This issue of Clinics in Geriatric Medicine, guest edited by Drs. Cynthia Boyd, James T. Pacala, and Michael W. Rich, is devoted to Chronic Conditions in Older Adults with Cardiovascular Disease. Articles in this issue include: Epidemiology of multimorbidity in older adults with cardiovascular disease; Impact of multimorbidity on clinical outcomes in older adults with cardiovascular disease; Assessment of goals of care in patients with multiple chronic conditions; Challenges in decision-making: balancing trade-offs; Multimorbidity in older adults with heart failure; Multimorbidity in older adults with acute coronary syndromes; Multimorbidity in older adults with aortic stenosis; Multimorbidity in older adults with atrial fibrillation;Anticoagulation in older adults with multimorbidity; Approach to evaluating the multimorbid patient with cardiovascular disease undergoing non-cardiac surgery; Integrating care across disciplines; Assessing risks and benefits of invasive cardiac procedures in patients with advanced multimorbidity; Multimorbidity and end of life care in patients with cardiovascular disease; and Future research directions for cardiovascular disease.
Good Times in the Hospital is a collection of unlikely stories, poignant vignettes, and humorous anecdotes gathered from a lifetime of experience with real doctors and patients. As the setting moves from Duke University Medical School, to The Mayo Clinic, to an inner-city charity hospital, to a military hospital, to private hospitals in metropolitan centers and rural towns, this inside look at hospital life allows the reader to gradually gain a new perspective on medical men and women: They are not much different from the rest of us. After forty years of medical education and hospital practice, the author concludes that, "Doctors are no worse than other people." As for the patients in these stories although hospitals are engaged in the most serious business imaginable you cannot find more laugh-out-loud behavior anywhere. This is because when people are seeking medical care, they are vulnerable and reveal their true, inner selves. And, it turns out that the true, inner selves of most people are often some combination of fascinating, inexplicable, and ridiculous. To paraphrase a quote by Mel Brooks: "So long as this old world keeps spinning around and around, every person riding on it will occasionally get dizzy and do something stupid." Good Times in the Hospital reminds us that it is unhealthy to take life too seriously and a lighthearted temperament is just as important as a sound diet. This point of view makes it possible for one book to combine a rare glimpse inside the hospital, an informative look at health care, and an entertaining collection of anecdotes. There are chapters about juvenile practical jokes among medical students, mistakes by doctors in training, serious life lessons learned at the bedside, hospital affairs that end badly, doctors threatening other doctors with handguns, a girl who tries to stop her grandma's pacemaker with an MR scanner, an identical twin who has the surgery intended for her sister, an old man patiently waiting his turn in a charity hospital emergency room while holding his intestines in his hand, boyhood memories of a doctor who accompanied his father making house calls, a doctor who missed his chance to win a Nobel Prize by not listening to his patient, an intriguing case of domestic abuse, fascinating hypochondriacs, insights into why intelligent people spend their last dollar on irrational treatments, amazing examples of cures by mind over matter, the importance of our attitude on our wellness, and even reflections on the question of medical miracles. Is it appropriate to laugh at the behavior of doctors attending their patients and entertain ourselves with yarns of patients in their sickbed? Good Times in the Hospital promotes the viewpoint that the best way to deal with our inevitable foibles is to laugh about them. The author says, "If you believe that some things are sacrosanct and immune from humor, you are reading the wrong book." In an epilogue following this rich tapestry of medical tales, the author offers some final thoughts on how to sort through medical advice, a discussion of alternative medicine, the real effect of malpractice lawsuits on doctors, and the responsibility of patients for their own health. This epilogue is a rare opportunity to hear from an experienced, retired physician on such matters. Such frank opinions are virtually never discussed by doctors in practice, who must be circumspect in what they say for fear of alienating their patients, losing their insurance coverage, or becoming the target of a law firm. Mostly though, Good Times in the Hospital is an insightful panoply of true-life stories that illustrate the best and worst of human nature, a chance for the reader to have some fun and learn a little along the way.
Wisconsin family physician, Dr. James Damos, knows firsthand what rural practice can contribute to the body of medicine and to the communities they serve. While most of today's medical students will choose specialized fields of care in a city environment, James Damos bucked the trend. For the past few decades, medical schools have steered their students toward specialization and away from the option of serving as a doctor in a small community. Damos would like to see this changed. Using real-life examples and illustrations from his own experience practicing in a small town, Dr. Damos provides a glimpse into the exciting challenges these doctors face day to day. Damos also describes the health challenges his own family has endured, detailing their struggles with childhood cancer and Alzheimer's Disease. These traumatic events and others described in this heartfelt memoir drive home the benefits of a close-knit community. From the viewpoint of a doctor, a husband and a father, Jim Damos illustrates how genuine personal relationships and a connection with others is sometimes the best medicine.
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