Doctor-Patient Conversation PDF

DOCTOR-PATIENT CONVERSATION Case: M/19, White, Right chest pain with decreased oxygenation DOCTOR: Good afternoon. You look so out of breath. Are you OK? PATIENT: No doctor, I’m having difficulty in breathing. DOCTOR: Let me check your arterial oxygen (Check using Pulse Oximeter). It’s a little bi...

DOCTOR-PATIENT CONVERSATION Case: M/19, White, Right chest pain with decreased oxygenation DOCTOR: Good afternoon. You look so out of breath. Are you OK? PATIENT: No doctor, I’m having difficulty in breathing. DOCTOR: Let me check your arterial oxygen (Check using Pulse Oximeter). It’s a little bit lower than normal. Don’t worry, I’ve already ordered oxygen for you because the nurse already told me earlier that you’re having difficulty in breathing. The oxygen should be here any minute soon. PATIENT: Thank you, doctor. DOCTOR: Aside from difficulty in breathing, what are the things that are bothering you right now? PATIENT: I’m also having chest pain. DOCTOR: I see. So is it manageable? PATIENT: No doctor. DOCTOR: Could you tell me exactly where the pain is? PATIENT: It’s on my right chest. DOCTOR: Can you still remember when it started? PATIENT: It started four hours ago. DOCTOR: Did it start all of a sudden or gradually? PATIENT: It was very sudden. DOCTOR: What were you doing when the pain started? PATIENT: I was reading a newspaper during breakfast four hours ago. DOCTOR: Did you experience any trauma recently? PATIENT: No doctor. DOCTOR: Is the pain consistent or intermittent? PATIENT: It’s on and off doctor. DOCTOR: But are you feeling better now or worse? PATIENT: I feel worse each time I take a deep breath. DOCTOR: What is the pain like? Is it sharp? Dull? Pressure-like? Or is it similar to indigestion? (Ask each symptom one by one) PATIENT: It’s a pressure like pain DOCTOR: Is there anything else that makes the pain worse? Like cough or positional changes? (Ask each question one by one) PATIENT: It becomes worse each time I move or take a deep breath. DOCTOR: But is there anything that makes the pain better? PATIENT: Yes Doctor. I feel a little better each time I take anti-coagulants. DOCTOR: Do you have any other symptoms like shortness of breath? Cough? Dizziness? Fever? Chills? Runny nose? Sweating? Nausea/vomiting? Diarrhea/constipation? (Ask each symptom one by one) PATIENT: My heart beats faster than usual, I feel dizzy at times together with low blood pressure, my temperature goes up and I sometimes catch my breath. DOCTOR: Don’t you feel any weird heart beats? PATIENT: No but my heart beats fast. DOCTOR: Do you have any other illness like Cancer? Stroke? Blood clot or what we call deep vein thrombosis? (Ask each symptom one by one) PATIENT: Luckily, I don’t have any of those.  DOCTOR-PATIENT CONVERSATION DOCTOR: What about past illness? PATIENT: No, doctor. DOCTOR: Have you had any surgeries recently? PATIENT: No, doctor. DOCTOR: Are you taking any medications right now? PATIENT: Yes, doctor. DOCTOR: Do you have any food or drug allergies? PATIENT: No, doctor. DOCTOR: Is there anybody in your family who is experiencing the same symptom? PATIENT: Yes, doctor. DOCTOR: Is there anybody in your family having problems in the lungs? PATIENT: No, doctor. DOCTOR: Anybody had a cancer in the past? PATIENT: My father has lung cancer. DOCTOR: Is there anything that I missed out? Nothing else that you think I should know? (Ask each question one by one) PATIENT: No. I think that’s all. DOCTOR: Now, I’d like to examine you a little bit. Is it OK with you? PATIENT: No problem. (Sample summary ) DOCTOR: (After doing physical assessment) OK, Mr. Jones. According to my assessment, the most likely source of your symptoms is the so-called pulmonary embolism. It is a little clot blocking your blood vessels going to the lungs. A part of your lungs collapsed which resulted to the symptoms that you are showing right now. But we are not certain yet if it is really pulmonary embolism. Other possible disorders are pneumonia and pneumothorax. The Lungs are covered with 2 layers of membranes but there is not space between these layers. Once the air gets in between the layers for some reasons, chest pain happens and that is what you are experiencing right now which is what we called pneumothorax. It is less likely to happen but there are still chances that heart problem could be the cause like myocardial infarction. To get an accurate diagnosis, I’d like to run some tests such as ECG, chest X-RAY and some blood tests. You might also need some more complicated test later on. Do you have any questions? PATIENT: Can you at least ease my pain right now? Can you give me some painkillers? DOCTOR: First sample answer: I know you are in a lot of pain right now. But if I give you painkillers before evaluating your symptoms, it would be too difficult to get a right diagnosis. I’ll do my best to do this as quickly as possible and try to ease your pain right after. Could you endure it a little more? I’m so sorry about your pain. Second sample answer: I know that you are under a lot of pain right now. However, giving you any medication will alter your symptoms and it will interfere with the evaluation. It will only take a few minutes. I am trying to give you the best treatment possible. And I promise to give you medication after I am done. So please bear with me. I won’t take long. Any other questions? PATIENT: No DOCTOR: As soon as I get the results, I’ll let you know.