A Collection of Clinical Case Stories as Emotional Landscapes of The General Physician-Sea Cliff

Short Communication

A Collection of Clinical Case Stories as Emotional Landscapes of The General Physician-Sea Cliff

Jose Luis Turabian ID ^*

Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia. Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain.

*Corresponding Author: Jose Luis Turabian, Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia. Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain.

Citation: Jose L. Turabian. (2026). A Collection of Clinical Case Stories as Emotional Landscapes of The General Physician-Sea Cliff, International Clinical and Medical Case Reports, BioRes Scientia Publishers. 5(3):1-3. DOI: 10.59657/2837-5998.brs.26.066

Copyright: © 2026 Jose Luis Turabian, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: June 15, 2026 | Accepted: July 20, 2026 | Published: July 31, 2026

Abstract

This International Clinical and Medical Case Reports section is a collection of descriptive clinical vignettes, "like the plates in a geography atlas" that will present the emotional situations (empathy, frustration, sadness, joy, exhaustion, etc.) metaphorically described as emotional landscapes (which can have emotional, cultural and spiritual significance for people, evoking feelings of peace, beauty, nostalgia or belonging): mountains, volcanoes, rivers, valleys, islands, waterfalls, glaciers, fjords, estuaries, etc, and who are experienced by general practitioners, when they dealing with different clinical cases and patients, with the aim of achieving a greater understanding of what we are and what we do as doctors in relation to patients. This story presents a case of postmenopausal osteoporosis treated with abaloparatide that poses significant risks and limitations for the patient. The physician understands, accepts, and shares her emotional state. This landscape emotionally suggests to the general practitioner tall sea cliffs uplifted above the sea, and from the edge, one can enjoy the views, yes, but one gazes at the landscape with anguish, a knot in one's stomach.

Keywords: osteoporosis; empathy; emotions; metaphor; patient-centered care; biopsychosocial approach; general practitioner; cultural context

Clinical Vignette/Emotional Landscape: Sea Cliff

Carmel, 69 years old. Her medical history included: supraventricular arrhythmia due to reentry, resolved with ablation 15 years ago; diverticulosis, treated with rifaximin; pyelonephritis due to right ureteral calculus-treated with ureteroscopy and percutaneous retrograde intrarenal surgery 8 years ago; dyslipidemia, treated with simvastatin; frequent dyspepsia; left elbow fracture-dislocation 6 years ago after a fall; right renal colic 4 years ago, with persistent microscopic hematuria; vitamin D deficiency, treated with calcifediol; chronic autoimmune thyroiditis for 3 years; and a right proximal humerus fracture 6 months ago after a fall. She was a non-smoker and did not drink alcohol. She was overweight.

She was referred to rheumatology to confirm a diagnosis of osteoporosis: FRAX score: 16-year risk of major osteoporotic fracture and 5.8% risk of hip fracture. Bone mineral density: T-score: lumbar spine (L1-L4): -3.1; right hip (neck): -3.0; left hip (neck): -2.9. X-ray of the thoracic and lumbar spine: degenerative disc disease in the lower lumbar spine. A diagnosis of osteoporosis with peripheral fractures [1,2] was made. Abaloparatide 80 mcg subcutaneously daily for at least 18 months was prescribed.

Carmel consulted her GP because she wasn't convinced about starting the treatment. She was worried that it might worsen her kidney stones and about the other common side effects. She was also concerned about injection site reactions, given that it was a long-term treatment. Furthermore, there were the storage requirements for the medication. Carmel was an active person who traveled frequently, and the treatment would make that impossible…

“I was so disappointed with the rheumatologist's appointment,” Carmel told her GP.

“So, you're very upset and surprised. You didn't expect this, did you?”

“No, I didn't expect it…”

“I can imagine your disappointment with the test results, the risk of fractures, and the difficulties and possible side effects of the treatment.”

“Of course, I don't know what to think anymore.”

“Carmel, I understand that you feel frustrated about the risks of the treatment…” the doctor said.

“I feel fine now… I understand the risk of further fractures if I fall, but the medication for osteoporosis, although it could reduce my risk of fractures, have other medical risks and limit my lifestyle…” Carmel explained.

“Do you have a lot going on?” the GP asked.

“Yes. I would love to reduce the number of doctor's appointments, tests, and medications. I'm already taking several medications for chronic conditions: calcifediol, rifaximin, simvastatin; I don't want any more…”

“So, you feel overwhelmed by all these difficulties… I can imagine how difficult it is for you… with your active lifestyle and frequent international travel, adhering to this treatment would be challenging…” the GP said warmly, providing unconditional positive regard for Carmel's experiences, fears, expectations, and emotions, thus empathizing with the patient's feelings of anticipation, and disappointment associated with the new treatment.

The GP knows that at present, abaloparatide, another PTH analog, is not clearly more effective, although growing evidence from preclinical and clinical studies has consistently shown that it increases bone mineral density and reduces the risk of fractures, but there is greater uncertainty about its safety [3,4]. In that patient-centered and contextualized interview, in an autonomous patient [5,6], it was ultimately decided to use only non-pharmacological treatment for osteoporosis [7].

Empathy is a fundamental skill in general practice. It is the ability to imaginatively identify with the patient's subjective experience of illness to provide genuine recognition and validation of that experience. Empathy means feeling what another person feels. Empathy is defined as the ability to understand and share the emotional state of others, and is essential in the doctor-patient relationship. It is recognized that the doctor's empathy not only improves patient satisfaction, but can also influence clinical assessment and treatment outcomes. In acute illnesses, empathy tends to be emotional, while in chronic illnesses it manifests more as cognitive empathy, due to the nature of the symptoms and the patient's experience. Effective communication is crucial in the treatment of diseases, and empathy facilitates the exchange of experiences and concerns between doctor and patient [8,9].

One of the crucial elements of medicine, especially general practice, is the combination of patient-centered care [10] and the biopsychosocial approach [11] with the effectiveness of medical intervention within the context of evidence-based medicine. It is important to consider that to develop or increase the effectiveness and efficiency of clinical medicine, it is necessary to understand patients and ourselves within their respective contexts.

In this scenario, qualitative aspects are incorporated: thoughts, beliefs, behaviors, the social context, and interactions with biological processes, to better understand and manage illness and disability. In this model, biological, psychological, and social processes are inextricably intertwined. For example, thoughts and feelings are inseparable from the biological processes that occur in the brain [12]. It's not about focusing solely on the disease and "some aspects of the patient," but rather about prioritizing the patient's context and underlying pathophysiology. The practice of medicine is an interpretive activity: it is the art of applying scientific principles to the individual case [13].

But despite everything, the general practitioner faces doubts, fears, and risks regarding his decision. He feels as if he is standing on the edge of a cliff: a high, extremely steep rock face, almost vertical, along the coastline. The general practitioner experiences the same sense of dread when observing his daily work in the clinic as when contemplating the landscape from the edge of this tall sea cliff, which, crumbling and retreating under the relentless onslaught of the sea, is formed by the constant pressures of various erosion processes [14,15]: one can appreciate the nice view, yes, but with a sinking feeling in the stomach.

References

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