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.
May 15, 2017 Issue
Providing Trauma-Informed Care
Family physicians commonly care for survivors of trauma, but they may not always realize it. Trauma, which can affect any patient regardless of age or sex, is broadly defined as the experience of violence or victimization, including sexual abuse, physical abuse, psychological abuse, neglect, loss, domestic violence or the witnessing of violence, and terrorism or disasters.
Mar 15, 2017 Issue
Palliative Care Through Illness Trajectory
Persons with multimorbidity often have unmet multidimensional needs related to their health. For example, Y.S. may also be experiencing poorly controlled symptoms, financial distress, and increasing anxiety. His family is likely distressed by his decline in health and unsure about what to expect next. Palliative care specialists employ a systematic approach to evaluating unmet needs across a range of physical, mental, social, and existential and spiritual dimensions, and then develop care plans that explicitly reflect patients' goals for their health.
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.