Patient advocacy in the 1990s

Article Abstract:

Medical carriers appear to restrict access to care for economic reasons in some cases. In the case of an infant girl with leukemia, the health maintenance organization (HMO) of the family denied bone marrow transplantation at a nearby hospital in favor of an out-of-state medical center. The logistics of work, caring for a hospitalized infant, and disruptive separation from an older sibling would be much more complicated if the infant was to receive care at a distant location. Despite attempts by the treating oncologist to consider the psychosocial needs of the family by referring to a nearby facility, transplantation took place at the center selected by the HMO. The family eventually discontinued HMO membership after extreme economic hardship. Physicians must speak up for the needs of their patients at a time when insurance carriers dictate medical decisions on the basis of economics.

Economic aspects, Column, Ethical aspects, Medical referral, Health maintenance organizations, Patient advocacy

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Brief report: a duodenal gastrinoma in a patient with diarrhea and normal serum gastrin concentrations

Article Abstract:

A 61-year-old man whose only symptom was two years of diarrhea was found to have a duodenal gastrinoma, a tumor of the duodenum, the upper part of the small intestine. Endoscopic examination of the upper digestive tract revealed abnormal growth of the finger like structures lining the duodenum. A secretin-injection test and pH monitoring of the stomach and intestine indicated the overproduction of gastrin, which stimulates stomach acid secretion. Treatment with omeprazole relieved the patient's diarrhea which was caused by an excess of stomach acid. Extensive, meticulous endoscopic examination finally revealed an intestinal tumor which was removed surgically. Approximately 18 months later the patient had no symptoms.

Case studies, Gastrointestinal tumors

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The patient with hypochondriasis

Article Abstract:

Patients with hypochondria can be treated by agreeing that some physical symptoms can be distressing to the patient even if there is no medical cause. Patients with co-existing psychiatric symptoms can be treated, and others can be taught stress management techniques.

Care and treatment, Hypochondria, Hypochondriasis

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