Guest Chieka Posted February 22, 2003 Report Share Posted February 22, 2003 Can we try this question, from an earlier post by Aneliz: An elderly man comes in complaining about headaches and worrying that he has a brain tumour. What do you do? Thanks, C. Link to comment Share on other sites More sharing options...
Guest Raid123 Posted February 23, 2003 Report Share Posted February 23, 2003 I think the full question was: The elderly gentleman is from a rural environment. He comes in day after day complaining of headaches that you believe are just headaches that can be taken care of with aspirin. However, the patient demands MRI/other services that you think are not necessary. What would you do? what will you do if he becomes beligerant when you refuse. I am not very good at these kinds of questions but i will give it a try. My initial reaction on seeing this question was that maybe if the patient keeps on coming back with the same complaint then it would be my obligation to look further into the problem. there may be some truth in his complaint and i would rather find it now than when the problem has progressed. However, being in a rural setting where resources are limited, i would have to be very careful in that i don't end up using these scarce resources for for a procedure that i feel is not necessary. I may refer the patient to another doctor for a second opinion ifhe continues to disagree with my opinion but in the end, whatever my conclusion is, i will stick to it. My role as a doctor requires me to be an educator and i feel that if i were to explain to the patient what i feel his problem is then he may be less aggressive and more understanding. Link to comment Share on other sites More sharing options...
Guest tirisa Posted February 23, 2003 Report Share Posted February 23, 2003 Another thing to consider is whether the elderly gentleman is lonely, a widower perhaps, with no family or friends, and is simply seeking attention. My emerg doc friends talk about such people who come in night after night looking for any friendly listening ears. So I think in this case, I would want to find out a bit more information about his social history and ask some open-ended questions about his current life, or even evaluate whether he may have a mental disorder of some sort, such as depression. Anyway, I would certainly still want to follow up on other possible diagnoses, since severe persistant headaches could be a symptom of something quite serious. Just my thoughts. Cheers, Tirisa Link to comment Share on other sites More sharing options...
Guest Biochem10 Posted February 23, 2003 Report Share Posted February 23, 2003 how about getting them to talk to a social worker if they are lonely and elderly? Link to comment Share on other sites More sharing options...
Guest tirisa Posted February 23, 2003 Report Share Posted February 23, 2003 Great idea, Biochem. I think that if you determined from your conversation with him that he might be slightly depressed and lonely or something, and similarly feel confident that there is no need for further diagnostic tests, then referring him to a social worker may be in order. However, I really don't know what the protocol is for referring pts to social workers. I'm sure social workers don't want doctors to be sending them every lonely pt that comes in their office?? Would a physician first need to diagnose depression?? and if depression is the dx, then is referral to a social worker the proper step?? or to a psychiatrist?? Not sure. What do others think. T Link to comment Share on other sites More sharing options...
Guest shelleyrn Posted February 23, 2003 Report Share Posted February 23, 2003 A simplified version....This elderly gentleman, although pushing you as the physician for services which you may deem as unnecessary, it may be prudent to "rule out" any pathological condition prior to prescribing the token aspirin. Explaining your concerns, and developing a plan of action (if not this, then that...etc.) This may open up the conversation, and you may be able to discuss the more psychosocial aspects of this gentleman's life ie depression, loneliness, etc. If this is the case, you may be able to hook him up with services ie. senior support groups, etc (if he is willing). Often, in my experience, it helps to give the patient the whole picture....explain, explain,explain.....cheers Shelley Link to comment Share on other sites More sharing options...
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