Seeing that the pain was not going away, and it even appeared to be getting worse, Jacopo finally visits a walk-‐in clinic/ER. Jacopo was still experiencing severe pain, limitation of movement and antalgia, though bending forward relieves the pain somewhat. (Having grown up immersed in Italian culture), Jacopo was very vocal and expressive upon seeing the physician. Jacopo would describe his physical complains in a dramatic manner and is very emotional in his responses to pain. His suffering is shown by groaning and moaning and he is not ashamed of his expression. He is particularly emotional because this pain experience is keeping him from doing his job properly at the AGO. Begin the role-‐play with one student playing Jacopo Perfetti and another student playing the physician who is currently taking Mr. Perfetti’s medication history. Discussion Questions 1. Similar sounding names of medications often get mixed up. What was the example in this case? What kinds of questions could you ask the patient to help you distinguish what medications the patient is taking? 2. What are some sources or strategies to help you identify what medications a patient is taking if the patient forgets the name of them? 3. Is medication compliance an issue in this case? What are some things you can do to increase medication compliance? 4. Different cultures have different ways of dealing with illnesses. For example, some may turn to homeopathy before seeing a physician. What is your approach when speaking with these kinds of patients? What are some things you can do to become culturally competent?
REFERENCES
1. Ende J, Rockwell S, Glasgow M. (1984). The Sexual History in General Medicine Practice. Arch Intern Med. 144(3):558-‐561. 2. Adapted from Contemporary Pediatrics, Getting into Adolescent Heads (July 1988), by John M. Goldenring, MD, MPH, & Eric Cohen, MD 3. IMS Health. (2012). Top 10 Reasons for Physician Visits in Canada 2011.
REMINDERS FOR SESSION 27, 28 AND 29
• Review the section on “Approach to Common Neurological Symptoms” • Watch the videos on “Cranial Nerves” on The Neurological Exam website (http://neuroexam.med.utoronto.ca) • Review the “Introduction to the Neurological Examination” lecture in Brain and Behaviour • Review neuro exam videos (http://media1.med.utoronto.ca/neuroexam/)