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.

Jan 01, 2022 Issue
Harm Reduction for Patients With Substance Use Disorders
Patients engaged in high-risk activities are often ambivalent about changing their behavior. Harm reduction is an approach that focuses on limiting harm and improving quality of life for patients who persist with high-risk behaviors; the foundations of harm reduction are pragmatism and compassion. The approach encompasses a range of evidence-based practices that decrease risk for patients and the community.

Nov 01, 2021 Issue
Climate Change and the Local Environment: Communicating with Your Patients about Health Impacts
This case provides an example of how climate change and the environment can have significant impacts on the health of our patients. It also illustrates the complex interaction of local, regional, and global environmental harms. The wide scope of environmental threats to human health presents challenges in managing patients who are increasingly affected by climate-related changes, including severe weather events, extreme heat, worsening air quality, increasing allergens, changes in vector ecology, water quality, food and water supply, and environmental degradation.

Sep 01, 2021 Issue
Using Race with Caution in the ASCVD Calculator
The use of race in clinical decision-making is a source of controversy in U.S. modern medicine. Definitions of race are inconsistent throughout the medical literature and in medical education, and most experts in biology and social sciences agree that race has a limited biologic basis and is actually a social concept influenced by culture and politics, not genetics.

Jul 01, 2021 Issue
Addressing Loneliness and Social Isolation in Older Adults
Social isolation and loneliness are increasingly recognized as complex clinical and public health problems, particularly in older adults, leading to adverse mental and physical health outcomes. The COVID-19 pandemic has led to physical distancing policies, which have exacerbated loneliness and social isolation.

May 1, 2021 Issue
Identifying and Addressing Vicarious Trauma
Vicarious trauma is part of a spectrum of responses to trauma exposure, including secondary traumatic stress, caregiver fatigue, compassion fatigue, and burnout. These conditions have varying definitions and categorizations, with overlapping symptoms, diagnostic criteria, and management strategies.

Mar 1, 2021 Issue
Caring for the Physician Affected by Substance Use Disorder
A 34-year-old physician, H.M., is an established patient in my practice. H.M. presents for a follow-up visit after finishing inpatient treatment for opioid use disorder.

Jan 1, 2021 Issue
Making Recommendations to Reduce Noise Exposure
A 23-year-old patient, M.P., presents to your office with upper respiratory symptoms. When you enter the room, M.P. is using earbuds to listen to music on a personal listening device. The volume is loud enough for you to hear the music but not distinguish details. After addressing the patient's symptoms, you ask about M.P.'s listening habits.

Nov 1, 2020 Issue
How to Manage a Patient with Weight Regain
A 50-year-old patient, M.W., successfully reached their goal weight by losing 15 lb (6.8 kg) over six months on a Mediterranean diet. After maintaining the weight loss for more than a year, my patient is now 30 lb (13.6 kg) over their ideal body weight of 140 lb (63.5 kg).

Sep 1, 2020 Issue
Palliative Care During Public Health Emergencies: Examples from the COVID-19 Pandemic
In public health emergencies such as the COVID-19 pandemic, some patients—especially older patients or those who have chronic health conditions—are confronted with treatment choices as they face life-threatening illness.

Jul 1, 2020 Issue
A Primary Care Approach to Adverse Childhood Experiences
A 41-year-old long-time patient presented with concerns about irritability, depression, and anxiety after getting into another fight with her mother-in-law. The patient was concerned that her symptoms were getting worse, and she was worried about lacking control over her emotions and behavior.

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