Tell Me About It: Someone at risk? An idea for helping

While I'm away, readers give the advice.

On helping someone whose health may be at risk:

I often wish advice columnists would counsel neighbors, family, and friends who are concerned about someone to send a letter to the patient's doctor. It's usually easy enough to find out names of people's doctors: Most people keep their meds in the bathroom medicine cabinet or on the kitchen counter, and the doctor's name and phone number are right on the pill bottle. If not, "New neighbors just moved in down the street and asked about good doctors but mine doesn't take their insurance - your doc has always seemed great, what's her name again?" works too. Include the patient's full name, date of birth and/or address so we can connect the letter to the correct patient's file, and then be as specific as possible about any observations and concerns. We can't respond to the letter because of privacy regulations, but a reputable doctor will take it under advisement. If the letter writer wishes, s/he can request anonymity.

While I can't guarantee the patient won't put two-and-two together, it's usually not too hard for me to make up a pretext about why I need to see the patient, and with a few routine questions and physical exam maneuvers, I can usually come up with enough to take good care of my patients without disclosing the letter.

This could be useful for concerns about driving safety, dementia, mental illness, elder abuse, domestic violence, sexual abuse, child abuse, or substance abuse. These are all situations in which neighbors, friends, and family are well-positioned to provide collateral history that patients may hide, and thus doctors may miss unless prompted.

Physicians are legally obligated to report potential child abuse, so writing a credible letter about that may trigger an alert to the relevant authorities. For patients with drug and alcohol problems, we can choose medications less likely to have harmful interactions. For victims of physical abuse, we might think twice before prescribing blood thinners, or order an additional X-ray to check for internal trauma.

Writing a letter probably won't fix the immediate situation, but it could help us do everything possible to keep the patient alive until they're ready to choose the help they need.

- A Physician