AFP DEPARTMENT COLLECTION
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.
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.
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?