Respond to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.  

CASE STUDY 2: 

Shawn Billings, a 28 year-old African American patient comes in to the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication. 

1) Post by Mirel Del

The etiology and progression of diseases are multifactorial. Therefore, it is essential to understand the social determinants of health and how they influence a patient’s well-being (Ball et al., 2023). The case provided describes Shawn Billings, a 28-year-old African-American patient who comes into the clinic with a chronic headache. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and four days ago with a migraine; he was given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache and is very agitated. He is here with his father and is worried he will not get any medication. Understanding the factors associated with the patient’s treatment-seeking behavior and current health status will provide a rich history that can be used to provide an accurate diagnosis and a patient-centred treatment plan. 

           Healthy People 2030 defines social determinants of health (SDOH) as environmental conditions that impact individuals’ quality of life, functioning and health (Office of Disease Prevention and Health Promotion, 2022). The main classifications of SDOH are the social context, the built environment, access to and quality of healthcare, the quality of and access to education, and economic stability. For the patient, his race may contribute to a lower socioeconomic status, resulting in lower access to nutrition and lower amounts and quality of sleep due to a noisy neighborhood. Therefore, it is essential to ask the patient about his diet and exercise patterns, where he lives, and how many hours of sleep he gets. The patient’s occupation can also provide information on his day-to-day activities, which might trigger the headache. Moreover, the patient is more prone to discrimination even in healthcare services. According to Morden et al. (2021), black patients often get undertreatment for pain and are more likely to be denied painkillers due to the stereotype that black patients are likely to be addicted to pain medication. Still, there is a risk of addiction to prescription opioids and other habit-forming medications. Therefore, ensuring that the patient gets appropriate treatment without discrimination is crucial. Asking the patient about the abovementioned factors is essential for accurate diagnosis. 

             It is important to address sensitive issues in a nonjudgmental to ensure that a patient is comfortable when sharing information. Among sensitive issues for the patient include potential prior bias and discrimination due to his ethnic and cultural background. The patient is already hypervigilant, as evidenced by bringing his parent to the hospital despite him being a grown man. The caregiver should ask about any worries and concerns of discrimination and provide reassurance and a commitment to providing culturally sensitive and non-discriminatory care (Ball et al., 2023). Cultural adaptations to screening tools, providing culturally competent responses, and understanding the impact of culture on illnesses and treatment are crucial for holistic treatment. The patient is also at risk of addiction to painkillers. Therefore, education on the importance of providing a comprehensive history can help uncover the cause of the headaches and gear treatment towards the cause of the symptoms instead of the symptoms. The use of drugs for recreational purposes is also a sensitive issue that can offend the patient. However, asking the patient about potential drug use is necessary to avoid drug interactions and encourage patient-centred care. 

              Here are five targeted questions I would ask the patient to build his health history and assess his health risks.

Are there any prescription, over-the-counter, or herbal medications you are currently taking, and are they useful in relieving symptoms?

Can you show me the specific area of your head that hurts and describe the pain you feel?

What is the duration and frequency of the headaches, have you noticed specific triggers and patterns that seem to contribute to the migraines?

Are there any medical conditions you have been previously diagnosed with?

Are you experiencing significant changes or stressors at work or in your personal life?                                                                                                                                                                                                                                                                                                                                                                                                                      

2. Post by Laur Bahar                                                                                                                                  

Considering this patient, a young African-American male who has been labeled a “frequent flyer,” raises a host of concerns. As a minority, it is almost certainly a given this young man has experienced racism to some degree at some point in his life. Without knowing his socioeconomic status, it is likely that he and his family have to and continue to face more obstacles and barriers than a non-minority. There is a high probability this young patient and his family have faced countless challenges, untoward behaviors, and attitudes, and come with understandable hesitancy when seeking healthcare. Inadequate healthcare and exclusionary healthcare experiences are common among racialized minorities. Racism is linked to a lack of trust in healthcare providers and delays in seeking care (Hamed et al., 2022). Before interviewing the patient, all of these points must be at the forefront of awareness to best serve the patient.      What are the feelings and thoughts this patient is potentially coming to the clinic with? Fear, anger, mistrust, and doubt are probable. This patient has already been in for the same reason, seemingly without any solutions. Regardless if the providers and staff at the clinic did not have any implicit or explicit biases towards him, it is safe to assume he is going to feel that way. However, the stark reality is the prevalence of implicit racial bias in patient and provider interactions contributes to the exacerbation of health disparities among minorities (Sim et al., 2021). This patient is agitated, rightfully so. His health concern was not fully addressed, and it bears consideration that he is treated like a “frequent flyer” as well. Being treated in that manner, patients, regardless of ethnic and cultural background, are automatically dismissed based on the presumption of wanting drugs, not really being sick, and being bored, to name a few. This behavior in itself is dismissive, demeaning, and trivializes patients. Couple that with the high probability of implicit and or explicit biases this patient has faced- to mention in healthcare as well, this patient merits our first meeting with a high level of empathy and sympathy.      When meeting the patient for the first time, it will be beneficial to understand that racism has been identified as one of the primary causes of poor health outcomes among racial/ethnic populations and health disparities among racial/ethnic communities (Williams et al., 2019). While this tragic reality continues to plague healthcare, it cannot be ignored.      I will do my best to warmly greet the patient and his father warmly, knowing that I may not receive the same reception. I will offer a sincere handshake to both of them. When walking the patient and his father to my office, I will walk with them, not in front of or behind them. When they are both seated in my office for the interview, I will face them, seated, without any devices, desks, or barriers between us. Despite the circumstances, I want to thank both of them for returning to the clinic. When addressing the patient, I will ask how he would like me to address him and ask the same question to his father. I will introduce myself and acknowledge some potential feelings the patient and his father may have. Before we start, I will ask the patient to tell me a little about himself. This opens a pathway of relationship-building and a genuine desire to know the patient outside his ailments. The patient’s initial meeting with a new healthcare provider is of paramount importance as it has the capacity to influence attitudes and behavior that contribute to the development and strengthening of the patient-healthcare provider relationship. The judgments made in the initial minutes of an encounter can significantly affect various behavioral outcomes (Dang et al., 2017).      

Questions I will ask my patient:       1) How are you feeling- physically and emotionally?      2) Can you tell me what brings you in today?       3) What do you expect from today’s visit?       4) What do you expect of me?       5) Can you tell me more about the headaches you’re having? (Frequency, duration, onset, precipitating factors, what helps, what makes it worse?)      6) Do you take any medications, vitamins, or supplements?       7) Can you tell me about any illnesses you have had recently, and in the past?       8) What does health mean to you?       9) Tell me about any other concerns you may have.        Building on these questions, I will ask him to tell me about his nutritional status, ability to obtain food, ability to obtain the necessities of life (clothing, personal hygiene items), economic stability, social stability,  recurrent struggles in his life, surgeries, immunizations, recent travel, home life, work life, and social life.       My goal is to build trust and rapport with the patient (and his father) in hopes he will continue to seek care here and break down the barriers that are seemingly already in place, using a high level of emotion with the patient.