Blog | Tuesday, May 8, 2012

If I wrote the questions for the boards


1) A 24-year-old male walks into your office. He is 40 minutes late for his appointment. He begins to talk loudly at the check-in so he is brought back to spare the other patients. On questioning he reports that his chronic back pain is worsening and his roommate has stolen his pain medication. Now what?

2) A 60-year-old divorced woman is seen for "fatigue." When you ask her how she is doing she begins to cry. She states that she is losing her job, and her sister, with whom she lives, is suffering from dementia. The patient's salary pays for their living expenses and the job provides the patient with health insurance. She has insulin-dependent diabetes and peripheral vascular disease. She went to a social worker who told her that she would have to sell her house before qualifying for Medicaid. Now what?

3) A 52-year-old man with a history of alcohol abuse comes to see you after being released from the hospital. In the hospital, two drug-eluting stents were placed as treatment for an acute myocardial infarction. He was sent home with five prescriptions, one of which is clopidogrel. The cost of this drug is $200 monthly and he lives off money from odd jobs. He is functionally illiterate. Now what?

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.