tag:blogger.com,1999:blog-13495125.post375234922123373971..comments2011-03-27T22:37:51.257-05:00Drew Rosielle MDhttp://www.blogger.com/profile/04345646798042773615noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-13495125.post-58166518396037268912011-03-27T22:37:51.258-05:002011-03-27T22:37:51.258-05:00I appreciate your pointing out the subversive nature of the ‘whole-organism’ concept. It was encouraging to see an article in JAMA last year on reductionism as opposed to complex systems. Now that we’ve gotten down to the level of individual alleles and find there’s no one-to-one correspondence between genes and diseases, it may force medicine to recognize both ‘whole-organisms’ and complexity. As the article states: “[T]he key obstacle to future medicine is the conflict between the reality of complexity and a reductionist approach.” (There’s a PDF version of the article, by Henry H. Q. Heng, here: http://complex.wayne.edu/caba08/CABA08_Heng.pdf )Jan Hendersonhttp://www.thehealthculture.comnoreply@blogger.comtag:blogger.com,1999:blog-13495125.post-52221585004011344342011-03-27T22:37:51.033-05:002011-03-27T22:37:51.033-05:00Excellent discussion, and appreciate the continuity with GeriPal.<br><br><i>those who fear &#39;socialized medicine,&#39;</i> probably shouldn&#39;t even look at dialysis in the U.S. which is, of course, paid for largely by our friends at Medicare.<br><br>I guess if you&#39;re gonna be really sick in this country, but don&#39;t want to deal with the usual insurance hassles, you could do worse than have end stage renal disease.<br><br>And the diagnosis qualifies the lucky holder for a regular disability check delivered direct to the mailbox by a uniformed employee of the federal government.Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-13495125.post-47211699535176084492011-03-27T22:37:50.697-05:002011-03-27T22:37:50.697-05:00After several years of interventions for multiple health problems, my 78 year old father (who up until this point in his life had always appeared much younger/stronger than his age)was left with the dialysis option. At first he was dead-set against, but when he asked us in a family meeting and we stated &#39;it was his decision, but we wanted him around as long as we could have him&#39;; he agreed to try. He&#39;d had several dialysis treatments during hospitalizations and was hopeful that he would benefit enough to &#39;get out in the boat, fishing, one more time.&#39; After 2 terrible weeks and worsening strength/edema, he made the decision to stop, even though the doctor told him that meant 1-2 weeks only. We were able to get all the grandkids home to see Grandpa A. again and really had a pretty fair week and a half on hospice before he died. Even as a long-time hospice nurse myself, I still encouraged Dad to try dialysis....wish I&#39;d been aware of this information sooner although I&#39;m not sure a different decision would have/should have been made. Thanks for all the information that is provided on Pallimed--I find it very helpful/thoughtful/thorough. Sandy Davenport, RNSandy Davenport RNnoreply@blogger.comtag:blogger.com,1999:blog-13495125.post-87437096058698468752011-03-27T22:37:50.320-05:002011-03-27T22:37:50.320-05:00Thanks all for the comments.<br>Jan thanks for the link to the reductionist article. Clearly, reductionism has been wildly successful the last 100 years in medicine, but it fails us, in a huge way, when patients start dying of chronic illnesses. <br>Sandy - thank you for sharing your family&#39;s story.Drew Rosielle MDhttp://www.blogger.com/profile/04345646798042773615noreply@blogger.comtag:blogger.com,1999:blog-13495125.post-20455169039534125272009-11-05T09:28:16.643-06:002009-11-05T09:28:16.643-06:00Thanks all for the comments.<br />Jan thanks for the link to the reductionist article. Clearly, reductionism has been wildly successful the last 100 years in medicine, but it fails us, in a huge way, when patients start dying of chronic illnesses. <br />Sandy - thank you for sharing your family&#39;s story.Drew Rosielle MDhttp://www.blogger.com/profile/04345646798042773615noreply@blogger.comtag:blogger.com,1999:blog-13495125.post-87352966760167294652009-11-04T14:01:20.449-06:002009-11-04T14:01:20.449-06:00After several years of interventions for multiple health problems, my 78 year old father (who up until this point in his life had always appeared much younger/stronger than his age)was left with the dialysis option. At first he was dead-set against, but when he asked us in a family meeting and we stated &#39;it was his decision, but we wanted him around as long as we could have him&#39;; he agreed to try. He&#39;d had several dialysis treatments during hospitalizations and was hopeful that he would benefit enough to &#39;get out in the boat, fishing, one more time.&#39; After 2 terrible weeks and worsening strength/edema, he made the decision to stop, even though the doctor told him that meant 1-2 weeks only. We were able to get all the grandkids home to see Grandpa A. again and really had a pretty fair week and a half on hospice before he died. Even as a long-time hospice nurse myself, I still encouraged Dad to try dialysis....wish I&#39;d been aware of this information sooner although I&#39;m not sure a different decision would have/should have been made. Thanks for all the information that is provided on Pallimed--I find it very helpful/thoughtful/thorough. Sandy Davenport, RNSandy Davenport RNnoreply@blogger.comtag:blogger.com,1999:blog-13495125.post-59528095304266745902009-10-30T17:47:05.723-05:002009-10-30T17:47:05.723-05:00Excellent discussion, and appreciate the continuity with GeriPal.<br /><br /><i>those who fear &#39;socialized medicine,&#39;</i> probably shouldn&#39;t even look at dialysis in the U.S. which is, of course, paid for largely by our friends at Medicare.<br /><br />I guess if you&#39;re gonna be really sick in this country, but don&#39;t want to deal with the usual insurance hassles, you could do worse than have end stage renal disease.<br /><br />And the diagnosis qualifies the lucky holder for a regular disability check delivered direct to the mailbox by a uniformed employee of the federal government.Jerryhttp://www.blogger.com/profile/01241842671993239496noreply@blogger.comtag:blogger.com,1999:blog-13495125.post-16643166663523541772009-10-30T17:27:01.582-05:002009-10-30T17:27:01.582-05:00I appreciate your pointing out the subversive nature of the ‘whole-organism’ concept. It was encouraging to see an article in JAMA last year on reductionism as opposed to complex systems. Now that we’ve gotten down to the level of individual alleles and find there’s no one-to-one correspondence between genes and diseases, it may force medicine to recognize both ‘whole-organisms’ and complexity. As the article states: “[T]he key obstacle to future medicine is the conflict between the reality of complexity and a reductionist approach.” (There’s a PDF version of the article, by Henry H. Q. Heng, here: http://complex.wayne.edu/caba08/CABA08_Heng.pdf )Jan Hendersonhttp://www.thehealthculture.comnoreply@blogger.comtag:blogger.com,1999:blog-13495125.post-27312661190797270012009-10-30T09:13:17.046-05:002009-10-30T09:13:17.046-05:00I applaud these efforts that look at function in patients--&quot;What will I be able to do?&quot; is a question most patients have about their conditions, but it is one that the medical profession is often slow to be able to answer. Life without function is often not much of a life for our patients.Dr. Pamhttp://www.blogger.com/profile/18229315297694888405noreply@blogger.com