The Clinical Assessment of Substance Use Disorders - role-modeling the initial visit

Summary

In 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

• 😔 Mrs. Anderson is experiencing persistent back pain that affects her daily life and work.
• 🏥 She has been seeing an orthopedist and undergoing physical therapy without significant improvement in her condition.
• 💊 Mrs. Anderson relies on the pain medication Percocet to manage her pain, taking it two to three times a day when needed.
• 😴 The pain often wakes her up during the night, and she sometimes uses medication to help her sleep.
• 👨‍⚕️ Her husband, a cardiologist, has been prescribing her Percocet, and occasionally an orthopedist does as well.
• 🚸 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.
• 🏫 She has recently been transferred from teaching at an elementary school to a high school, where she finds the students' behavior challenging.
• 😓 Mrs. Anderson reports feeling down, lacking enthusiasm, and having poor concentration, which could be symptoms of depression.
• 🍻 She occasionally drinks with friends and smokes marijuana in the evening to help her relax and sleep.
• 🤔 The doctor suggests that Mrs. Anderson's depression might be impacting her recovery from the accident and her dependency on pain medication.
• 💡 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

00:00

😣 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.

05:02

😔 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.

10:05

🍹 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.

Keywords

💡Back pain

Back pain is a common medical condition that can be caused by various factors, such as injury, muscle strain, or underlying health conditions. In the video, the patient, Mrs. Anderson, is experiencing persistent back pain that has affected her work and daily life since an accident six months prior. The pain is severe enough that she has missed work and relies on medication to manage it.

💡Physical therapy

Physical therapy is a treatment method that uses physical exercises and manual therapy to help patients recover and improve their physical abilities. Mrs. Anderson mentions that she has been attending physical therapy sessions every six to seven weeks, but she does not feel that it has significantly helped her back pain.

💡Medication

Medication refers to drugs or other chemical substances used to treat or prevent diseases. In the context of the video, Mrs. Anderson is taking Percocet, a prescription painkiller, to manage her back pain. The script discusses her usage pattern and the concerns about dependency on the medication.

💡Depression

Depression is a mental health disorder characterized by persistent feelings of sadness, loss of interest in activities, and difficulty in carrying out daily tasks. The video suggests that Mrs. Anderson may be experiencing depression, as she mentions feeling down, having poor concentration, and a lack of enthusiasm for things she usually enjoys.

💡Dependency

Dependency in the context of the video refers to the reliance on a substance, such as medication, to the point where it may interfere with normal functioning. Mrs. Anderson expresses concern about becoming dependent on Percocet, but she also acknowledges that she does not feel she is using more than necessary to manage her pain.

💡Accident

An accident is an unforeseen and unplanned event that can result in injury or damage. The script mentions that Mrs. Anderson's back pain started after an accident about six months ago, which seems to be a pivotal event that has led to her current medical condition.

💡Orthopedist

An orthopedist is a medical specialist who focuses on the diagnosis, treatment, and prevention of disorders of the musculoskeletal system. Mrs. Anderson has been seeing an orthopedist in addition to attending physical therapy sessions, indicating the complexity and persistence of her back pain.

💡Sleep disturbance

Sleep disturbance refers to disruptions in the quality, timing, or duration of sleep, which can be caused by various factors, including pain. In the video, Mrs. Anderson's back pain is so severe that it wakes her up at night, causing her to rely on medication to get a good night's sleep.

💡Family history

Family history is the medical and genetic background of an individual's relatives, which can provide insights into potential health risks. Mrs. Anderson discusses her family's history of depression and addiction, which may be relevant to her current mental health and potential dependency on pain medication.

💡Antidepressant

An antidepressant is a type of medication used to treat depression and other mood disorders. The doctor in the video considers prescribing an antidepressant for Mrs. Anderson, suggesting that addressing her potential depression could also help improve her overall well-being and possibly her back pain.

💡Stress

Stress is a state of mental or emotional strain or tension resulting from adverse or demanding circumstances. The video implies that stress from Mrs. Anderson's back pain, work, and family concerns may be contributing to her feelings of depression and her reliance on medication and other coping mechanisms.

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