TO THE EDITOR: I must take exceptio...

TO THE EDITOR: I must take exception with the Curbside Consultation in the February 1 2004 issue of American Family Physician. (1) The authors confuse the bounds "needs" and "wants," and in doing to such a degree create a situation where patient expectations trumpet sound medical decision-making. In the case at handed the authors state: "Although the physician wants to perform a finished diabetes work-up, it would be incongruent with the lacks of this patient." I disagree wholeheartedly. What the patient penurys first and foremost is improved house glucose control, but also a clean examination to look for already existing complications of diabetes, laboratory work including chemistries, a lipid panel, A1C on a levels urine test for microalbuminuria, dilated funduscopic examination, diabetes education, and routine follow-up What the patient wants is a one-stop, quick fix including a prescription for medication that may have possible adverse effects

Physicians are routinely faced with patients who "need" antibiotics for a two-day viral upper respiratory infection, cortisone injections for benign rashes, and prescriptions for the latest put drugs into they saw advertised on television. As physicians, we cannot give in to these beseechs or we will be guilty of not providing quality care, opening ourselves to medical liability and a lack of credibility in the community. When faced with so patients, physicians have the responsibility to completely inform the patient that their ask is outside usual practice, and then document this discussion. Physicians should not be made to be stirred that they must accommodate these patient requests

REFERENCES

(1) Ogrinc G Mutha s A one-stop health care beg [curbside consultation]. Am Fam Physician 2004;69:750-2

CHRISTINE EADY, DO

15808 Hwy 620 N Ste 100

Austin, TX 78717

IN REPLY: Dr Eady not aways an important reflection on our article. (1) We completely agree with her that "as physicians, we cannot give in to these requests" for inappropriate treatments as it is as antibiotics for viral infections and cortisone injections for benign rashes. However, when interacting with patients whose frame of allusion for chronic disease is different from our admit we should work to negotiate with the patient and the family to proper the patient's needs. In the original article, (1) the patient wanted a quick fix for new-onset diabetes. Obviously, diabetes is not amenable to a quick fix, unless one could initiate some treatment to help with symptoms and vital fluid glucose control without ordering a battery of ordeals and consults. Our intent was not to advise that physicians should acquiesce to each patient request, but to acknowledge that there is field to negotiate a plan of diagnosis and treatment (particularly when dealing with patients from a different culture) that may be beneficial for the patient and satisfying for the physician. This is presented as a challenging, but acceptable, alternative to refusing care for patients.

REFERENCES

(1) Ogrinc G Mutha s A one-stop health care beg for [curbside consultation]. Am Fam Physician 2004;69: 750-2

GREG OGRINC, MD

White River Junction Veterans Affairs Medical Center

215 N Main St

White River Junction, VT 05009-0001

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