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, 2012 Issue
Care of a Sexually Active Adolescent
The American Medical Association's Principles of Medical Ethics clearly state that physicians “shall safeguard patient confidences and privacy within the constraints of the law.” However, the laws in American jurisdictions vary with respect to a minor's ability to consent to medical treatment. Many adolescents forego medical services in sensitive situations out of fear of parental notification, which partially explains why more than 40 out of every 1,000 15- to 17-year-old American girls become pregnant each year.

Jul 1, 2012 Issue
Evaluating and Treating Sexual Addiction
This patient’s behavior is concerning because of ongoing compulsive behavior despite significant repercussions in his home and work life. Sexual addiction has been described as a behavioral addiction (similar to gambling), a compulsive disorder (similar to obsessive-compulsive disorder), and an impulse control disorder.

Mar 1, 2012 Issue
A Case of Medical Uncertainty
Medical uncertainty (i.e., not knowing how to proceed with a patient-related problem) can stem from any number of potential situations in daily clinical practice. The causes of uncertainty are many, but the feeling of stress or discomfort it creates is a familiar constant, though it may vary in intensity.

Feb 1, 2012 Issue
Primary and Subspecialty Care: Building a Collaborative Relationship
For the referring physician, proper etiquette includes identifying the clinical reason for the referral, confirming the appropriateness with respect to the subspecialty, providing the subspecialist with accurate and timely information, and maintaining an open and effective line of communication.

Nov 1, 2011 Issue
Flaws in Clinical Reasoning: A Common Cause of Diagnostic Error
Many medical errors have been identified as systemic and addressed with interventions, such as checklists. However, a substantial number of errors that occur in diagnosis and treatment are attributed to flaws in clinical reasoning.

Jul 1, 2011 Issue
Should I Be "Friends" with My Patients on Social Networking Web Sites?
First of all, kudos for getting involved in social media with the goal of promoting the health of your patients and collaborating with colleagues.

May 1, 2011 Issue
Palliative Sedation for a Patient with Terminal Illness
A patient has the right to make an informed decision about discontinuing life-prolonging treatments. The patient in this scenario is requesting palliative sedation to control her anxiety while electrolyte replacement is stopped.

Mar 1, 2011 Issue
Self-Injurious Behavior in an Adolescent
The behavior of this patient is nonsuicidal self-injury, defined as the intended destruction of body tissue without suicidal intent. Nonsuicidal self-injury is a common biopsychosocial disorder observed in adolescents.

Jan 1, 2011 Issue
Comforting a Grieving Parent
The death of a child is the most devastating loss any parent can face. If physicians can help even a little, we will have done something of lasting value. Most of the things we can do may seem small to us, but are appreciated by the parents.

Nov 1, 2010 Issue
Spending Time with Patients in Labor
This scenario raises several key questions that are important not only to patient care, but also to physicians' quality of life and satisfaction with practice. First, what are the critical roles for the family physician during prenatal care, labor, and birth?

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