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.
Jul 1, 2018 Issue
The Doorknob Phenomenon in Clinical Practice
By definition, the doorknob phenomenon or doorknob statement occurs when patients wait until the last moment in the clinical encounter—often while the physician is grasping the doorknob to exit the examination room—to utter something that, not uncommonly, provides crucial information. Physicians must then determine whether to pursue this new information immediately or to defer the new issue until the next visit.
May 1, 2018 Issue
Clinical and Personal Utility of Genetic Risk Testing
On April 6, 2017, the U.S. Food and Drug Administration (FDA) approved marketing of the 23andMe Personal Genome Service, the first direct-to-consumer genetic test. This test uses genomic DNA collected from mail-in saliva collection kits to provide information on a patient's genetic risk of certain medical diseases or conditions.
Mar 1, 2018 Issue
Medical Aid in Dying
Requests for hastened death are not unusual from patients with life-limiting illness, and many primary care physicians encounter these requests over the course of their career. Medical aid in dying is the practice of a physician providing a competent, terminally ill patient—at the patient's request—with a prescription for a lethal dose of medication that the patient intends to use to end his or her own life.
Jan 1, 2018 Issue
Female Genital Mutilation or Cutting
FGM/C involves partial or total removal of the external genitalia or other injury to the female genital organs for nonmedical reasons. It is considered a human rights violation. It has no known health benefits, but many reported harmful consequences.
Nov 1, 2017 Issue
Tapering Patients Off of Benzodiazepines
When prescribed at a low dosage for a short time (fewer than 30 days), benzodiazepines can effectively treat generalized and social anxiety, panic disorder, and sleep disorders. Long-term use for anxiety and sleep disorders is not supported by research because it is associated with the development of physiologic and psychological dependence characterized by tolerance, withdrawal, and reluctance to reduce or discontinue use despite the objective lack of effectiveness.
Oct 15, 2017 Issue
Social Media Use and Mood Disorders: When Is It Time to Unplug?
Americans spend more time on Facebook, the world's largest online social network, than any other website. On the surface, social media networks provide an “invaluable resource for fulfilling the basic human need for social connection.” However, rather than enhancing well-being by fulfilling communication needs that are deeply human, current research suggests that these online platforms may actually undermine it.
Aug 1, 2017 Issue
Patients with Disabilities: Avoiding Unconscious Bias When Discussing Goals of Care
False assumptions about patients' quality of life can affect prognosis, the treatment options that we present, and the types of referrals that we offer. In this case, the physician equated complex disability with terminal illness.
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.