From the Editor
Patrick is not participating in physiotherapy, and is thus not eligible for discharge. To the staff on the orthopedics ward at the hospital where I work, that’s a Big Problem.
On Tuesday afternoons, I finish at the Birchmount campus of The Scarborough Hospital and drive to the General, where I see patients on medical and surgical floors. And on a recent Tuesday, I met Patrick.
For the record, Patrick has more than one Big Problem. Patrick smokes and he drinks too much. Patrick has diabetes and lung changes. Patrick is obese. And it’s the combination of all of the above that led to the fall that left him with the fractured hip and the surgery. If Patrick is doing badly – this is his second hospitalization in fifteen months – it’s not for lack of health-care effort. Since his last discharge, he has seen an endocrinologist, his family doctor, and a respirologist. Patrick has home care. Patrick is, in other words, a heavy user of the health-care system. And if we are serious about restraining health costs in light of an aging population, we need to find better ways of dealing with people like Patrick.
This week’s Reading: an excerpt from the new Maunder-Hunter book. In it, the authors forward the following idea: people like Patrick can be better helped if we think about attachment theory.
As you will recall, attachment theory is based on experiments with children exposed to strangers. To summarize (and possibly oversimplify) some very clever experiments: after seeing the stranger, if the child seeks out the parent, and is soothed, it’s considered healthy, or secure attachment, as opposed to insecure attachments, like avoidant attachment and resistant attachment (where the child is less interested in the parent or is difficult to soothe).
This is a terrific and important book – and of interest to all clinicians.
It’s thoughtful and relevant. Do you see patients? You should get this book.