Case 1: 60 years old, male, having history of hepatitis for 20 years, he was hospitalized with abdominal destination, physical examination revealed ascites, as a doctor how will you convince this patient to perform abdomen paracentesis & treatment ? First of all, introduce yourself to the patient Example : Good morning, am Dr Rawan, how are you doing ? so what brought u to hospital today ? Or may I know what’s bothering you ? Review the case - discuss the case with simple language, avoid using medical terms and abbreviation - for this case we all know that chronic hepatitis will cause hepatomegaly, ascites and eventually abdominal distention. So for example you tell the patient that: Discuss the hepatitis experience with patient. As you know dear that hepatitis is an inflammation of liver that might cause some complications so for your situation, it accumulated some fluid in your belly. Which cause you such unpleasant feeling. So as an 10 years doctor is this hospital , I have seen many cases like yours.. so we mostly do a small procedure to take out fluid from your belly. Of course you might feel tensioned since its your first experience. But I assure you it will give you better life quality. !1 All you will feel is needle stick at beginning then it’s all fine since we give local anesthesia. As you know each and every procedure have its complications; but let’s hope for the best. In rare situations very few patients face form abscess, cellulitis or aspiration of bowel. - discuss payment options
Case 2: 40 year old, male, he was hospitalized with High BP for one year, his highest blood pressure was 160/90 mmHG. He does not take his medications regularly, he refuses regular treatment, blood pressure control is not ideal, your role as a doctor is to give healthy education for patient to cooperate with the treatment. First of all, introduce yourself to the patient Talk about HTN, complications and suggest the patient to change his lifestyle. Complications: might affect eye, brain, kidneys, heart and it is sometimes associated with Diabetes - tips: 1) choose a person they want to please ( like for ur beloved ones sake ) 2) If swallowing pills bother patient consider liquid or crushing pills in food 3) Take most important medications first 4) Suggest the patient to change her diet and lifestyle so he become in less need for medications
Case 3: A 10 year old boy, comes to you with gingival hemorrhage, purpura. A CBC was done and it showed that he has low platelets with normal WBC and RBCs, after discussion the whole medical team in department agrees on taking BMA for better diagnosis, so now your mission is to communicate with the father ( 40 year old PHD with high income and this is his only child ). Introduce yourself to the patient !2 Discuss the case and why we chose BMA. Severity of illness. And it might lead to cerebral hemorrhage. And to make it clear that BMA is a gold standard to dx ( might eliminate leukemia ) .. mention risks and payment - what kind of disease the child have - Is it risky to take BMA? - Complications might happen - Which hospital is best in Jiangsu province ? Convince the father that he should be included in the process
Case 4: 30 years old，individual business operator，G3P1，Her child is 3 years old，She is at her 38th week now. She had the perinatal care card on time and have regular obstetric examinations at 24th weeks gestation. No vaginal bleeding or vaginal fluid. She comes to hospital for an obstetric examination in the morning, NST suggested 8 points（Fetal heart rate accelerated when the fetus moved，The magnitude and duration of fetal heart rate acceleration are not very good，NST decreased ). Placental maturity is II °，The doctor recommended that the fetal heart monitor should be checked in the afternoon. Pregnant women recheck NST afternoon，it’s 9 points. She had the perinatal care card on time and have regular obstetric examinations at 24th weeks gestation. No vaginal bleeding or vaginal fluid, The woman is so nervous，she says her husband is busy with business， lives in jiangbei，It's inconvenient to come to hospital, she hospitalized . the temperature and blood pressure are all right。height of uterus is 35cm，abdomen circumference is 106cm，position of fetus is LOA，fetal presentation is head，The fetal head is not engaged. now you should talk about situation with pregnant woman and family members. Introduce yourself to the pa2ent
Discuss the case and findings and suggest the pa0ent to stay at hospital for observa0on for 1 to 3 days ( so we be able to count fetal movement ) Check AFI and FHR If they remain low we have to do c-SECTION for maintaining mother and fetus safety Discuss the complica0ons of NST decreasing > might lead to fetal distress syndrome !3
Case 5: An 80 year old, farmer was hospitalized. He has no educational background. hence, He does not have medical insurance so he will pay for any treatment expanses. This patient was diagnosed with adenocarcinoma of rectum. After several discussions and referrals. He gets a clear indications for surgery. Your mission now is to talk to the patient and his son which works with low wage salary. Introduce yourself to the patient and his son Discuss the case and how does it occur , treatment options, why surgery, instructions for surgery, safety and how it affect life quality ( try your best to convince the patient that surgery is the last and best option for this case ) Try to assure the son and provide good communication environment
Case 6: 69 year old male was hospitalized with fever and purpura for 3 days, CBC reveals anemia, agranulocytosis, thrombocytopenia. Cause symptoms are kind of vague. You suggest that patient should do BMA, how will you discuss and convince the patient of your way of diagnosis? Introduce yourself to the patient Discuss the case and why we chose BMA. Severity of illness. And it might lead to cerebral hemorrhage. And to make it clear that BMA is a gold standard to dx ( might eliminate leukemia ) .. mention risks and payment & complications You can say : Your bone is like a factory for your blood cells so we need to take part of this BM in order to know the exact cause of your symptoms how procedure is done ? !4
Case 7: A 56 year old woman, was hospitalized for one week for stuffy chest and X-ray shows that she has bilateral pleural effusion. You suggest thoracentsis, to get better understanding of the underlying cause, your mission is to convince this patient to do this procedure. Introduce yourself to the patient Discuss the case in detail , talk about respiratory diseases and that they cause fluid in the chest ( pleural effusion ) Try to use the x-ray as a clue to show the bilateral effusion and its level Try to do physical examination and auscultate the abnormality Make sure that patient understand why are you doing this ? !5