A challenging patient, an innovative solution. WMJ 2005 Nov;104(8):72-5
Date
01/24/2006Pubmed ID
16425926Scopus ID
2-s2.0-31444447688 (requires institutional sign-in at Scopus site) 1 CitationAbstract
This report of the management of a 28-year-old patient over 2 and a half years illustrates how interaction between psychosocial issues and physical symptoms complicates diagnosis and management. The case also highlights the challenges inherent in a large health care system with multiple health care professionals, clinics, and available resources. A "team model" approach is outlined as a useful strategy in such cases. Once problem areas are defined, a partnership agreement (contract) is recommended, which applies structure and limits to the physician-patient relationship. This contract calls for mutual trust, communication, and accountability while preventing excessive use of the health care system. Our patient and hospital system greatly benefited by this approach as evidenced by (1) a 60% decrease in medication costs, (2) markedly decreased ED visits and telephone calls, (3) successful treatment of depression and anxiety, and (4) a positive outcome on the patient's health.
Author List
Hariharan J, Denson KMAuthor
Kathryn M. Denson MD Chief, Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAnxiety
Asthma
Case Management
Communication
Comorbidity
Continuity of Patient Care
Contracts
Diabetes Mellitus
Dysthymic Disorder
Female
Health Services Misuse
Humans
Hypertension
Patient Care Team
Physician-Patient Relations
Prednisone
