Transcription
Come in, Miss Bellamy. Yes, hi. Kind of, um, hear us. I'll be your doctor today. Um, let me just wash my hands really quick. Um, would you prefer Miss Bellamy, or would can I call you Pat?
Pat's fine. Great. Well, it's nice to meet you.
Nice to meet you. Um, can you tell me why you're here today?
I have a terrible headache. Looks really bad.
Um, yes. Is there anything, anything else besides your headache, that you want to address here today at the clinic?
Apart from no, just that. Except I am concerned. I just recently changed insurance companies and I'm not sure this is going to be covered yet.
All right. Um, was there anything, um, because, uh, what we can do is while we're talking and I'm doing your history and physical, um, I will have my office secretary looking up the insurance plan that you have. All right, so you don't have to worry about that.
That sounds good.
Okay, sounds great. Um, is there anything else?
No, I just, this is just really bad.
Okay, okay. So, what I'd like to do today and, um, is let's, let's take a look at what's causing your headache. Um, I will go over history, physical, and then, um, we'll do again a physical exam, and then we will look into your insurance policy and make sure that's all okay, you know, taking care of that. Sound like a good plan for you?
That's, that's good. Perfect.
Um, so tell me a little bit more about this, the head, head pain that you're having.
Well, um, it started about 3 days ago and, um, uh, uh, nothing has helped it. It's, it's just laid me flat. I, um, haven't been able to go to work. Um, it's, um, nothing's helped. I, I, um, it's, it's all over. Um, I, it really bad when I move, so I'm trying not to move too much, and the light is bothering me a lot.
Okay. Um, and unfortunately, I can't dim the lights in this room, but so I'll try to go quickly. And, um, would it be okay if I took some notes?
Oh, sure.
All right. So, you said this headache started about 3 days ago? Okay. Um, was there any, um, anything that brought it on? Anything unusual that happened maybe three days ago?
Not really. No.
Okay. Um, can you tell me, uh, anything that makes it better?
Is, oh, nothing's made it better. I, I took some Tylenol, I tried Motrin. Nothing. Um, I just try not to move too much.
All right. Um, is there anything that makes it worse?
Yeah, like movement. Um, and, and light.
Okay. And, um, it's just constant though? There's, you know, it doesn't, it's just constant. It's, it's all over.
Okay. Um, so if you had to rate on a pain scale, um, zero being no pain, 10 being the worst pain you ever had?
Oh, it's a 10. A 10. I've never had a headache like this.
Okay. Yeah, that sounds really bad. Um, now, as far as radiation, does it move? Does that, you said the head, the pain is all up?
It's kind of all over, um, but it also, I've got this shooting pain down my neck, and my neck is is very stiff. Okay. Um, but it's not, it's, it's, it's the entire head. Entire head.
Okay. Yeah. Um, as far as in the, in the timing, you said that started three days ago, but is it, you said, is it constant?
Yeah, it, it, it started gradually, but once, once it got there, it hasn't gone away. It doesn't get better, it doesn't get worse, it's just the same.
Okay. Um, so do you, what I want to get is your perception of what you think is going on.
I don't know. I just, I can hardly think, it's so painful. I, I just, um, because it's so bad, I was afraid. Um, my neighbor, um, had a headache and ignored it last year, and, uh, he suddenly started having seizures, and it turns out he had a, um, a brain tumor. So I thought, I, I just should come in.
Yeah, I can understand your concern. Um, what, how is it impacting your daily life?
I can't go to work. Um, uh, I can't do anything.
Yeah. Um, so it sounds like it's really impacting your life.
Yeah. I can't.
Um, if it's okay, I would like to go, so talk about a little bit about your medical history and your social history.
All right.
Um, can you tell me, as far as your medical history, have, do you have any medical conditions I should be aware of?
Not, um, I was diagnosed with high blood pressure about three years ago, but, uh, we've been addressing it with diet changes and been monitor, yeah. I go in yearly. I had been just, and it's been well controlled, so.
Okay, great. I haven't been on medication, but other than that, I haven't had any problems.
Okay. Um, any surgical history?
No.
Um, any hospitalizations?
No.
All right. Um, and you said you're, um, the only medicine you're taking was the Tylenol and Motrin?
Yeah. And they didn't help.
Yeah. Okay, just wanted to verify. Um, do you have any drug allergies?
Uh, no. No.
Okay. Um, what about family history? Um, do you have any medical history of headaches or in your family?
Right. Um, you know, my mom said she used to get migraines when she was in her 20s and 30s. Um, okay. But I don't remember her saying anything else about it. My sister, uh, I have one sister, she's, she's healthy. My dad, uh, he has high blood pressure. Other than that, he's healthy. And, um, that's about it. I don't, I don't have any kids.
All right. Um, it's all right. I would like to ask you some social history questions that, um, just for there are records. Um, do you smoke?
Uh, yeah, I do.
Okay. Um, is it, um, cigarettes or chewing?
Yeah.
And how much do you smoke?
About a half a pack a day.
Okay. Uh, what about alcohol?
I don't drink.
Okay. Um, also, um, are you married?
Yeah, I'm married.
Okay. And children?
No.
Okay. And, um, just, uh, some, some just some additional questions is, um, um, looking at kind of GYN history, are you, um, less menstrual period?
Oh, I'm in menopause.
Okay. Yeah. Um, so going back into the history again, um, have you, um, you said your mom had migraines earlier on, um, have you been around and, you know, other, you haven't been nauseous or have you been?
Yeah, there, I've been nauseous. Um, okay. Uh, in fact, I threw up twice early on. Okay. Because when I move, it makes me nauseous.
Okay. Um, nothing out of the ordinary over the past couple weeks? Have you been on any trips or anything?
Or actually, a week ago, I was in, um, North Carolina for a family reunion. Okay. And there was a four-year-old who was sick there. I, I don't know what they had, but they, I guess, I guess they ended up taking them into emergency.
Know. Um, so let me just, so summarize to make sure I've got everything straight so far is, um, you started an onset of a severe headache about 3 days ago. Um, it's worse with movement, light really makes it hurt bad. Um, it's a 10 out of 10 pain, and you're also complaining of a stiff neck with that?
Yes.
Um, it came on gradually and it's been constant pain in the frontal area. Um, medical history, you're in hyper, you have high blood pressure, but that's, um, controlled with diet. Uh, no surgical history, no ear hospitalizations. Um, the pain though is really impacting your day-to-day living and daily life. Um, you to tried Tylenol, Motrin, it didn't help. Otherwise, no medications. Um, you've got the family history of your mom with migraines, otherwise you're, um, family is healthy. Yeah. U, you smoke about a half a pack a day, you don't drink. Um, and then you were, you, you said you took a trip about a week ago or two weeks ago?
Yeah. Okay. A week ago. Yeah. I don't know. It was in North Carolina.
All right. Um, yeah, I can understand your concern you about your friend, you said that was having seizures. Um, I've just never had this kind of pain before.
Yeah. And I can understand that. And, you know, um, so what I would like to do is, um, we've pretty much gone over your the history. What I'd like to do is, uh, complete a physical exam. Okay. Um, do some testing. All right. Um, and I want to ask too, if there's any other concerns I need to address, um, before we get to that final exam.
Okay. That that sounds good.
Okay, sounds great. Okay. All right. Hi, I'm Deb. I'm your standardized patient. Nice job. Um, I'm going to, uh, give you some feedback on your communication skills in this encounter, but before I do, how did you feel it went?
Um, I pretty good. I was, I was nervous at first, I think, and, um, just trying to make sure that, um, I was getting all your patient information so we could, you know, make sure we got the correct tests and, yeah, you know.
Yeah. How did you feel when when you walked in? You feel pretty comfortable?
Uh, I think I got more comfortable as we sat down and got to talk.
I could see that. Yeah. Good. Okay. Um, well, I thought you did a a nice job. Uh, you had an appr introduction, introduced yourself for some last name, shook hands. Um, I think you have a very warm demeanor and you're comfortable, uh, which, uh, makes me as a patient comfortable. You did, um, ex, elicit my chief complaint and asked about any other concerns, and that's when I told you I was also concerned about my insurance, so that was another thing on the agenda. So you did set a mutual agenda, asked me if I agreed, and so we had a clear roadmap going forward. So you did, um, you hit all those real well. You, your first question, "Tell me about this pain," or, um, that was a nice open-ended question, so allowed me to then tell my story. Um, followed up with some more, um, pointed questions just for clarification on, um, and you had, you're an active listener, had good contact, eye contact, and, um, could do a little bit more, um, uh, reflective listening, just to little points where you could verify, check for accuracy, maybe paraphrase as as I'm going through, through. Um, you did a nice summary in the middle, that's good, but just a little bit more reflection on that to let me know as a patient that you're hearing me. Um, you asked my perspective of what I thought was going on, and then you got the story of M fear that maybe I've got a brain tumor. Oh, no. Yeah. So, um, I thought you had nice flow, logical, U, uh, sequence of questioning. Little bit of signposting, "We just covered this, and now we're going to do that." I, I heard that once, and as these, um, interviews get longer, you're going to want to signpost between each, um, section. "I've taken your history now, I'd like to go into, um, a, a physical exam kind of thing." Um, did a nice summary in the middle. Um, you move through quickly, so you attended to, um, the timeline. You did ask permission, permission to ask some, um, uh, social questions. Maybe you want to mention, "Social questions may not be a flag for me that this is, this could be personal or uncomfortable. Maybe I'm going to ask a little more some personal questions here. Is that all right with you?" Just so I'm, "Social question" sounds fine to me until you start asking something that might sound personal. So you might use the word "some more personal perfect questions here." Um, not non-judgmental, didn't, you know, didn't bad an I when when I said I smoke half a pack. Um, you have nice, uh, vocal range, eye contact, UM, comfortable demeanor, so, uh, that, um, felt real good. And then, um, you, uh, did a summary, um, at the end, and, um, asked, "Did you ask, do anything else?" Okay. So, "Anything else before, um, we do a physical exam?" So it was very nice, nice encounter.
Well, thank you so much. Nice meeting you.
You too.