From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.
In January 1999, at Medicine Grand Rounds, Gordon Guyatt, MD, discussed
care for a 75-year-old retired fisherman. Mr C had exertional dyspnea associated
with congestive heart failure and chronic obstructive pulmonary disease,1 with a history of heavy smoking and hypertension and
evidence of dilated cardiomyopathy. He subsequently developed diabetes and
renal failure. He was treated with a complex regimen of medicines, oxygen,
and attentive care from his family and visiting nurses. Dr Guyatt discussed
an approach to managing the treatment of such a patient, noting the usefulness
of "N-of-1 randomized control trials" and the importance of therapeutic recommendations
based on the best available medical evidence. We asked the patient's physician
to comment on the months that followed the rounds.
Delbanco T, Hartman EE. A 75-Year-Old Man With Congestive Heart Failure, 1 Year Later. JAMA. 2000;283(8):1054. doi:10.1001/jama.283.8.1054