Items in AFP with MESH term: Physician's Role
Doctorhood and Motherhood - The Last Word
Reinventing Family Medicine - Editorial
Balancing a Personal Life With OB Care - The Last Word
Looking Out for Others - The Last Word
ABSTRACT: Grief and depression present similarly in patients who are dying. Conventional symptoms (e.g., frequent crying, weight loss, thoughts of death) used to assess for depression in these patients may be imprecise because these symptoms are also present in preparatory grief and as a part of the normal dying process. Preparatory grief is experienced by virtually all patients who are dying and can be facilitated with psychosocial support and counseling. Ongoing pharmacotherapy is generally not beneficial and may even be harmful to patients who are grieving. Evidence of disturbed self-esteem, hopelessness, an active desire to die and ruminative thoughts about death and suicide are indicative of depression in patients who are dying. Physicians should have a low threshold for treating depression in patients nearing the end of life because depression is associated with tremendous suffering and poor quality of life.
ABSTRACT: The incidence of hip fracture is expected to increase as the population ages. One in five persons dies in the first year after sustaining a hip fracture, and those who survive past one year may have significant functional limitation. Although surgery is the main treatment for hip fracture, family physicians play a key role as patients' medical consultants. Surgical repair is recommended for stable patients within 24 to 48 hours of hospitalization. Antibiotic prophylaxis is indicated to prevent infection after surgery. Thromboprophylaxis has become the standard of care for management of hip fracture. Effective agents include unfractionated heparin, low-molecular-weight heparin, fondaparinux, and warfarin. Optimal pain control, usually with narcotic analgesics, is essential to ensure patient comfort and to facilitate rehabilitation. Rehabilitation after hip fracture surgery ideally should start on the first postoperative day with progression to ambulation as tolerated. Indwelling urinary catheters should be removed within 24 hours of surgery. Prevention, early recognition, and treatment of contributing factors for delirium also are crucial. Interventions to help prevent future falls, exercise and balance training in ambulatory patients, and the treatment of osteoporosis are important strategies for the secondary prevention of hip fracture.
ABSTRACT: The relationship between spirituality and medicine has been the focus of considerable interest in recent years. Studies suggest that many patients believe spirituality plays an important role in their lives, that there is a positive correlation between a patient's spirituality or religious commitment and health outcomes, and that patients would like physicians to consider these factors in their medical care. A spiritual assessment as part of a medical encounter is a practical first step in incorporating consideration of a patient's spirituality into medical practice. The HOPE questions provide a formal tool that may be used in this process. The HOPE concepts for discussion are as follows: H--sources of hope, strength, comfort, meaning, peace, love and connection; O--the role of organized religion for the patient; P--personal spirituality and practices; E--effects on medical care and end-of-life decisions.
ABSTRACT: Physicians are frequently involved in the assessment of impairment and disability as the treating physician, in consultation, or as an independent medical examiner. The key elements of this assessment include a comprehensive clinical evaluation and appropriate standardized testing to establish the diagnosis, characterize the severity of impairment, and communicate the patient's abilities, restrictions, and need for accommodation. In some cases, a functional capacity evaluation performed by a physical or occupational therapist or a neuropsychological evaluation performed by a neuropsychologist may be required to further clarify the functional capacity of the patient. The results of the impairment evaluation should be communicated in clear, simple terms to nonmedical professionals representing the benefits systems. These individuals make the final determination on the extent of disability and eligibility for benefits and compensation under that particular benefits system.