Managing the suicidal patient

Suicide is a major public health problem. Worldwide, approximately 1% of deaths are due to suicide. In the United States, suicide is the eighth leading cause of death. More than 30,000 Americans commit suicide each year, and nearly 500,000 others make a serious suicide attempt warranting emergency medical attention. Suicide attempts account for 23% of psychiatric visits to emergency rooms.     

Managing the patient with dysphagia

Dysphagia, or difficulty swallowing, is a common medical condition among today's patients. It is estimated the approximately 15% of individuals older than 60 years experience dysphagia. Approximately 40% of institutionalized patients (i.e., patients residing in nursing homes, group homes, or assistive care facilities) have swallowing difficulties (Zagaria 2005). The swallowing mechanism is quite complex, involving more than 50 pairs of muscles. Impairment of any one or more of these muscles may result in a serious health risk to the patient. The patient may be at risk of aspirating food or saliva into the lungs, creating a potentially life-threatening medical condition.     

Managing pain in the dying patient

End-of-life care can be a challenge requiring the full range of a family physician's skills. Significant pain is common but is often undertreated despite available medications and technology. Starting with an appropriate assessment and following recommended guidelines on the use of analgesics, family physicians can achieve successful pain relief in nearly 90 percent of dying patients. Physicians must overcome their own fears about using narcotics and allay similar fears in patients, families and communities. Drugs such as corticosteroids, antidepressants and anticonvulsants can also help to alleviate pain. Anticonvulsants can be especially useful in relieving neuropathic pain. Side effects of pain medications should be anticipated and treated promptly, but good pain control should be maintained. The physical, psychologic, social and spiritual needs of dying patients are best managed with a team approach. Home visits can provide comfort and facilitate the doctor-patient relationship at the end of life.     

Managing asthma in the allergic patient

Asthma is a chronic disease afflicting more than 12 million people in the United States alone. In many patients, environmental allergens trigger their asthma. Physicians can control the disease with modification of the environment and education of the patient in allergen avoidance.     

Managing the patient with Parkinson's disease

When patients have a clear understanding of the etiology and pathophysiology of Parkinson's disease, management is easier for the physician and the patient is better able to cope with the disease. Patients also should be made aware of the proper use of antihistamines and anticholinergics that control tremor, as well as their side effects. In addition, life at home can be simplified by using zippers or Velcro closures on clothing, large kitchen and eating utensils, and grab rails.     

Managing the patient with peripheral neuropathy

Peripheral neuropathy may be a minor, even unrecognized, clinical problem, or it may be severe and virtually disabling. As in any chronic disorder, the physician's role is to look for treatable disease and to teach patients about the symptoms and natural history of the dysfunction as well as methods for coping with it. The physician can help patients by explaining how to contend with a damaged peripheral nervous system on a daily basis, even if healing or significant organic relief cannot be achieved.