It Is A Source Of Learning

Mr. XXXX is a 44 years old Caucasian male, a general construction worker who works on a nearby highway for the bridge project, and checked in this urgent care center for complaining of chest pain and shortness of breath (SOB). The chest pain is constant dull and pressure like pain, and started 3 hours ago. The pain is located on the center of chest. He rates the pain 4 out of 10 on a pain scale 0 to 10 while resting. The pain gets worse and increases after eating. He experienced increased chest pain and SOB with simple walking from the parking lot to this office. The pain was not resolved with taking PO 365mg of Aspirin 2 hours ago and resting. He was diagnosed with hyperlipedemia 10 years ago. He is taking medication to manage his high cholesterol level. He denies past history of chest pain, hypertension, and coronary artery disease. He denies any history of heart surgery or cardio artery bypass surgery. He is anxious and fearful for his first chest and SOB. He smokes a half pack a day for past 20 years. He drinks one bottle of bear every evening with meals. He denies taking any herbal medication or illicit drugs. He has been a good appetite. He reported 20 lbs weight gain since his retirement from military. He has an irregular meal time and does not exercise as much as he used to do in the military.

Although Internal Medicine has taught me the importance of clinical decision-making by physicians, my academic interests lie with how

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

Every patient has a right to decide on their own course of treatment and freely consent to that treatment. In order to make an educated decision they must be provided with the proper information to make an informed choice (Opinion 8.08 - Informed Consent, 2006). It is the physician’s legal and ethical obligation to provide this information when making their recommendation on treatment. The choices given must be in accordance with good medical practice (Opinion 8.08 - Informed Consent, 2006). The informed consent is the legal policy, either written or verbal, that gives full disclosure of all the information including potential risks that is applicable to the patient’s condition and treatment being offered (Kazmier, 2008).

John was diagnosed with heart failure a year ago after being hospitalised three times in the space of four months. Stewart (2004) feels that a diagnoses of heart failure is problematic in older patients as their symptoms can often mimic other

Analyzing Mr. Edward blood pressure (140/85) during his last visit to the doctor, plus the constipation and the GERD, and also the level of his cholesterol, it show that he has all the condition to develop myocardial

On arrival at the ED, the physician auscultates muffled heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is

History of cardiomyopathy. The most recent echocardiogram was done in 2014 showing improved ejection fraction at 55%. He feels asymptomatic, at this time. He did have recent testing with Dr. Dourdoufis. I will request those notes and review them when they arrive. He will certainly let myself or Dr. Dourdoufis know or seek care if necessary if his symptoms change acutely.

The Atlanta-based internist is concerned with how recipients and providers of medical services receive and make health advice and recommendations, respectively. He rues the current practice of medicine, which now pays more emphasis to data or evidence: anything that the data reveals are immediately taken as hard science, with the results taken from studies that claim to “represent a consistently reliable representation of the real world of human beings” i.e., those who do not participate in the studies. For Paul, the data or studies could mean

Good communication between physician and patient is vital for a patient to make an informed choice regarding their care.

He reported that he had a cardiac cath done at Tampa General Hospital this year with no intervention. He has had a history of hypertension since the age of 19. He was not adherent to medications, but for the last three years, he has been adherent to all his medical care. No history of stroke or peripheral vascular

“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”

Considerable evidence demonstrates the clinical effectiveness and potential cost reduction associated with shared decision making. A review by the Cochrane Collaborative published in 2014 evaluated 115 randomized control trials with 34,444 participants for the effectiveness of decision aids for persons facing treatment or screening decisions. The data demonstrate use of decision aids results in better than usual care in several quality domains. Namely shared decision making had a positive effect on patient knowledge, communication with the health care provider, improved patient engagement in the decision making process and provided more realistic outcome expectations. Interestingly, decision aids were also

Shared decision making should involve both health professionals and patients in discussions about their care. “While health professionals hold the expert clinical and technical knowledge, patients are experts about their own lives and treatment objectives, and also what is important to them when making decisions. (Lally, Macphail, Palmer, Blair and Thomsom, 2011).

Patient is a 45 yo male; 5’7”, 221 lbs who entered the emergency room at 6:30 am on 9/7/14 with severe chest pain (onset at 6:00 am) radiating to his arm, L arm numbness and nausea and vomiting. Past medical history reported by wife includes peptic ulcer, tobacco use (1-2ppd for 27 years), elevated blood pressure (controlled by lopressor). Wife did not know of any family history but reports patient’s father is deceased, died at 42 in his sleep. Mother alive and with high blood pressure.