TC 401: Tone and Point of View (Short Assignment 3)

The following letter was written by a medical case worker to a doctor. The memo
attempts to convey the health care worker’s concern for a patient. Please consider all of
the topics we have discussed this quarter and then do the following two activities.
 Write a short paragraph that reports the results of your analysis of
stylistic weaknesses in the memo.
 Rewrite the memo by revising the weaknesses you discussed in your
critique. Remember to consider all issues that we have focused on in
your rewrite.

Bring your paper to class on the assigned date (see the syllabus).

Joyce Garrison, MSW

Madison Patient Services
1422 Oak Street
Madison, Wisconsin 53705

July 1, 2005

Dr. Joan Sanderson

Madison Medical Center
410 Walnut Street
Madison, Wisconsin 53705

Dear Dr. Sanderson,

As a follow-up to a telephone conversation I had with your assistant, Suzanne, earlier this week, I’d just
like to repeat myself and outline a few areas where my colleague, Susan Jones, M.S., and I believe your
patient needs some help, but that she might not discuss with you during her upcoming visit.

Of immediate concern to me is her daily care. Her husband, who had been assisting her with daily life, has
been hospitalized since Oct. 10. (My assistant has been helping her out since then.) Her husband will not
be coming home for another 1 to 2 weeks from today, and then he will be limited in what he can do. He
had serious arrhythmia and recovery has been and will be slow due to his age and pre-existing heart
condition. The husband had been preparing meals, etc. for your patient, and maintaining the house and
yard (albeit in deplorable condition). Beyond that, your patient says she takes care of herself, but we
suspect she relies on her husband more than she admits to/is aware of. In an effort to help meet your
patient’s needs and remove the pressure from her husband, we had arranged for an evaluation by Madison
Home Care Associates. Your patient called them this morning and cancelled that appointment, declining
the option of arranging a later date. All she will tell me is that she can’t handle it and she is a “nervous
wreck.” She says the doctor appointment Monday is all she can manage in a week. Without further
explanation, she told me it takes her a full day to prepare for a doctor appointment! She has a lifelong
history of anxiety and social phobias. Currently, she leaves the house only for doctor appointments. Can
you please help her—or perhaps gently coerce her—to accept the help she needs to battle her social
phobias? But more importantly, could you please help to convince her of the need for some in-home help.
We are willing to do whatever we can in the meantime, as well as be present for the first few visits of her
“helper.”

We also wonder whether she could benefit from a different or additional assistant walking device.
Currently, she moves around the house okay with her walker, but cannot stand for any length of time. Are
there walkers with built-in seats? And what about physical therapy—is that a lost cause this long after her
knee replacement surgery? She maintains that her lower extremity circulatory condition and degenerative
disk disease make it impossible for her to participate in physical therapy. Also, we believe she is not
adequately attending to personal hygiene. Should the bathroom be modified to make things easier for her
to bathe? (We were hoping the Madison Home Care Associates could get into the house and make this
determination, but thus far she won’t allow them in.)

And, of course, there is the cigarette smoking. We bring this up because she has mentioned that she as well
as her husband has heart disease. Could you discuss with her all the options for quitting, as well as the
benefits for her and her husband? (Her husband swears he has quit for good with his last illness. We fear
for his continued success if he returns to a smoke-filled house.)

You may suspect that we are overreacting, or are perhapssimply wanting to impose our will on poor
unsuspecting people. But, if you’ll review your patients health history, you’ll see that when she was
hospitalized for the knee replacement surgery, she was brought in by ambulance from her home where she
was discovered, unable to move, and suffering the mental and physical effects of extreme pain and serious
bone injury. Her husband had not recognized the severity of the situation and she refused to get help. In a
very similar scenario, her husband’s recent illness was present for two weeks before his condition was
discovered in a routine check-up after which he was immediately admitted to the hospital. When we asked
your patient why her husband didn’t get to his doctor sooner, she said she told him he needed to go to the
doctor, but that he wouldn’t go. We asked her why she didn’t call me and she didn’t respond. This is how
they ‘take care” of each other. Thus you can perhaps understand our concern and our reason for asking for
your help.

If you could contact me, I would appreciate it very much. Although the doctor-patient confidentiality
agreement may prohibit you from discussing your patient with us, we sure would appreciate confirmation
you received this letter and perhaps any advice you could offer.

Thank you very much for your attention to our concerns.