Julie R. Rosenbaum, MD
Requests for Single Reprints: Julie R. Rosenbaum, MD, Yale University, Primary Care Internal Medicine Residency, Waterbury Hospital Health Center, PO Box 208030, New Haven, CT 06250; e-mail, firstname.lastname@example.org.
Rosenbaum J.; Daily Dilemmas. Ann Intern Med. 2011;155:855-856. doi: 10.7326/0003-4819-155-12-201112200-00011
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Published: Ann Intern Med. 2011;155(12):855-856.
As a primary care physician, sometimes the smallest requests can create the biggest challenges.
Between patients, I peeked at my electronic inbox. Among the usual prescription refills, there was a request for a callback from Mrs. Talbot, a spry elderly patient of mine with well-controlled high blood pressure, osteoarthritis, and a remote history of cancer. She was an active participant at the local senior center, had lunch regularly with friends on her fixed income, and loved to talk about her grandchildren. Speaking with her would probably brighten my day.
“Every year, I receive a subsidy from the state to help cover the costs of my apartment,” she told me when I reached her. “Yesterday around the usual deadline, I went to the office, and they told me that I was too late, that the deadline had been last week.”
David O., Staats, MD
January 18, 2012
Author Misses the Boat
To the Editor: This piece misses the boat in several regards.
1. An older, highly-functioning person, who suddently misses an important deadline, should be a red flag to the clinician that this change in behavior could be the sign of illness, ranging from presntation of a silent stroke or acute myocardial infarction, to delirium from fecal impaction or occult infection, or heralding the onset of memory changes.
2. In such a person, living on a fixed income, an increase in costs of $400 per month has a staggering effect on the person's quality of life. Deciding among medications is unfortunately a common and vexing conundrum for many older persons in this country. Not seeing the medical effects of this impoverishment demonstrates a lack of understanding of the tripartite assessment of the medical, psychological, and social support domains which is the fundamental basis of clinical geriatric medicine.
3. To feel anger, to feel frustration is good. It may lead to good quality assurance studies or better organization of clinics to minimize the clerical functions of physicians. To become angry at patients, to cast them as the enemy, who stands between the physician and her family duties, is burnout knocking at the door. It leads to bad clinical judgment and bad care.
Let us remember the words from the Oath of Maimonides: "May I never see in the patient anything but a fellow creature in pain."
David O. Staats, MD Nichols Hills, OK
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