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.