title: A challenging patient, an innovative solution.
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.
authors.affiliation: Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA. jharihar@mcw.edu
authors.forename: Jaishree
authors.initials: J
authors.lastname: Hariharan
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Denson
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology*; D001249:Asthma / Q000175:diagnosis / Q000523:psychology*; D019090:Case Management; D003142:Communication; D015897:Comorbidity; D003266:Continuity of Patient Care; D032982:Contracts; D003920:Diabetes Mellitus / Q000139:chemically induced; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D010348:Patient Care Team; D010817:Physician-Patient Relations; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D011241:Prednisone