Dr. Michael Lowe of RTA Hospice and Palliative Care has some surprising medical advice.
- "People should not go to their doctor about how to stay well. We don't know. We can help you get well when you're sick."
- "Get a good consulting pharmacist to go over your medications with you, if you are taking six or more prescriptions."
From his work with hospice, Lowe said he has discovered that too many medications can contribute to someone feeling bad.
"I've turned into a minimalist," he said. "I am not one of those doctors who is always looking at what's latest and greatest on the market."
He said, more often than not, if someone he is seeing is taking a bunch of different medications, he will see which ones he can stop and then see how that makes them feel. Frequently, they start feeling a lot better when taking fewer medications.
The medication he uses in his practice with hospice is often chosen for its side effects. Morphine is used to control pain and it is also used to help patients suffering with rapid breathing problems. Steroids are used, because they can help patients put on weight.
"I can't tell you when we have ever checked a hospice patient's cholesterol level," he said.
Advances in medicine today are not geared toward the elderly, he said. "Medical research with the elderly is limited due to their lifespan. But that is starting to change. Alzheimer's medicine is an example."
Past advances in treating and preventing heart attacks are keeping more people alive longer and so later-life illnesses are being seen. "And we have to figure out how to handle the higher number of people. Censuses of patients in nursing homes is up."
He said social services for the elderly are limited and it is hard to find enough nurses and certified nursing assistance to provide the growing need for care among the elderly.
He said a way needs to be found to maintain a level of care for the elderly in the home, so it is not a matter of waiting for the next medical disaster to make adjustment in medications and other care. He thinks that is where palliative care can play an important role, because it gets someone in the home who knows the signs of a deteriorating condition and can advocate for more immediate attention for the patient by their health care provider.
"We tried to do that with palliative care, but since it is not in the current medical model we had to scale it back," he said -- funds were not available to pay for the level of service provided.
That could change though. He said Hospice of the Valley is currently conducting a pilot program to show Medicare the cost benefits of expanding funding for palliative care. Efforts are also being made to show Medicare the benefits of more funding for nursing care in the home.
"It is a decision being made at the political level and I don't know where it's going to go. There are talks about cutting back for hospice."
On a more positive note, Lowe said the growing trend of hospitalist programs is a move in the right direction.
A hospitalist is an on-staff internist at a hospital. The primary care provider turns over a patient's hospital care to them, so their needs can be more immediately met.