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Joanne Lynn, MD, MA, MS

JAMA. 1997;277(20):1633-1640.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Dr DALEY: Mrs J is an 88-year-old widow who has had multiple recent episodes of congestive heart failure [CHF] requiring hospitalization. She lives alone in an assisted living center for senior citizens in a suburb of Boston, Mass. She has 1 daughter, Mrs V, who is very involved in her care. She has Medicare insurance and a supplemental Medigap insurance policy.

Mrs J has long-standing essential hypertension, coronary artery disease with stable angina pectoris, aortic stenosis, and an elevated alkaline phosphatase suggestive of Paget disease of the bone. She has chronic CHF, paroxysmal atrial fibrillation, 2 to 3 episodes of angina per week relieved by nitroglycerin, and recurrent episodes of flash pulmonary edema, necessitating 4 hospital admissions in the previous 10 months. Within the past year, Mrs J refused needle biopsy for evaluation of a multinodular goiter. Functionally, she needs assistance only with bathing, but notes fatigue and some shortness . . . [Full Text PDF of this Article]

Footnotes
Dr Lynn is Professor of Health Care Sciences and Medicine and Director of the Center to Improve Care of the Dying, George Washington University Medical Center, Washington, DC.

This conference took place at the Medicine Grand Rounds of the Beth Israel Deaconess Medical Center, East Campus, Boston, Mass, on January 23, 1997.

Reprints: Erin E. Hartman, MS, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, East Campus, 330 Brookline Ave, LY318, Boston, MA 02215.

Clinical Crossroads at Beth Israel Deaconess Medical Center is produced and edited by Thomas L. Delbanco, MD, and Jennifer Daley, MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Senior Editor, JAMA.

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