1. Is This Patient a "Time Bomb" if She Goes Home?
SUKHIT PHAOSAVASDI, M.D.*, CHUMSAK PRUKSAPONG, M.D.*''*, SURASAK TANEEPANICHSKUL, M.D.* HENRY WILDE, M.D.**, YUEN TANNIRANDORN, M.D.*,
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkhon University, Bangkok 10330, ** Queen Savapha, Thai Red Cross Society, Bangkok 10330, *** Department of Surgery, Police Hospital, Bangkok 10330, Thailand.
It was hot and humid and none of the residents were at their best during infectious disease consultative rounds at a local university hospital last week. The patient was a 56 year old women from Bangkok who was a chronic alco- holic with several prior admissions for liver cirr- hosis. She had at least one upper GI bleed, spleno- megaly and was moderately jaundiced. Her new problem was fever, a milliary pattern infiltration in her lungs and a sputum which was positive for acid-fast organisms. She was also confused but without focal neurological signs or a stiff neck. The residents and ward staff wanted to know how to treat her tuberculosis in view of the liver disease. This issue was discussed and resolved but when I asked about her posthospital care, assuming that she would recover from her tuberculosis, this question drew a complete blank. None of the resi- dents knew where she lived, if alone. and none had considered the likelihood of her continuing any medications after discharge. Whether or not this confused chronic alcoholic lived with family. perhaps including gr;,ndchildren and a person who could take responsibility for her after care. had also not been investigated or even considered. How often do we see this type of case'7 Do we not have a responsibility of protecting the public from such a patient who would be unlikely to continue anti- tubercular drugs after discharge unless this ts supervised? Is it not high time that we do not only treat the disease while in hospital (Tuberculosis. 1-IIV infection, etc.) but also plan achievable post- hospital care as well as look for contacts and new cases in and around the index patient?
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