1. A challenging patient, an innovative solution
- Author
-
Jaishree, Hariharan and Kathryn M, Denson
- Subjects
Adult ,Patient Care Team ,Physician-Patient Relations ,Communication ,Comorbidity ,Contracts ,Anxiety ,Continuity of Patient Care ,Health Services Misuse ,Asthma ,Hypertension ,Diabetes Mellitus ,Humans ,Prednisone ,Female ,Dysthymic Disorder ,Case Management - Abstract
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.
- Published
- 2006