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On Being a Doctor |

Daily Dilemmas

Julie R. Rosenbaum, MD
[+] Article, Author, and Disclosure Information

From Yale University, New Haven, CT 06520.

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, julie.rosenbaum@yale.edu.

Ann Intern Med. 2011;155(12):855-856. doi:10.7326/0003-4819-155-12-201112200-00011
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As a primary care physician, sometimes it is the smallest request that can create the most trying challenge.





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Author Misses the Boat
Posted on January 18, 2012
David O., Staats, MD
Conflict of Interest: None Declared

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

Conflict of Interest:

None declared

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