Doc, I can’t do anything with my kids because my back pain is so excruciating sometimes. I just have to lay in bed all day. I just don’t know Any patient statements/actions that what to do with myself. I really need my pills. provide opportunities for empathic reflection by the student? Should patient respond Yes differently to different types of students? Other encounter guidelines: HISTORY OF THE PRESENT ILLNESS PHYSICAL SYMPTOMS Chief Complaint/Reason Back pain, medication refill for Visit or Admission: 5 years ago Onset: 5 years Duration: Across lower back Location: Aching Character: Sometimes down right leg Radiation: Intensity: 14/10 (scale of 1-10) Aggravating Factors: Any activity such as walking, bending, picking up kids Alleviating Factors: Rest, Percocet Pattern: Constant Course: Same over the years, sometimes gets exacerbated (getting better or worse?) MVA 5 years ago Context: (what was the setting/context of onset?) Associated Symptoms: Intermittent tingling in bilateral legs, stomach cramps, constipation, no incontinence or numbness in genital area I’ve tried everything! Ibuprofen doesn’t do anything. I’ve tried a heating pad, Response to Symptoms: ice, I’ve even done physical therapy (three trials of various modalities; heat, (what has the patient done about the symptoms other US, exercise). than seeking health care?) Consequences: The pain is so bad; I can’t do anything with my kids. (what to the symptoms interfere with?) Meaning of the illness: I’m frustrated that I’m always having back pain and nobody has helped me. Nothing except the pain medications seem to help my pain. (patient’s ideas, feelings, fears about the causes/implications)
Any patient statements/actions that provide opportunities for empathic reflection by the student? Doc, I can’t do anything with my kids because my back pain is so excruciating sometimes. I just have to lay in bed all day. I just don’t know what to do with myself. I really need my pills. Should patient respond differently to different types of students? Yes Other encounter guidelines: HISTORY OF THE PRESENT ILLNESS PHYSICAL SYMPTOMS Chief Complaint/Reason for Visit or Admission: Back pain, medication refill Onset: 5 years ago Duration: 5 years Location: Across lower back Character: Aching Radiation: Sometimes down right leg Intensity: (scale of 1-10) 14/10 Aggravating Factors: Any activity such as walking, bending, picking up kids Alleviating Factors: Rest, Percocet Pattern: Constant Course: (getting better or worse?) Same over the years, sometimes gets exacerbated Context: (what was the setting/context of onset?) MVA 5 years ago Associated Symptoms: Intermittent tingling in bilateral legs, stomach cramps, constipation, no incontinence or numbness in genital area Response to Symptoms: (what has the patient done about the symptoms other than seeking health care?) I’ve tried everything! Ibuprofen doesn’t do anything. I’ve tried a heating pad, ice, I’ve even done physical therapy (three trials of various modalities; heat, US, exercise). Consequences: (what to the symptoms interfere with?) The pain is so bad; I can’t do anything with my kids. Meaning of the illness: (patient’s ideas, feelings, fears about the causes/implications) I’m frustrated that I’m always having back pain and nobody has helped me. Nothing except the pain medications seem to help my pain.
chronic-back-pain-opioid-resistance-20180928.docx