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On Being a Doctor |

Time's Up

Stephen Raffanti, MD, MPH
[+] Article and Author Information

From Vanderbilt University, Nashville, TN 37203.


Requests for Single Reprints: Stephen Raffanti, MD, MPH, Comprehensive Care Center, 345 24th Avenue North, Suite 103, Nashville, TN 37203; e-mail, sraffanti@compclinic.org.


Ann Intern Med. 2006;145(1):73-74. doi:10.7326/0003-4819-145-1-200607040-00013
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Maggie sat staring in the exam room, remnants of the hot Tennessee sun darkening her white blouse. I had originally misinterpreted her blank stare as a sign of indifference. But now, after years of office visits, hospitalizations, and family strife and care, I realized that her stare was part of her way of dealing with a less-than-generous lot in life. Maggie had indirectly benefited from her diagnosis of HIV infection. She had never before received care in a comprehensive health system, but her diagnosis of HIV and resultant TennCare coverage allowed her to be seen regularly by a medical provider who could address her various medical needs. Her shortness of breath and night cough led to a cardiology evaluation and a diagnosis of hypertensive heart disease. Her many joint pains set us on a course that revealed her avascular necrosis of the hip. Not surprisingly, her insulin resistance developed into diabetes and, most important, her mood swings finally culminated in a serious breakdown at the clinic, after which she was hospitalized and received aggressive treatment for depression. Through it all, Maggie amazed us with her diligence in keeping appointments, taking medications, and calling when she needed us. Her quality of life improved significantly despite her desperate home situation. Her HIV infection was the least of her problems. She remained on her first antiretroviral regimen with undetectable viremia, while dealing with an abusive methamphetamine-driven son and his 3 hyperactive children. On this day, she had traveled 40 miles from her small house trailer to discuss a new problem.

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