Are Your Health Wishes Known?

By Dr. John Ropp | Family Physician | Hartsville

When my wife and I married seventeen years ago, our eight grandparents attended the wedding on a warm May evening.  A picture of them together stands as one of our most treasured memories from that special day.  What is even more special, however, is that five of them remain with us today and our children have grown up knowing them well.   The years have not passed, though, without some very difficult discussions and decisions about their well-being, medical care, and other plans if and when they need additional attention.  In the last several weeks alone, I have advised my parents and in-laws concerning matters with their parents, and I sat with neighbors around their dining room table to consider alternatives for their aged mother.  Many of you know what hard talks these can be with family members and other special people in our lives.  Often, we delay speaking until a problem arises that forces us to face a reality- that there will probably come a time when our loved one’s health will not improve or when they cannot take care of themselves any longer.  What then? 

This month we celebrate National Health Decisions Day and as a family physician, I encourage you to take several actions to insure that you and your family have communicated your wishes with one another throughout various life stages.  As a doctor who cares for many seriously ill patients, I cannot tell you how important these discussions are for the peace of everyone involved in a person’s life.  First, please identify a health care power of attorney for yourself and ask other adult members in the family to do the same.  A local attorney can help you with this and other advance directives that may be helpful as well.  Second, when you are diagnosed with a medical condition that you will live with for the rest of your life, please establish and maintain good communication with your primary care physician through the years.  This step will insure appropriate care is provided no matter how long you live with the condition as you continue efforts to cure the malady.  Finally, when a disease process becomes overwhelming or when care needs are extraordinary in a person who is nearing the end of life, consider the appropriateness of more direct palliative care in discussions with your doctor.  Goals to relieve pain and suffering, while honoring patient wishes and dignity, are a hallmark of this care. 

Additionally, we are very pleased that the start of the South Carolina Physicians Order for Scope of Treatment (SC POST) pilot study coincides with NHDD this year.  Our state coalition has worked long and hard to insure that all seriously ill patients in South Carolina and their families have an active voice in their health decisions and communicate these wishes with their physicians and other providers.  I hope you will help join us in this effort by taking the action steps suggested so that we can deliver the best care to our most vulnerable patients.

A few of my interesting and not uncommon conversations...

By John Eberly, MD, Family Medicine

Dr. John Eberly, a family physician from Greenville, writes with humor about some of the common burdens of bureaucracy affecting family practice physicians in their daily practice.

I was reading my trustee’s report this evening (Rob Morgan, MD. Greenville) on the SCMA website and I decided to click on to our organization’s new “blog-site.” It was great to see familiar names contributing to various areas of interest in the name of South Carolina happenings in medicine. Though I am not a blogger, or even a writer, I have noticed a trend in on-line media over the past several years. It seems that anyone can contribute to a blog, or even have their own “expert” page or column. This is sometimes good and sometimes bad. Right now it’s good, because as a real novice, and down-right amateur scribe, I can feel “free” to pen anything in 2013 that my high school and college teachers may have cringed to read. There are no red pens awaiting these blogs; or at least I hope there are not. This is my chance. No shame. Probably no one watching (reading) either. So as a family physician, I wanted to post a few of my interesting and not uncommon conversations I had today with patients in my office.

I have a typical family practice. Plenty of acute problems mixed in with some chronic conditions plus a few visits I am not sure how to characterize. Some of today’s more interesting conversations with patients included a new onset diabetic, age 39. I knew he was coming in today because a cardiologist called me yesterday to let me know his random glucose was 424 yesterday after a cath; thankfully a normal cath. Anyway, there was nothing interesting regarding the workup, other than I thought that it was amusing that he felt like he could “beat this” disease if he gave up his 12-14 soft drinks a day that he had been consuming “for the past 15 years.” Wow. Then he informed me that he would be willing to speak with the dietician as long as she would work with him because he was “a vegetarian.” Another geriatric couple came in together to complete their “annual medicare wellness exam.” It was one of my favorite moments of the day because we all got some solid, belly-aching laughter out of the visit. They both couldn't figure out if I was serious or not while asking them the appointed questions that the CMS elitists say I must ask during this “free” Medicare benefit. It doesn't matter that I’ve known them for 21 years. I just want to make sure I performed the measure so that I don't become an outlier. And oh yeah, did I mention that it was “free” to them? I enjoyed praying with a college student who asked that I do so (because that’s still legal I think) because she was struggling with an eating disorder. Speaking of legalities, I enjoyed a brief breakfast of yogurt and coffee provided by an (evil) pharmaceutical rep.

I learned about a novel insulin delivery system and its nuances, efficacy etc. The yogurt was especially tasty as I knew it would be the last before the Sunshine Act kicked in next month. From August 1st until I die, someone up in D.C. will be publishing online all of the meals and trinkets I receive from Big Pharma and other medical suppliers. This is scary, because up until now, I have been able to deceive my patients into thinking I actually care about them and am not influenced by pens and chicken fingers. But soon I suspect my cover will be blown, thanks to those pesky busy-body congressmen. If only us physicians could be as ethical and selfless as they are!

Finally, I was able to make quite a few people feel better today who were either in need of an antibiotic or reassurance about a test or procedure. It was a fairly typical day for a Family Physician or Internist.

I can now say that I have “blogged.” Thanks for the platform SCMA. 

Good night, Honey?

By Dr. John Ropp, Hartsville Family Physician, SCMA Young Physicians Trustee

If I had a quarter for every time a parent asked me what OTC medicine they can use for their kid’s cough and cold, well…I could probably make up the 2% loss in practice revenue from this year’s sequestration.  Since this is not a billable code under ICD-10, however, then perhaps I will have to wait for ICD-11 or 12.  In the meantime, I was encouraged to read an article in a recent issue of The Journal of FamilyPractice that offered a simple, time-tested remedy for the parent (yes, the parent) of kids who fall ill due to the latest cough illness making the ____________ (fill in blank here for child location of choice- school, church, playgroup, ballclub, other) rounds.  For as we all know, the late night childhood cough is a phenomenon unlike any others and must certainly be an invention of the demons designed to minimally affect the ill, but to inflict the greatest harm on their guardian- the loss of sleep and the gain of anxieties.  But rest assured, oh sleepless parent, for grandma was spot on- the sweet elixir of honey can calm the cough.   The article title gives the answer- “A spoonful of honey helps a coughing child sleep,” and the article goes on to describe the randomized controlled trial that studied children between the ages of one to five years old with a nocturnal cough of less than seven days duration.  They excluded other obvious or possibly more serious conditions and randomized each child to receive 1.5 teaspoons of one of three honey types or placebo 30 minutes prior to bedtime.  Follow up results showed that there were statistically significant differences in efficacy for the honey groups (but not favoring one over the other) versus the placebo.  Of course, our dentist friends will remind us to use this remedy sparingly due to the sugar content, and we will need to continue preaching caution to children less than one year of age, but this would be a nice recommendation if we can break our collective OTC drug habits.  When faced with getting a good night’s rest themselves, though, it’s good to know that we might reach for the pantry instead of the drug shelf.  Sleep tight, honey.

Ashkin MD, Evan and Mounsey MD, Anne (March 2013). A spoonful of honey helps a coughing child sleep.  The Journal of Family Practice, Vol 62, No. 3.  Retrieved from jfponline.com.