My Mentor in Geriatrics: Leslie S. Libow MD
Were it not for Leslie S. Libow I would not have entered the specialty of Geriatrics. This past weekend at the annual meeting of the American Medical Directors Association (AMDA), I sat in the audience as Dr. Libow received the prestigious James Patee Award for Excellence in Education. Afterward I had the opportunity to schmooze with my former mentor, whose photo is above. In 1983 …Read More
Medical Education, Geriatrics, and the Humanities
The education of today’s physicians cannot be regarded as complete or adequate without substantial exposure to geriatrics. It is not just the facts of geriatric medicine, but the humanistic aspect of its practice that is important. Medicine is taught as a cut-and-dry collection of information, taking the humanistic fundamentals and historic background either for granted or with a grain of salt. Lewis Thomas pointed out …Read More
New Rules for Pressure Ulcer Risk Assessment in Nursing Homes
MDS version 3.0, the mandatory assessment tool for residents of skilled nursing facilities, was finally implemented October 2010 after years of planning. Section M: Skin Condition has been completely revised and expanded. This blog post will address MDS 3.0 sub-section M0100: Determination of Pressure Ulcer Risk, which approaches “at-risk” status in a much more sophisticated and clinically acceptable manner than past versions, enabling better targeting of preventive …Read More
Pressure Ulcer Prevention for Patients in Wheelchairs
In most cases pressure ulcer prevention can be accomplished by risk assessment followed by common sense choices for pressure reduction. In these days of evidence based medicine, health care providers need to listen to the evidence and implement best practices to reduce the incidence and prevalence of adverse outcomes such as pressure ulcers. An important research article on pressure ulcer prevention recently came out in …Read More
The Faces of a Generation Deserve Attention
An Essay by Dr. Jerry Winakur [This essay written by author and physician Jerry Winakur is reprinted with permission from Caring for the Ages, a publication of the American Medical Directors Association. Dr. Winakur is Clinical Professor of Medicine at University of Texas Health Science Center at San Antonio where my exhibit, Aging Across America, was shown this past winter in the Briscoe Library.] For the …Read More
The Myth of the Mechanical Fall
Recently on hospital teaching rounds a medical resident presented an elderly man who fell. The patient suffered no fall-related injuries but was diagnosed with pneumonia and congestive heart failure. The resident called the event a “mechanical fall,” and the interns and residents nodded in agreement regarding the assessment and plan. When I questioned the young doctor, he did not ask about gait and balance, did not …Read More
Free Online Training for MDS 3.0 Section M: Skin Condition
This is the video of the pressure ulcer assessment and coding training session for MDS 3.0 Section M: Skin Condition that I delivered in Las Vegas on August 10, 2010. It was posted online by the Centers for Medicare and Medicaid Services (CMS) on January 20, 2011. This lecture was part of the CMS sponsored introduction to MDS 3.0 that was free to any facility or provider who …Read More
White House Backtracks on Payment for End-of-Life Counseling
Medical doctors are trained to understand and administer powerful technologies which can prolong life. They get paid to do this. But should they also get paid to inform patients of alternatives if they do not want these technologies? The Obama administration has said no to this question. During the healthcare reform debate the issue of physician reimbursement for end-of-life counseling took a nasty turn when conservatives adopted …Read More
Geriatrics by Legislation: The Trend Continues
In a recent blog post I pointed out some legislative initiatives that essentially make certain principles of geriatric practice required by law. I noted how these laws can be interpreted as an effort to make up for the scarcity of practicing geriatricians, and the lack of geriatrics training for most physicians in America. President Obama has continued this trend by signing a new Medicare regulation …Read More
Brief Reprieve from Congress for Medicare Cuts to Doctors
Earlier this month the Senate voted to postpone for one year the impending Medicare pay cuts to doctors that would have gone into effect January of 2011. This is the latest postponement for a measure that will have deep impact on care of the elderly in America. In a recent blog post I discussed the imminent Medicare pay cut for physicians and the impact on …Read More
