Case #4: Mrs. Lindsey
Mrs. Lindsey is an 80-year-old retired school teacher who lived independently in her own home. Dr. James became her primary care doctor when her prior doctor took a job in a different state. He had been evaluating her for weight loss and some abnormal liver tests. As part of his usual approach, Dr. James asked Mrs. Lindsey to describe a typical day in her life.
She said, “I get up quite early, around 6AM, go into the bathroom, wash myself off with a washcloth, and then get dressed. Then I spend the next hour or so trying to get my socks and shoes on.” Of course, Dr. James stopped her at that point and asked her why on earth it took so long to put her shoes on? She said that she wasn’t able to bend far enough forward to reach her feet easily without stretching, bouncing, and struggling because of the arthritis in her hips and knees.
Dr. James referred Mrs. Lindsey to an occupational therapist, who, in one 45 minute session, taught her how to use a sock donner and a long-handled shoe horn. With those two inexpensive pieces of equipment, she was able to comfortably finish dressing in about five minutes.
The problem-oriented approach to Mrs. Palmer’s arthritis would more likely have unfolded in one of the following ways. Since she was not complaining of any pain, it might not have been addressed at all. If she had mentioned stiffness or trouble walking, her doctor might have ordered X-rays and lab tests, which would have confirmed the diagnosis of osteoarthritis. Management might have included Tylenol or an anti-inflammatory medication, injections, measures which would probably not have improved the quality of Mrs. Lindsey’s daily life.