Friday, May 20, 2011

Doctor and Patient: Finding the Patient in a Sea of Guidelines -

Every Friday morning, the patient, a homeless man in his 60s, lumbered into one of our exam rooms, slipped off the running shoes he wore like bedroom slippers and gingerly lifted his swollen legs so we could remove the medicated bandages and examine the raw wounds on his inner ankles.

Those baseball-size leg ulcers were only one of his many medical problems. He also suffered from obesity and poorly controlled diabetes and blood pressure. Like his other doctors, I encouraged him to lose weight, watch his diet and take his diabetes medications, and stay on his blood pressure pills while making mental note of our medical aims — lower his body mass index to under 25, his hemoglobin A1C to under 7 and his systolic blood pressure to 130.

The reality, however, was that even getting to our clinic was a small triumph for him.

One morning, the clinic nurse approached me after I finished examining him. "Do you know what the problem is?" she whispered, as we watched the man shuffle out to the waiting room. "We keep trying to treat the guidelines rather than him."

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