General Systems Theory in Medical Education -- A Medical-Psychiatric Liaison Fellowship
A middle-aged man comes to the emergency room with chest pain typical for a myocardial infarction; he signs out against medical advice when the pain is relieved, in spite of great efforts to convince him to stay.
A young girl with juvenile diabetes has a series of admissions for diabetic ketoacidosis; each time her electrolytes and insulin requirements are managed elegantly, but the events in her life and her conflict with parents and sexuality are not sought out.
A woman with chronic obstructive pulmonary disease and new onset asthma insists she is not well enough to leave the hospital when discharge is recommended; she has two more admissions in a 2-week period for exacerbations of the asthma; closer inspection reveals she is still grieving the death of a brother and is not yet ready to deal with making a new home after a recent move from another city.
A patient with terminal cancer has high pain medication requirements without adequate relief, cries out fearfully and says a rosary regularly; when it is suggested that the fearful images during the rosary be replaced by positive, comforting and supportive ones, the pain medication requirements drop by half in 24 hours.
KeywordsChronic Obstructive Pulmonary Disease Diabetic Ketoacidosis Biopsychosocial Model General System Theory Specialty Area
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