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.

May 1, 2005 Issue
HIV Testing on Demand
Two valuable questions are raised by this clinical dilemma in primary care. The first is whether it is appropriate to perform tests at a patient’s request without clear indications. The second is whether billing the insurance carrier for these tests is proper.

Jan 1, 2005 Issue
Is This Patient Really Incompetent?
This physician is trying to balance his duty to the patient and the legally appointed guardian and finds it difficult to know how to approach the patient. The physician is particularly puzzled because of his “near-normal” interactions with her. This commentary will discuss the legal role of a guardian, the primacy of the patient’s rights, and the position of a physician who must balance the two.

Nov 1, 2004 Issue
Completing and Signing the Death Certificate
This scenario is becoming less common in primary care practice because the most common place of death (in nearly 80 percent of cases) in the United States has changed from the patient’s home to a hospital or long-term care facility. This shift in death location means that family physicians often are not the ones asked to certify the cause of unsupervised deaths.

Aug 1, 2004 Issue
When Patients Cannot Afford Their Medications
For physicians who realize that drug costs can be a problem, we offer some practical solutions and discussion about how to help these patients.

Jun 1, 2004 Issue
Using Medical Interpreters
Many physicians are facing a similar dilemma because the Hispanic population is growing rapidly, and Spanish is the preferred language for many Hispanic people. The use of interpreters is a multifaceted issue.

May 1, 2004 Issue
The Right to Know--But at What Cost?
This case scenario, submitted by the patient’s son, brings up three interesting ethical questions. The first question involves whether it is ever ethically justifiable to withhold information from patients, and if so, under what circumstances? The second question is: who decides whether invasive medical procedures should be offered to a given patient? The last question is: does the patient have a right to determine his own health care?

Apr 1, 2004 Issue
Conflict with a Consultant
This scenario presents two main issues. The first issue involves the evidence for or against the use of cerclage to prevent second-trimester pregnancy loss. The second issue is the way family physicians should interact with consultants.

Mar 1, 2004 Issue
Cutting Back on High-Dosage Narcotics
Over the past decade, the promotion of narcotics for control of malignant and non-malignant pain has been advocated by specialists in the pain community. While most physicians accept the use of aggressive narcotic analgesia in patients with cancer-related pain, the use of opioids in chronic, nonterminal conditions remains highly controversial.

Feb 1, 2004 Issue
A One-Stop Health Care Request
This scenario is likely to be common in clinics such as the one described here. This physician's frustration with the patient, his family members, and the system as a whole is evident. Providing care to a transient visitor with a chronic disease is a difficult proposition. While many physicians want to make decisions guided by the best evidence, this scenario is one of many in medicine where physicians must rely on clinical intuition. We suggest that maintaining a patient-centered approach with culturally appropriate care and evidence-based disease management might provide a reasonable health care visit for the patient and serve to limit frustration on the part of the physician.

Jan 1, 2004 Issue
Should Doctors Call in Sick?
Many practical factors mitigate against a physician taking a sick day. For physicians in private practice, the economic considerations are great because office overhead and staff payroll costs continue during their absence. Even salaried physicians are subject to the powerful physician work ethic that says we are here to serve and care for patients. In other words, “You need to be here.”

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