A 46-year-old woman comes to the office to establish care. She has not seen a physician in several years and takes no medication. The patient has recently been experiencing a significant amount of stress due to her mother's recent diagnosis of metastatic breast cancer. She expresses sadness due to her mother's condition but has had no suicidal or homicidal ideation or substantial loss of interest or pleasure in performing her activities. She lives at home with her mother, who is widowed, and no other family members live nearby. Due to her mother's worsening condition, the patient has needed to personally assist her with activities of daily living and transportation to medical appointments. The patient works at a large company and states that she is having increasing difficulty fulfilling her commitments at work. She has used up all her sick and vacation days, and her supervisor cannot give her additional time off. The patient is tearful and states, "I'm really hoping you can help me. I am going through so much stress. I just need a few weeks off work so I can look after my dying mother." Which of the following is the most appropriate response by the physician?

Question

A 46-year-old woman comes to the office to establish care.  She has not seen a physician in several years and takes no medication.  The patient has recently been experiencing a significant amount of stress due to her mother's recent diagnosis of metastatic breast cancer.  She expresses sadness due to her mother's condition but has had no suicidal or homicidal ideation or substantial loss of interest or pleasure in performing her activities.  She lives at home with her mother, who is widowed, and no other family members live nearby.  Due to her mother's worsening condition, the patient has needed to personally assist her with activities of daily living and transportation to medical appointments.  The patient works at a large company and states that she is having increasing difficulty fulfilling her commitments at work.  She has used up all her sick and vacation days, and her supervisor cannot give her additional time off.  The patient is tearful and states, "I'm really hoping you can help me.  I am going through so much stress.  I just need a few weeks off work so I can look after my dying mother."  Which of the following is the most appropriate response by the physician?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c1e2_0c41_8f63_b527fdd73f08_MD0005_00 This woman, who is serving as primary caregiver for her mother, who has severe illness and requires significant assistance, has exhausted her employer's options for leave (eg, vacation time). However, she may qualify for additional, unpaid time off through the Family Medical Leave Act (FMLA). FMLA is a federally mandated benefit offered by large employers (ie, >50 employees). FMLA provides employees with up to 12 weeks of unpaid leave (eg, in contrast to disability benefits, which provide compensated time off). The employer must allow the employee to return to the job, or its equivalent, after leave is completed. Conditions appropriate for FMLA include: Employee has a serious illness or qualifying health condition (including pregnancy), or Employee is caring for an immediate family member (spouse, parent, child) with a serious illness (eg, cancer) The employee must also have been with the employer for ≥1 year. FMLA requires certification from the provider caring for the person with a serious illness. In this case, the mother's provider should certify the metastatic breast cancer diagnosis and describe the specific services requiring the daughter's involvement (eg, transportation). (Choice B) Although hiring a personal caregiver may lessen care demands on the patient, this may not be feasible or desired by the patient or family. This patient specifically expresses her desire to provide care for her mother and should be counseled on options to facilitate her request. (Choice C) Even though it is true that the physician cannot supersede the policies of the patient's employer, FMLA is a federally mandated benefit, and the patient should be counseled that leave under FMLA may be possible and appropriate. (Choices D and E) Although this patient is experiencing stress, she has no specific signs (eg, suicidality, anhedonia) raising concern for serious medical illness (eg, severe depression). Her primary demand is instead related to her mother's condition, and a psychiatric referral solely to acquire a mental health diagnosis is not recommended or necessary for this patient's FMLA qualification. Educational objective: Employees of large companies may qualify (with provider certification) for up to 12 weeks of job-protected, unpaid time off work through the Family Medical Leave Act (FMLA) in cases of serious illness or caring for an immediate family member with personal illness. References: Employment, family leave, and parents of newborns or seriously ill children. (http://www.ncbi.nlm.nih.gov/pubmed/22459063)

A 46-Year-Old Woman Comes to the Office to Establish Care