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, 2006 Issue
Discussing Terminal Illness with a Patient
Communication training stresses that “breaking bad news” is more about listening and asking questions than it is about relaying information.

Jun 1, 2006 Issue
Determining Prognoses for Patients with Terminal Illnesses
Physicians often overestimate a terminal patient's life expectancy.

May 1, 2006 Issue
Determining Eligibility for Gastric Bypass Surgery
This case scenario brings up two issues: (1) whether the patient should undergo a risky procedure that might benefit her and (2) responsible allocation of health care resources. First, American College of Physicians (ACP) guidelines1 recommend optional bariatric surgery for those who have BMIs greater than 40 kg per m2 and obesity-related comorbidities (e.g., hypertension, diabetes, obstructive sleep apnea) but who could not lose weight with dietary drugs, diet, or exercise.

Apr 1, 2006 Issue
Confronting a Colleague Who Covers Up a Medical Error
In the past, physicians had no formal medical ethics training and learned that the best way to deal with medical errors and possible malpractice lawsuits was to say as little as possible, deny everything, and never to apologize or acknowledge error. Today, physicians receive very different ethical and legal advice.

Mar 1, 2006 Issue
Implementing the New Model of Family Medicine
The New Model of family medicine, introduced in the Future of Family Medicine report,1 offers physicians the opportunity to increase the efficiency and reliability of their practices and improve clinical care, patient satisfaction, and the “bottom line.”

Feb 1, 2006 Issue
At-Home Genetic Tests
Current genetic tests for complex diseases are not diagnostic. They instead provide important information about susceptibility and can be key in prevention.

Jan 1, 2006 Issue
Physicians Who Do Not Follow Screening Guidelines
This scenario asks two basic questions: (1) Why would a physician perform screening tests more often than recommended? and (2) What should a physician do if he or she has a colleague who does not follow current practice recommendations?

Dec 1, 2005 Issue
Nonmedical Ultrasonography During Pregnancy
The quality and detail of ultrasonography has advanced to the point of providing easy-to-interpret, striking fetal images, especially with newer three-dimensional (static) and four-dimensional (real-time three-dimensional) imaging.

Nov 1, 2005 Issue
Patients' Preconceptions and Convictions About Antibiotics
Multiple studies have demonstrated that patients who seek care for respiratory ailments often expect to receive antibiotics, and that patients or parents who expect antibiotics receive them more often than those who do not.

Oct 1, 2005 Issue
A Sex Offender as a Patient
Before addressing the particulars of this scenario, it may be helpful to review the current status of notification laws, which have evolved in the last decade. It is important to keep in mind that the presumptive purpose of community notification through registration is solely to inform the public, not to exclude or deny sex offenders services, not to ostracize them, and not to undermine their readjustment into society.

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