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Perspective
August 19, 2019

Medical Discharge Summary—“Disposition: To the Street”

Author Affiliations
  • 1University of California, San Francisco, San Francisco
JAMA Intern Med. Published online August 19, 2019. doi:10.1001/jamainternmed.2019.3603

“I’m tore up, doc. I’m tore up.” This was frequently Bill’s response when I asked him how he was doing. “I can’t keep living like this.”

I am Bill’s primary care physician. He is 58 years old, but a litany of medical and psychosocial challenges have weathered him far beyond his years. Ten years ago, a stroke left him with dense, right-sided weakness (he is right-handed). He is now dependent on a wheelchair to navigate his city and his life. A few years after the stroke, he underwent an ileal conduit urinary diversion to treat urinary retention due to neurogenic bladder and severe benign prostatic hyperplasia. He also has substantial cognitive impairment and a stimulant use disorder. On top of all of this, he is homeless and has been sleeping on the street for nearly 3 years.

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