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.

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.

Mar 1, 2014 Issue
Complex Care: Treating an Older Patient with Multiple Comorbidities
Although there are guidelines for management of single chronic illnesses, the evidence base for management of multiple comorbidities is lacking. The American Geriatrics Society described a clinical approach to managing patients with multiple comorbidities in 2012.

Jan 1, 2014 Issue
Inheriting Patients with Questionable Medication Regimens
Inheriting a patient on an inappropriate or questionable medical regimen is a scenario that every physician confronts when practicing continuity care. It can present frustrating challenges, especially for resident physicians, who, because of the nature of training programs, care for patient panels with high turnover rates. Regardless of the practice setting, several issues pertaining to certain medication categories should be considered.

Nov 1, 2013 Issue
Talking with Children About a Parent's Serious Illness
It is not uncommon for children to have parents who have cancer. Although parents may be understandably apprehensive about discussing a serious illness, children want and need to know what is happening. It is strongly recommended that children be involved and informed in the illness and death of a parent.

Sep 1, 2013 Issue
Undetected Childhood Sexual Trauma and Its Health Effects in Adults
It is essential for physicians to understand the relevance of childhood sexual trauma to adult medical conditions. Recognizing this connection can help physicians begin to manage the resulting damage. Exposure to childhood sexual trauma is highly prevalent in the United States, but is vastly underreported.

Jul 15, 2013 Issue
Treating Patients with Borderline Personality Disorder in the Medical Office
The prevalence of borderline personality disorder in the general population is thought to be between 1% and 2%. As family physicians, we often treat these patients for chronic medical conditions. There are multiple obstacles to caring for these patients because of their difficult behaviors (e.g., angry outbursts, self-harm, suicidal ideation) and lack of social skills.

Jun 1, 2013 Issue
Caring for Colleagues, VIPs, Friends, and Family Members
There may be no higher professional honor than being asked to care for a colleague, a “very important person” (VIP), a friend, or a family member. However, these requests can be problematic if they are not addressed properly. The following strategies can help physicians avoid pitfalls when faced with these situations, keeping in mind that all cases are different, and you must use your best judgment in choosing a course of action.

Mar 1, 2013 Issue
Caring for Older Patients Who Have Significant Hearing Loss
This scenario illustrates issues related to end-of-life care and placement in a long-term care facility for older individuals with significant hearing loss. An analysis of data from the 1999 to 2006 cycles of the National Health and Nutrition Examination Survey, and statistics from the National Institute on Deafness and Other Communication Disorders, indicate that 26.7 percent of persons 50 years and older (including 30 percent of persons 65 to 74 years of age, and 47 percent of persons 75 years and older) struggle with hearing loss.

Nov 1, 2012 Issue
Demoralization: A Precursor to Physician Burnout?
Demoralization is a state of hopelessness and helplessness that is akin to, but separable from, depression.

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