Curbside Consultation

This department addresses legal, psychological, and ethical issues physicians may encounter in their day-to-day practice. Each article contains a brief case scenario, followed by a commentary section written by a consultant who responds to the particular issue addressed in the scenario.

Sep 1, 2015 Issue
Late Presentation to Prenatal Care
Pregnancy carries concrete and immediate risks that need to be addressed and managed in a timely fashion. Patients who initiate prenatal care late in pregnancy tend to present with a challenging variety of concerns, encompassing the full range of their medical, psychosocial, and economic well-being.

Jul 15, 2015 Issue
Care of a Transgender Adolescent
Although the actual number may be higher, research estimates that approximately 700,000 Americans are transgender. Many in this population have inadequate insurance to cover appropriate health care. Primary care clinicians treat transgender patients in their practices, and although not every clinician assumes a primary role in cross-sex therapy, it is important to be mindful of the following principles at each visit.

May 1, 2015 Issue
Caring for Muslim Patients Who Fast During Ramadan
A 68-year-old Muslim man who was recently diagnosed with type 2 diabetes mellitus presented for a routine health visit. His initial A1C level was 8.2%, which decreased to 6.7% after dietary changes, exercise, and treatment with metformin (Glucophage). He stated that he wanted to fast during Ramadan and requested advice on how to manage his diabetes while fasting.

Apr 15, 2015 Issue
Counseling Patients with Unintended Pregnancy
Nearly one-half of all pregnancies in the United States are unintended. Risk factors for unintended pregnancy include limited access to contraception, less than a college education, poor social support, age between 20 and 24 years, and black race. Family physicians are often the initial medical contact for women with unintended pregnancy.

Apr 1, 2015 Issue
Advance Directives: Navigating Conflicts Between Expressed Wishes and Best Interests
Clinicians and surrogates can be faced with challenging decisions when a patient loses the capacity to participate in medical decision making. A significant number of hospitalized and critically ill adults lose decision-making capacity during hospital stays and cannot make treatment decisions.

Jan 15, 2015 Issue
Screening for Hereditary Cancer Syndromes
Family physicians play a key role in identifying patients in need of increased cancer surveillance because of a personal or family history of cancer. How does one know if a patient warrants genetic testing for hereditary cancer predisposition?

Nov 1, 2014 Issue
Caring for Unaccompanied Minors from Central America
The surge of unaccompanied minors from Central America crossing the United States–Mexico border in recent months has made national headlines, creating an “urgent humanitarian situation.” The reasons for this migration are multifactorial, and the resultant politics are deeply complex.

Oct 1, 2014 Issue
Challenges and Opportunities in the Care of Asian American Patients
In cases such as this, patients are often told, “You don't need treatment now,” but they only hear, “You are fine.” Subsequent failure to follow up may result from a combination of issues related to health literacy, educational attainment, linguistic barriers, and cultural differences.

Jul 1, 2014 Issue
Ethical Use of Diagnostic Technology: Balancing What's New and What's Necessary
This case boils down to being realistic about what new screening tools and techniques can and can't do, and understanding their actual value in diagnoses. I'd argue that it is not unethical to accommodate a patient's requests, as long as the physician's approach to the patient, the pathology, the technology, and the decision-making process was pragmatically sound and prudent.

May 1, 2014 Issue
The Hospice Referral
Hospice is a program of care and support for persons facing life-limiting illnesses. Hospice care involves a team-oriented approach to medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes.

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