One of the frustrations of medical practice is the struggle to help patients trapped by circumstances of homelessness, poverty, illiteracy, addiction, and mental illness. Almost all internists, whether hospital- or office-based, are familiar with these scenarios: A 54-year-old homeless man is admitted and treated for cellulitis, only to be discharged to his riverbank encampment, where he promptly develops, another infection. An 83-year-old female nursing home resident is admitted six times in as many months for urinary tract infections, bedsores, and delirium. A 37-year-old woman with multiple sclerosis and diabetes breaks her motorized wheelchair, and for lack of a replacement part, cannot pick up her medications at the local pharmacy or make it in for scheduled clinic visits. Feeling ill, with a fingerstick glucose of 508, she has the paramedics bring her to the ED.
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