The Clinical Assessment of Substance Use Disorders - role-modeling the initial visit
Summary
TLDRIn this medical transcript, Mrs. Anderson discusses her ongoing back pain since an accident six months prior. Despite orthopedic care and physical therapy, her condition hasn't improved, and she relies heavily on Percocet for relief. She also mentions job stress, concerns about her teenager's behavior, and feelings of depression. The doctor suggests an antidepressant and discusses the possibility of her pain being linked to her mental health, raising concerns about her dependence on pain medication.
Takeaways
- đ Mrs. Anderson is experiencing persistent back pain that affects her daily life and work.
- đ„ She has been seeing an orthopedist and undergoing physical therapy without significant improvement in her condition.
- đ Mrs. Anderson relies on the pain medication Percocet to manage her pain, taking it two to three times a day when needed.
- đŽ The pain often wakes her up during the night, and she sometimes uses medication to help her sleep.
- đšââïž Her husband, a cardiologist, has been prescribing her Percocet, and occasionally an orthopedist does as well.
- đž Mrs. Anderson is concerned about her 15-year-old son's behavior, suspecting he might be involved with a bad crowd and possibly using drugs.
- đ« She has recently been transferred from teaching at an elementary school to a high school, where she finds the students' behavior challenging.
- đ Mrs. Anderson reports feeling down, lacking enthusiasm, and having poor concentration, which could be symptoms of depression.
- đ» She occasionally drinks with friends and smokes marijuana in the evening to help her relax and sleep.
- đ€ The doctor suggests that Mrs. Anderson's depression might be impacting her recovery from the accident and her dependency on pain medication.
- đĄ The doctor proposes to prescribe an antidepressant for Mrs. Anderson and to discuss a plan for tapering off Percocet to address potential dependency.
Q & A
Why did Mrs. Anderson visit Dr. Schindler?
-Mrs. Anderson visited Dr. Schindler due to her back pain that has been acting up and causing her to miss work.
What happened to Mrs. Anderson six months ago?
-Six months ago, Mrs. Anderson had an accident which seems to be related to her current back pain.
What has Mrs. Anderson been doing for her back pain since the accident?
-Since the accident, Mrs. Anderson has been seeing an orthopedist and undergoing physical therapy every six to seven weeks, with additional therapy in between.
Is the physical therapy helping Mrs. Anderson's back pain?
-Mrs. Anderson does not believe the physical therapy has helped; she still experiences the same amount of pain as she did after the accident.
What medication is Mrs. Anderson taking for her pain?
-Mrs. Anderson is taking Percocet for her pain, which is prescribed by her husband, a cardiologist.
How often does Mrs. Anderson take Percocet?
-She takes Percocet two or three times a day when her back pain acts up, and she may take it for a couple of days in a row.
How does Mrs. Anderson cope with her back pain at night?
-Mrs. Anderson uses Percocet to help her sleep at night, and if she wakes up in pain, she may take medication or write it out.
What changes has Mrs. Anderson noticed in her life since the accident?
-Besides the ongoing back pain, Mrs. Anderson has been transferred from elementary to high school teaching, which has been challenging due to behavioral problems and lack of support.
Is Mrs. Anderson concerned about her 15-year-old child's behavior?
-Yes, Mrs. Anderson is worried about her 15-year-old child's behavior, as he seems to be hanging around a crowd she disapproves of, possibly engaging in smoking and other risky behaviors.
How is Mrs. Anderson's emotional state?
-Mrs. Anderson is not feeling very positive or enthusiastic, and she has difficulty enjoying things she usually enjoys and concentrating, which could indicate depression.
What is Dr. Schindler's proposed course of action for Mrs. Anderson?
-Dr. Schindler suggests prescribing an antidepressant for Mrs. Anderson and discussing a tapering schedule for her Percocet use to address both her depression and potential dependency on pain medication.
Outlines
đŁ Chronic Back Pain and Medication Dependency
The first paragraph describes a patient, Mrs. Anderson, discussing her ongoing back pain with Dr. Schindler. She mentions missing work and her routine of orthopedic and physical therapy visits without significant improvement. Her pain management currently relies heavily on the medication Percocet, which she takes two or three times a day when needed, with periods of a few days without it. Mrs. Anderson also talks about her difficulty sleeping due to pain, her work challenges as a high school teacher, and concerns about her 15-year-old son's behavior, which she suspects might involve drug use.
đ Struggling with Depression and Substance Use
In the second paragraph, Mrs. Anderson opens up about her feelings of depression, lack of enthusiasm, and difficulty concentrating, which she attributes partly to her students and partly to herself. She admits to having felt very down in the past, especially after losing her purse, and needing her mother's support. The conversation touches on her family's history of depression and addiction, including her mother's struggles and her father's alcoholism. Mrs. Anderson also expresses her dependency on Percocet for pain relief and her concerns about needing to use more of it.
đč Coping Mechanisms and the Impact of Depression
The third paragraph reveals Mrs. Anderson's coping mechanisms, which include social drinking with friends and smoking marijuana in the evenings to help her sleep and calm down. She discusses the stressors in her life, such as her back pain and work challenges, and acknowledges that these might be contributing to her feelings of depression. Dr. Schindler suggests that treating her depression might alleviate her back pain and expresses concern about her Percocet use, hinting at the possibility of dependency. The doctor proposes starting an antidepressant treatment and discusses the potential side effects and a gradual reduction of Percocet use.
Mindmap
Keywords
đĄBack pain
đĄPhysical therapy
đĄMedication
đĄDepression
đĄDependency
đĄAccident
đĄOrthopedist
đĄSleep disturbance
đĄFamily history
đĄAntidepressant
đĄStress
Highlights
Patient visits Dr. Schindler with back pain that has persisted since an accident 6 months ago.
Patient has been seeing an orthopedist and undergoing physical therapy every 6-7 weeks without significant improvement.
Patient relies on medication (Percocet) 2-3 times a day to manage pain, with varying effectiveness.
Patient experiences difficulty sleeping due to pain, waking up in discomfort.
Patient's husband, a cardiologist, has been prescribing Percocet occasionally, raising concerns about potential dependency.
Patient's job as a high school teacher has become more challenging due to classroom management issues.
Patient's 15-year-old son is exhibiting concerning behaviors, possibly related to substance use.
Patient reports feeling down and lacking enthusiasm, indicative of possible depression.
Patient's concentration and ability to enjoy activities have diminished, consistent with depressive symptoms.
Patient acknowledges a family history of depression and addiction, which may be relevant to her current condition.
Patient's father had alcohol-related health issues and exhibited abusive behavior when drinking.
Patient occasionally drinks with friends and smokes marijuana in the evening to relax and sleep.
Dr. Schindler suggests that treating the patient's depression may help alleviate her back pain.
Dr. Schindler expresses concern about the patient's potential dependency on Percocet and the impact on her overall health.
The patient is prescribed an antidepressant to address her depressive symptoms, with a discussion on usage and side effects.
A plan to taper off Percocet use is discussed, considering the patient's dependency and the need for pain management.
The importance of addressing both the patient's physical pain and mental health is emphasized for holistic treatment.
Transcripts
good morning missus anderson so nice to see you again
Dr. Schindler! tell me what brings you here today! well
my back has been acting up I had to miss
a couple days work I called your office and they said I had to come in to see
you before I could get no
I'm glad you were able to come in today I really haven't seen you since the
accident
which I guess was about six months ago yes how things been going for you since
then
well I i've been seeing orthopedist and
physical therapy every six to seven weeks and
physical therapy in between there and has that helped
I'm not I don't think it's to be honest
iced I still have as much pain now as I did back then
and so what do you do to help the pain
having yourself more comfortable the only thing that really helps is
is the medication pain what kinda medication taking
percocet purposes okay and can you tell me how often you taking
said well when it acts up maybe
maybe two or three times a day and
is that every day here can take it couple days in a row Intel that
and tell it feels better and pain gets better
and how long can you go without taking percent arm
sometimes a couple days maybe three or four
and he said you take it a couple times a day
me taking could you tell me a little bit more about us
when you take it during the day well
you know so I can make it to school in the morning
maybe hey depending on how bad it is in the afternoon and
and then you know so I can sleep at night easy to use it helplessly
can you tell me a little bit about the trouble the Chipettes sleeping
I we gotta wake up with in a lot of pain
it wakes me up and
what do you do when you wake up well if I have a medication or take it then
by if not I have to write it out some
you don't sound like you don't always have an educational
now who's been prescribing
my husband he's a doctor cardiologists
here's he is here and anybody else been prescribing
arm once in a while the orthopedist
but it sounds like there times when you're right now
right and my doctor and my husband said I should probably
come to you so you described
home the pain and in what's happened since the accident
anything else going on in your life while having a classroom this year
they transferred me from my school that I locked
I was in elementary teacher now I'm in high school
have a sec pretty months what's happening
last that's upsetting difficult other high schoolers they're like
man and there's like 45 I
perhaps group behavior problem have know-how
no teachers aid this year so it's its very out of control
and you've been missing a number of days yes
because %uh the painters because work it's been difficult
I came home page my heart you know I can't get in there because my back P
so it's mostly the back is keeping
anything else that you've noticed thats
that's changed for you last six months since his accident well the only other
thing is my
my 15-year-old I noticed him
his some same behaviors as these these high schoolers that I
he worries me hanging around the crowd that I really don't want it to end
I think you might be smoking there nation
well you know he comes in jolly one minute and
very tired the next 10 eats non stop in
and you know the wrong like about sixteen I'm afraid
driving and having an actual bath
that is a worry and you have to
virtual yes and how are they doing we're doing pretty well
their income he did both in college now so that's cool so we talked a little bit
about you back pain in about the travel agent
sleeping are you having any other symptoms
you concerned now how should be
passion I'm
mom I'm I'm here just feel very me
how would you describe I just
I I'm not very positive thanks to be like enthusiastic and
I don't feel that way and
are you able to enjoy things it usually enjoyed
hasher concentration
I guess it's pretty poor it's hard for me to stay focused even at school in
teaching and
you know I blame it on the kids I think it's me as well
revealing this actions I do feel nervous
yeah and how would you sing
much sums not not real good
I mean I don't feel like I'm doing the best I can
can do
he have times we feel when you're feeling down
you feel like life's not worth living parts
arms no now honey
house now now so itself but you could be depressed as well as
you now struggling spanking strong situations
have you had problems with depression past hiding call it depression
but I did feel very down after
after to love my purse
to my children so in the best price
hard time period and what was that like who is really tough
I I couldn't even get
yeah what kinds said have two sides
nothing well very tired no energy
just felt really bad about myself my mom had to come
page I could have done it without her depression tends to run in families
I'm wondering your family had problems
russians my mom yeah yeah
she had you have a period
be feeling really down Mike like I and you know
treatment to ever talk about
not really she can can be justly now
yeah so we talked a little bit about your family history
depression your mom's district Russian anybody else
family engine Grampians uncles cousins
systems I'm not that I know
and because problems with addiction tend to run
families as well
run in families that have problems be and depression
tell me a little hatch family history me
10 problem pens homes
well my father drink a lot T
and should s
no cirrhosis
rice and when he was ill
to the doctors talking on that one that was related to his
drinking yes the family the time
he had a problem all yes want me
bad well he was mean
he had a mean streak abuse here
as and that only happen after he drink a lot so when he was drinking
news well let's come back and talk a little bit about
mine came in today Singh
doctors can you tell me a little bit more about
what you'd like to be able to help you
well i I me the doctor's note to get back to school why I did have to take
off the couple days
and and then if I could have the percocet
to take away the pain so I can get back to
to work well let's talk a little bit percocet
it sounds like you've been taking it you know sometimes a couple days in a row
sometime
much she said you've taken companies of from using
have you found you're needing to use more of it
then he hadn't passed I don't think so
and have you
filter all like you need to cut down this well i
I think I'm at the minimum asset is in it still
the back pain doesn't go away a cell if I come back
it's just gonna be worse and his
any money pitcher close to my family
been talking to you matching use a percocet express concern
well only my husband and I
he's just so busy he would rather me see you then
and hingis writing prescription and that's what he's been doing
home and have you fell
guilty at all using guilty
now give find some time situation happened morning
feeling kinda shaky be to take percocet 27 himself down
well i do I do for myself
nervous and shaky is the is what it is but
II don't use that to to calm myself down I do use it for the back pain
what do you use to congress of tax it sounds like
you know between sleep problem nervousness
depression must be feeling
pretty awful times well arm once in awhile how go and have some drinks with
with friends after work and then
I do smoke marijuana in the evening
so that I can sleep calm down it does relax me
is that something pretty much
and how about other times during
night usually now and he said you drink with your friends
cation here how of see
now more than a
couple times a week and
to do at home and restaurant
usually well-used usually at a restaurant that has a bar
and so how many drinks using
just a couple maybe two or
three well
itself like you're struggling with a lot of things right now
I'm certainly the stress were back pain
you know resulting accident which you know at this point should begin batters
six-month using hard doing physical therapy
to try how it also sounds on top of that
like you have some reason sign so they're
your number things on right playing
sounds like you may be depressed one of the things that we know is that
women who have problems with depression some sometimes impact
mornin sometimes will turn to drugs or alcohol
help medicaid your depression my wonderful maybe something
be going and it may be why
needed used percent continued person
despite your back should be healing why I don't think so doctor
improve it does hurt my back is
is you know in a lot of pain and I don't think that
I'm questioning in all back teacher you're having paying
are having is feeling very painful but we do know
pain painful symptoms
sometimes a pain can be very calm have two passions
one other thing said I think we need to try this one out together
here's how much in is happening
maybe read passion which
you can't reach for more whether
in fact is as a secondary problem now
develops independence on pain medication
I don't I can stop me
I mean I I quincy that I was dependent on but what would I do about my back
pain
okay well I think that's something that we need to talk about
continue to work on one other thing certain families
if you start to treat depression that very often the back pain starts to get
there
but we also have to find out how dependent Jimmy be on pain medication
and caper you of it death
in fact case what I'd like to do missus anderson is right now
a prescription for an antidepressant for you today
and we'll talk a little bit about on how you take it
what some other side effects potentially could be
and also right now description
schedule for taking you slowly of purpose
okay okay
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