Sylvia's Walker Balls

Learning objectives

After listening and discussing, participants should be able to:

1. Discuss how a long doctor–patient relationship shapes diagnosis and care.
2. Practice interpreting physical findings in the hands and nails of an older patient.
3. Reflect on how the electronic record and problem lists represent, and miss, a patient's life.

Discussion questions

1. The narrator has cared for Sylvia for over twenty years. What does he notice that a new clinician would miss?
2. What can the hands and nails tell you on exam? Which findings in the story are real signs, and which are satire?
3. Sylvia's problem list is “as long as the Bronx telephone directory,” yet no one knows her story. What belongs in a record that doesn't fit in a problem list?
4. How do you balance curiosity about a patient's past with respect for what they choose not to share?
5. What happens to patients like Sylvia when their long-time physician retires?

Quick activity

Write a two-sentence “who this person is” summary for a patient you know well, the kind that never makes it into the problem list.

How to run it

Play the episode together (11 minutes) or assign it beforehand. Start with the first question to let people react to the humor, then move to the harder ones. Remind the group that the episode is satire and some of its “facts” are invented; spotting which ones is a good exercise in itself.

Background reading

• Robots in elder care: what they do and don't do