and try to reach a high object by climbing on furniture.
Tips on preventing falls in the home.
Check for safety 

Monday, October 22, 2012

Sweet Dreams

If you need an alarm to wake up in the morning, you are not getting enough sleep. You have an internal clock and if that doesn’t correspond to your daily schedule you may have “social jet lag.” Socially jet-lagged people are three times more likely to be overweight and performance at work and in school may suffer.

Your biologic clock works best if you awaken at the same time every day. That said, your body needs enough time to complete the metabolic work of sleep:  tissue growth, energy is restored and hormones are released. The brain cools down and consolidates memories: much like a computer rebooting after having too many open programs.

Go to bed at least eight hours before you plan to awaken. Establish a regular relaxing, not alerting, bedtime routine. Create a sleep-conducive environment that is dark, quiet and cool. Turn off all screens well before bedtime.

When you do get up, try to get some sunshine on your face. You will get into gear faster.

The Harvard point of view.

Sunday, October 7, 2012

Three Stars

When I get a letter from an insurance company the greeting is usually “Dear Provider,” since the same letter (usually bearing bad news) is sent to doctors, nurse-practitioners, physical therapists and social workers. The letter usually details how we “providers” will be paid less money or will face additional roadblocks in getting care for our patients.

I should have known that something was up when I received a letter addressed “Dear Physician.” The letter, from a major insurer, informed me that I received a 3 star designation for care – in fact, my score was 95%. I supposed that I should be flattered, but in actuality my score could have just as easily been 65%. I was being measured on the percentage of my patients that had received services such as mammograms.

I don’t have a mammogram machine in my office. Patients need to make another appointment at another office. I treat my patients as the grown women that they are and ask them to have a mammogram. I hand them a referral slip and hope that they will make an appointment. I remind the patient at almost every contact, but I cannot drag the patient to the mammography suite and hoist her breasts onto the machine. It's up to the patient to have a mammogram, not me.

Mammograms help find breast cancer. The jury is out if they actually save lives. They are inconvenient, uncomfortable and can be expensive (thank you to insurance companies that will weasel out of paying for services). I do think that they are a good idea and actively promote them.

So, this year I am a 3 star physician. From what I can see, my 2 star and 1 star colleagues are taking good care of their patients too.