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.

Jan 15, 2017 Issue
Taking Care of Disadvantaged Patients
No single person can be responsible for the health of a population. However, there are a number of strategies for taking care of members of disadvantaged populations. These range from targeted compassion and interventions for the individual patient to broad advocacy for disadvantaged groups.

Nov 1, 2016 Issue
Pet Therapy: Enhancing Patient Care Through Time with Animals
A 16-year-old girl and her parents presented to my office for her wellness evaluation. The patient has generalized anxiety disorder with comorbid major depression, for which she has been prescribed a serotonergic antidepressant. She is a high school student, lives with her parents, and is currently preparing college applications. She has occasional headaches and disturbed sleep. She takes daily three-mile walks and plays on her school tennis team, both of which help relieve her anxiety symptoms. The therapist she sees once a week has suggested enrollment in a therapeutic foster dog walking program to help further relieve her anxiety symptoms.

Sep 15, 2016 Issue
Helping Pregnant Women Keep Their Jobs
At 7.5 months pregnant, my patient found herself increasingly uncomfortable at work. Her varicose veins ached from standing on the job, where she was required to work a cash register and walk prescriptions from the pharmacy to the checkout area. I wrote a note to her boss explaining that she was pregnant and needed light-duty work for the duration of her pregnancy. Her employer's human resources department told her that there were no available alternative positions, and that she did not meet the eligibility criteria for leave as defined by the Family and Medical Leave Act.

Jul 15, 2016 Issue
Caring for Patients with Job Insecurity Who Are Experiencing Chronic Work-Related Pain
In addition to providing direct medical care, the physician can help this patient by obtaining an occupational history, formulating hypotheses about the cause of the pain and potential interventions, and establishing a therapeutic relationship.

Apr 15, 2016 Issue
Evaluation of Behavior Change in Patients with Developmental Disabilities
A mother brought her 19-year-old nonverbal, autistic son to our clinic. She requested medication for him to reduce the number of episodes that include loud vocalizations, thrashing, and head banging. These episodes usually occur in the car. At baseline, the man has difficulty with movement, characterized by decreased fine-motor control, impulsivity, and sudden darting away. His vision and hearing are normal. He often becomes overstimulated in busy environments.

Mar 1, 2016 Issue
When Physician Family Members Are Involved in Patients' Care
It is not unusual for physicians to care for patients who have physician family members. This can be advantageous for patients, their families, and the clinical team because physician family members often better understand the clinical situation, its severity, and the treatment options. They can also assist the clinical team in educating the patient and other family members. However, the presence of a physician family member can also become a barrier to the delivery of care.

Dec 15, 2015 Issue
Addressing Suspected Labor Trafficking in the Office
An estimated 18,000 persons are trafficked into the United States for labor each year. They most commonly originate from Latin America (31%), Southeast Asia (26%), and South Asia (13%), and 71% of persons enter on lawful visas. Health care may be one of the few fields in which professionals are likely to interact with persons who are enslaved. About 30% of trafficked persons are exposed to the health care system at some point during their captivity, yet their situation is seldom recognized.

Nov 1, 2015 Issue
Menstrual Concerns in an Adolescent with Disabilities
Clinicians who care for female adolescents with cognitive and physical disabilities are often consulted on the management of menstrual bleeding for purposes of hygiene, dysmenorrhea, and treatment of premenstrual symptoms. Contraception is also commonly discussed to mitigate pregnancy risk from consensual intercourse and situations of abuse. During these visits, discussions regarding menstrual suppression are common. Effective interventions may improve patient quality of life and caregiver fatigue.

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.

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