1、DOI 10.1378/chest.121.6.20852002;121;2085ChestDean GianakosWorry Listhttp:/chestjournal.chestpubs.org/content/121/6/2085.1.full.htmlservices can be found online on the World Wide Web at: The online version of this article, along with updated information andISSN:0012-3692)http:/chestjournal.chestpubs
2、.org/site/misc/reprints.xhtml(copyright holder.reproduced or distributed without the prior written permission of theIL 60062. All rights reserved. No part of this article or PDF may be American College of Chest Physicians, 3300 Dundee Road, Northbrook,It has been published monthly since 1935. Copyri
3、ght 2002 by the CHEST is the official journal of the American College of Chest Physicians. 2002 American College of Chest Physiciansby guest on January 11, 2010chestjournal.chestpubs.orgDownloaded from References1 Kelly WF, Crawley EA, Vick DJ, et al. Spontaneous partialexpectoration of an endobronc
4、hial carcinoid. Chest 1999;115:5955982 Dieter RA Jr, Parker P, Cornell R, et al. Unusual expectora-tion. Am Fam Physician 1974; 10:112116Worry ListTo the Editor:The other day I asked Eileen when it was time to stop worryingabout M. M is a pleasant, likeable guy in his forties, with a goodsense of hu
5、mor. He works construction for a local company. Asfar as I know, he works hard and pays his bills. In the office, weoften joke around and swap stories. He tells me about his wildfishing trips on the Chesapeake. I tell him about the obnoxiousparents I encounter at my sons little league games.When M c
6、omes in, it takes Eileen forever to get his BP. Sheenjoys his stories as much as I do.We both like the one he told about spending 4 days on the baywith his fishing buddies. Didnt catch a thing, he told usnot onetiny fish. He said one of the guys got so frustrated that he fishedon a hand-held compute
7、r the last day of the trip.“I learned a lot about myself on that trip, Doc. Blue skies, calmwater, and good friends. Everything seemed perfect, and it reallywas, except for the fish. But hey, you cant control everything.”Ive been Ms doctor for 5 years. On most visits I urge him toquit smoking. I don
8、t push hard, but I make sure he knows howI feel about it. He listens to me patiently. I see him maybe twicea year, which is a little more frequently than he sees his preacher,he tells me. Not that I preach, he quickly adds. He has beenhealthy, except for a period of depression 5 years ago during ame
9、ssy divorce.Last summer I discovered that M has a lung nodule. It showedup on a routine chest radiograph. It was his first chest radiographever. After a lot of back and forth, I had talked him into it (hesmokes two packs a day).“I dont get it, Doc. I feel fine. There must be some mistake.Really, Im
10、okay.”“Im sure you feel fine, M. However, sometimes these thingsshow up without symptoms. I think the next step is to do a CTscan to get a better look.”“Doc, Im fine. Dont worry about me.”“M, thats hard for me to do, especially when you come to mefor help. How about thisthink it over, and call me to
11、morrow.This nodule could be many things, including cancer.”“Ive thought about it.”“At least come back in 6 weeks for a repeat chest radiograph.”“Sure.”M did not show up for his 6-week appointment. I thought tomyself: many patients live in a state of denial after receiving badnews. Maybe M is one of
12、them. He has a history of depressioncould he be depressed? Sometimes patients forget appointments,maybe he simply forgot. M does not own a carmaybe he missedthe bus. Being a single dad is tough. Maybe he could not get asitter for his kids. He once told me that his boss was a bastard.Maybe he couldnt
13、 break free from work. Maybe he cant affordthe scan. Maybe he is too embarrassed to tell me that he cannotafford the scan. Maybe hes simply scared. Maybe there are otherreasons. Maybe the reason is none of my business.I called him the next day and left a message on his machine toreschedule the appoi
14、ntment. Several weeks went by. No wordfrom M. I asked Eileen to call him. She got him at work, and hepromised to come in. He didnt. I sent him a certified letterexplaining the importance of finding out what was in his chest. Inever heard back. For the next 6 months, Eileen and I tried toreschedule h
15、im. No show. No show. No show.I keep a list of patients like Mpatients with abnormal testswhom I worry may get lost to follow-up. Patients who missscheduled tests. M had been on my worry list for over a year.I know that seems like a long time to worry about a patient. Buthow long is too long? What w
16、ould a medical ethicist say?Several weeks ago, I decided to take M off the list. Dont askme why. Some combination of time, frustration, wisdom, prayer,other patients, and the final okay from Eileen. I dont worryabout him now. Really. Maybe he has cancer. Maybe he will die.Maybe he will sue me. No wo
17、rry.Your choices, M. Your life.Months later, I saw M in the grocery store. He gave me a warmhandshake that I gladly returned. We talked about fishing andbaseball. We both had a good laugh. I did not ask him about hishealth. I think he appreciated that.“You know, Doc, Ive been thinking. Maybe I do ne
18、ed to comesee you sometime.”I smiled, shaking my head.He smiled back.“Maybe you do, M. Maybe you do.”Dean Gianakos, MD, FCCPLynchburg Family Practice ResidencyLynchburg, VACorrespondence to: Dean Gianakos, MD, FCCP, Associate Di-rector, Lynchburg Family Practice Residency, 2097 LanghorneRoad, Lynchb
19、urg, VA 24501; e-mail: ErrataIn the March 2001 issue, the article, “Association of AirwayResponsiveness With Asthma and Persistent Wheeze in a Chi-nese Population” (CHEST 2001; 119:691700) by Xu et al,contained an error. On page 692, in the “Procedures” section, thelast two sentences of the first pa
20、ragraph should read: “Subjectenrollment started in February 1995, after obtaining local Chinainstitutional review board approval. Brigham and Womens Hos-pital institutional review board approval was received in Septem-ber 1995.”In the February 2002 issue, the article, “Inhibition of HumanNeutrophil
21、Elastase-Induced Acute Lung Injury in Hamsters byRecombinant Human Pre-elafin” (CHEST 2002; 121:582588)by Tremblay et al, contained a typesetting error. In the firstcolumn of Table 1 (page 585), the entry “H92511-Antitrypsin” shouldbe followed by a double dagger () instead of a single dagger ().Clar
22、ificationIn the April 2002 issue, the editorial, “Balancing Self andPatient in the Physician-Patient Relationship” (CHEST 2002;121:10191021) by Henry S. Perkins, contained a punctuationerror. In the fifth paragraph, the second sentence should read:“While others may disagree, Miller, Shorr, and I sus
23、pect thephysicians in this study failed in their fiduciary duties to patients.”www.chestjournal.org CHEST / 121/6/JUNE, 2002 2085 2002 American College of Chest Physiciansby guest on January 11, 2010chestjournal.chestpubs.orgDownloaded from DOI 10.1378/chest.121.6.20852002;121; 2085ChestDean Gianako
24、sWorry ListJanuary 11, 2010This information is current as of & ServicesUpdated Informationtmlhttp:/chestjournal.chestpubs.org/content/121/6/2085.1.full.hfigures, can be found at:Updated Information and services, including high-resolutionOpen Access Freely available online through CHEST open access o
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