Archive for the ‘Healthcare Professionals’ Category
Usually we operate on a Hip Fracture. We do that in order to: preserve Independent Living; or preserve independent ambulation in Assisted Living; or preserve assisted ambulation in a Care Facility; and always to preserve quality of life. But what if none of those goals are possible?
At the St Paul Geriatric Fracture Conference this month, it was proposed that alternative care to surgery is sometimes more humane and less costly to society – both laudable goals. The ideal care for a patient with a fractured hip is to thoroughly discuss all alternatives before proceeding to surgery.
Family and other caregivers should all join the patient for a relaxed discussion of the future, weighing quality of life issues radically changed by the usual loss of function / independence imposed by the fracture. Only after concensus is reached, should surgery proceed – if that is the chosen path.
Unfortunately, the clock is ticking. The likelihood of death, medical complications of the fracture, medical complications of surgery, and permanent disabilities begin to increase only 12 hours after fracture. Gathering all interested parties and making informed life-changing decisions within that time limit is very challenging.
Ideally the patient, family, care-givers and primary physician have discussed the possibility of fracture and come to tentative decisions about what sorts of care are desired. This is especially true for patients who already cannot ambulate, are becoming demented, or have a limited quality of life.
Involve the patient in the decision while he/she can still express his/her desires. Written Advanced Directives are ideally on file with physician and hospital. Allow the patient to Take Control of his/her Future.
My wife and I have discussed our desires with our children. We have advanced directives on file. You should too.
Jay Ginther, MD
Wrong Question! What you should be managing is Fracture Risk. If you only look at Bone Mineral Density (BMD), you miss the chance to decrease Fracture Risk in the overwhelming majority of people.
85% of the women who Fracture have a DXA score of “osteopenia” or even “normal”. Keeping their bone density at “only osteopenia” does them no favor. So how can you manage Fracture Risk?
Our Amgen Medical Liaison met with us this week. Her job is to supply information which has been published or presented at major meetings. She meets only with practitioners (MD, NP in our case) and cannot market any medications.
This is good. For the first time in 5 years, I missed ASBMR (American Society for Bone & Mineral Research). She was able to show us several studies presented at that meeting that were most helpful.
NP Katie and I, like most practitioners, always approach scientific papers with a critical eye. The studies answered several questions. They also raised further questions. Perhaps those answers will come next year.
Legislators pass rules and regs to keep medical practitioners away from information supplied by persons employed by Pharma. They fail to understand the value of critcally evaluating new scientific data. Detailed information about each available medication is needed if we are to find the best osteoporosis medication for each patient each time.
No single osteoporosis medication is right for everyone all the time. Every osteoporosis medication is the best choice for someone at some time. There are times when no medication is the best choice.
The more information Katie and I have about medications, the smarter we are when helping to choose what is best for each individual. No one can go to all meetings or read all published studies. A Pharma Medical Liaison helps gather relevant information.
YOU too can gather information before and after you visit your doc. Use the left column to find blogs about topics that interest you. You can Take Control.
Jay Ginther, MD
Katie Bries, ARNP, taught the Bone Health section for the Nurse Practitioner students at Allen College this year. She did a great job covering the basics. Unfortunately, she had time only for the basics. This is true in teaching NPs everywhere. It is true of all aspects of medicine when teaching MDs, DOs, PAs, and all others. There is only time for the basics.
Any Healthcare Provider who wants to fully master a subject must take “Electives” for additional training in the field they plan to focus on in practice. With MDs and DOs there are formal “Residencies” lasting 3 or more years after graduation. NP and PA students take “Clinicals” in various fields before, and sometimes after, graduation. Cedar Valley Bone Health has hosted clinicals for local and out-of-state Providers.