Charles E. Lewis

Factors influencing the return to work of men with congestive heart failure

Abstract What then is the composite picture of the man who returns to work? He has heart disease, but usually does not have severe congestive failure. His cardiac compensation may improve to the degree where he can discontinue digitalis or its derivatives. He has been employed most of the past 5 years; he has a high school education or better; and he has a physician that he sees regularly (but the type of physician does not seem to matter). He is a ‘white collar worker’ or if a ‘blue collar worker’ he usually belongs to a union. He is not known to welfare agencies. He is optimistic, and his doctor agrees with his optimism. He resumes off-job activities and also resumes sexual activities. His family, according to him, does not reject him or behave in an over-protective manner. On the other hand, the man who does not return to work has a more limited cardiac reserve. He is ‘inferior’ with regard to education. He does not belong to a union. He is frequently ‘laid off’ after the onset of his congestive failure, or feels that he is. He frequently has other health and welfare problems, and is known to social and welfare agencies. His outlook is pessimistic; he has few outside activities; he usually does not resume or engage in sexual activities after the onset of his heart failure. He may admit that he is afraid to return to work. He feels that his family rejects him or is overly protective. Much of the information presented in previous paragraphs as a composite description of these two types of men might be used to describe any group of patients with chronic disease. Some are ‘good patients’ who are highly motivated. They follow physicians advice, they make a great effort to take medication as directed and stay upon other therapeutic regimes. There are others who are destined to live out the natural history of their disease in limbo. The difference between these groups, as indicated in this study of men with congestive heart failure, seems to be related to the interaction of social and psychological factors with physiological limitations imposed by the biologic disease process. The current methods of ‘managing’ these poorly motivated, apathetic patients seem doomed to failure. The provision of effective long-term supportive care for this type of patient may depend upon the development of new and imaginative methods of delivering medical care.

Medical care for patients with neurological and sensory diseases—I: Utilization of institutional facilities☆

Abstract 1. 1. A study was made of the utilization of short-term general hospital beds in Kansas by patients with neurological and sensory disorders. A stratified sub-sample of all such hospitals, grouped according to bed size, was studied. Eighty-seven per cent of all the institutions cooperated in the survey. An average of 7 per cent of all patients dismissed from these hospitals had been discharged with a primary diagnosis of a neurological or sensory disorder. This estimate is based upon approximately 30 per cent of all hospital beds of this type in the state. The most common dismissal diagnoses were cerebrovascular disease and polyneuropathies secondary to diabetes or alcoholism. In the pediatric age group strabismus and meningitis were the most common causes for hospitalization. 2. 2. All of the records of patients discharged in one month at the University Medical Center (the large referral center in the area) were reviewed. A total of 79 per cent of the records of 1592 patients discharged were complete and available for this survey, and of these patients 158 (10 per cent) were discharged with a primary diagnosis of a neurological or sensory disorder. Of the 158 such patients, 13 per cent had at least one other chronic disease. Of the total number of charts reviewed 12 (1 per cent) had a secondary diagnosis of a neurological or sensory disease. The most common disorders recorded were cataract, epilepsy and/or convulsive disorder. A total of 56 different diagnoses were recorded. The average duration of hospitalization for patients with primary diagnoses of neurological or sensory diseases was six days. 3. 3. Statistics were provided by the State Department of Health on the broad categories of admission diagnoses of adult care home residents in 1962. Nineteen per cent of all residents of these homes had a diagnosis of a neurological or sensory disease as their primary reason for hospitalization. During 1962 a total of 2050 residents of these homes were admitted to various hospitals in the state. Of this total, 201 were transferred to general hospitals because of neurological or sensory disorders. Approximately 1 per cent of all individuals in the geriatric group in the state are patients in adult care homes because of these diseases. Only senility and disease of the circulatory system produce more transfers from adult care homes to acute short-term hospitals. 4. 4. Data were obtained from the Director of Institutions regarding patients with neurological and sensory diseases in these facilities. A total of 2000 or 28 per cent of the residents of state institutions have one of the diseases under consideration. The annual cost to the state is estimated to be between two and three million dollars for the custodial care of these persons. The most common diagnoses observed among these patients were cerebrovascular disease, mongolism, syphilis and heredodegenerative diseases.