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.

Feb 1, 2000 Issue
Setting Limits on Demanding Patients
The first step in addressing unnecessary demands is to ascertain the patient's needs.

Jan 1, 2000 Issue
Why Can't This Patient Take Insulin?
One of the prevailing challenges for physicians is dealing with noncompliant patients—those patients who seem unable or unwilling to comply with their treatment plan. When faced with such a patient, the physician's first impulse is frequently one of anger and frustration. The reasons for these feelings are many and varied, but they ultimately boil down to the importance physicians attach to providing high-quality care and the tendency to define that care in terms of patient satisfaction, clinical improvement and their own effectiveness as physicians.

Dec 01, 1999 Issue
Is My Colleague Overprescribing Narcotics?
Physicians regularly face the ethical dilemma of determining whether the prescribing habits of a colleague are appropriate, and must then decide how to deal with that person. Such situations can engender hostility and resentment among colleagues and are rarely easily handled.

Nov 1, 1999 Issue
Caretaker Burnout: Supporting Families of Patients with Alzheimer's Disease
The case study described above outlines a situation that is far too common in families dealing with Alzheimer's disease.

Oct 1, 1999 Issue
Approaching a Terminally Ill Patient in Denial
Denial is a common coping mechanism for those facing a terminal illness—most people use denial to one degree or another, denying some aspects of their illness at least some of the time.

Sep 1, 1999 Issue
Disclosing the Truth About a Medical Error
Despite the frequency of mistakes in medical practice, there is no unequivocal formal guidance on how physicians should deal with medical errors.

Aug 01, 1999 Issue
Female Circumcision
Girls in Somalia are circumcised before the age of five years, usually by female family members, although it is also performed legally there in some hospitals. Uncircumcised women are seen as unclean.

Jul 01, 1999 Issue
A Troubled Teen: Matters of Confidentiality
This case highlights a family physician's dilemma regarding confidentiality when caring for a minor patient. This sort of scenario is not uncommon in an office practice.

Jun 1, 1999 Issue
An HIV-Positive Patient Who Avoids Treatment
It is always frustrating when patients withhold important medical information or are not trusting or honest with their physicians. In these situations, it is helpful to first look at the possible reasons for the lack of forthrightness.

May 1, 1999 Issue
Communicating Effectively with a Patient Who Has a Somatization Disorder
How did things go wrong in this physician-patient relationship? The patient ended up angry and distrustful of the physician. At what point did this lack of trust develop? One obvious trouble spot occurred when the patient only reluctantly agreed to see the psychiatrist. A referral to a mental health professional is often interpreted by a patient as “He doesn't believe me. He thinks it's all in my head.” There is much that a physician can do to discover underlying meanings and emotions before referring a patient to a mental health professional.

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