Tuesday, December 15, 2009

Jennifer Frank, MD: The family in family medicine

I open the door, greeting the older couple, patients of mine for the last three years.

“Let’s see the picture,” the husband demands good-naturedly. I know what he means; he wants to see a picture of my new baby. “I don’t have one on me right now,” I admit sheepishly. He looks disappointed and I promise to retrieve one from my office before the visit is over.

Today’s visit focuses on the wife’s slow and inevitable decline. I try to focus on the myriad social, medical, and logistical issues that assault the couple as they progress through their 80s, trying to live together at home. They do their best to sidetrack me.

“Is he sleeping through the night yet?” “What’s his name again?” “Our great-grandson is 3 years old now.” As a family physician I both recognize the value of the details of my patients’ lives and relish the opportunity to share those details with my patients.
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However, I am also trying to determine whether this couple can continue to live at home safely and for how long. I wonder whether my patient is falling more often than she lets on and attempt to discover whether her memory loss is reflective of dementia, depression or both.

“I’m in charge of all the pictures,” the husband interrupts me as I question his wife. He describes how he cropped a digital photograph recently to accompany a friend’s obituary. “I am keeper of all our family photos,” he explains. He has two external hard drives each containing his family’s pictorial history. There is one hard drive for each of his children, “in case something happens to me,” he says.

After repeated attempts at questioning the pair, I come to the conclusion that things are, for the meantime, stably unstable. Not as good, or as safe as they could be, but pretty close to baseline. I adore this older couple and the playful affection they show for each other, especially while bickering. I am saddened by the future I can see for them and realize that there is little I can do to ease the numerous challenges in their normal day.

“Let me go get that picture,” I say. I return with two photos, one of my newborn son, hair standing on end in a post-bath mohawk, the other of my husband holding him during an outing to the park. The husband positions them each on the exam table and whips out his digital camera. He adjusts the pictures under the fluorescent light just so, trying to avoid a glare as he takes a picture of my pictures. I use the opportunity to probe his wife. “How are you sleeping?” “Are you still taking the Celexa?” “When did you notice your memory being a problem?”

“I got a good one,” the husband announces and shows me some remarkably clear pictures of pictures. I imagine they will end up in his family’s photographic archive, leaving his children to wonder which distant relative is pictured. I can’t say a lot was accomplished medically during this visit, but I am flattered that this couple thinks of me and my family as part of their own. I hope this bond will allow me to gently explore how well they are coping as they decline together.

Jennifer Frank, MD, FAAFP, is an assistant professor in the University of Wisconsin Department of Family Medicine and a faculty family physician at the Fox Valley Family Medicine Residency Program in Appleton, Wis. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.

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