On your internal medicine rotation, you are rounding on Patricia, an 86-year-old woman who lives with her daughter. Your patient has dementia and her daughter manages her finances, medications, and important medical decisions. Patricia is very thin and has been evaluated in the past for malnutrition. She tells you she sometimes eats just once per day. Her most recent labs show a hemoglobin of 7.3 and an MCV of 73, indicating a significant microcytic anemia. Her daughter tells you that Patricia has been prescribed iron supplements in the past, and that she gives them to her mother daily. Later, she tells the intern on the team that her mother’s only medication is for her blood pressure and does not mention the iron. When questioned, Patricia’s daughter says she does not give her mother iron supplements. During the conversation, the patient’s daughter tells the intern that she never finished high school and that she doesn’t understand all of her mother’s medical problems. You and the intern discuss your concern that the patient’s daughter may not be equipped to handle her mother’s medical care. As you review the chart with the team, you see that the patient has had several visits in the past 3 years, with similar lab results indicating microcytic anemia and multiple iron panels indicating very low iron levels. In each visit, there is substantial documentation of counseling and education for the patient’s daughter. You and the team discuss the plan for Patricia and her daughter’s ability to care for her. What should you do next?
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Bridget Ralston is a member of The University of Arizona College of Medicine – Phoenix Class of 2020. She graduated from Santa Clara University in 2015 with a Bachelor of Science in Chemistry and a French minor. She de-stresses by whipping up delicious treats (and subsequently devouring them), playing soccer, and cuddling with her cat, Tuxedo. She has a particular interest in healthcare for underserved communities.