Tag: Muriel Gillick
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Palliative Care – Not Just for the Dying
I used to think that palliative care was just for people who were dying. Then I found out—about a dozen years ago—that palliative care had expanded its original focus on end-stage cancer patients to include people with serious illness throughout the course of their disease (or diseases). Palliative care, I realized, is far more than…
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Caring for Nursing Home Patients under Medicare
What drove me crazy about practicing medicine in a nursing home wasn’t the patients, although with their many medical problems often including cognitive impairment they were a challenge; and it wasn’t the families, though with their anxiety and attentiveness and sometimes their guilt they were an even greater challenge. What drove me crazy about nursing…
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Dementia and the Goals of Care
Even though you think and behave perfectly normally, you might already have Alzheimer’s disease. In fact, you might warrant the label of “pre-clinical Alzheimer’s disease” for a full 20 years before graduating to the full-fledged condition. That according to the latest definition of Alzheimer’s put forward by the National Institute on Aging together with Alzheimer’s Association…
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Call the Concierge
My mother recently got a letter from her doctor informing her that he is going into “concierge medicine.” If she wants to keep him as her doctor—and she does (she’s 88 and has known him for years)—she will have to sign up for his new plan, paying a retainer fee of $3500 a year on…
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Alzheimer’s Association 2014 Annual Report
It’s that time of year again, when the Alzheimer’s Association releases its annual report: Alzheimer’s Disease Facts and Figures. The 2014 edition doesn’t tell us much that’s new—which amounts to a good deal of bad news. The facts boil down to these:
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Keeping Frail Elderly out of the Hospital
When I was a medical resident at Boston City Hospital, a large, public, inner city hospital, I began wondering whether hospitals sometimes caused as many problems as they cured. Over and over, I saw older patients admitted with one disease such as pneumonia or a heart attack, who ended up falling and breaking a bone…
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Pulling the Plug on DNR
Recently, a friend commented that she was not sure whether or not to agree to a “DNR order” for her 90 year-old mother. Her mother has dementia and lives in a nursing home; she is her mom’s health care proxy. Complicating her decision was the knowledge that her mother had chosen a DNR status when…
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Aging Well
My mother will turn 88 in a few weeks. According to the definition of successful aging put forward by Rowe and Kahn nearly 16 years ago, she is aging quite well. Her kidneys, lungs, and heart work fine. She is still very active—she teaches a French class once a week at the local senior center,…
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Aging Well
My mother will turn 88 in a few weeks. According to the definition of successful aging put forward by Rowe and Kahn nearly 16 years ago, she is aging quite well. Her kidneys, lungs, and heart work fine. She is still very active—she teaches a French class once a week at the local senior center,…
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No Sense, Lots of Dollars
Twenty-five years ago, discussions of medical futility were the rage in bioethics circles. The discussions petered out when it became clear that futility was in the eye of the beholder: physicians and patients often had very different ideas about what futility meant, depending on what they hoped medical treatment would accomplish. In one…