This is a case of a 60 year old elderly with complaints of persistent coughing for at least the past three months with pulmonary secretions. The patient’s name is A.D. (initials used for confidentiality purposes). She lives with her family and it was her daughter, D.F., who brought her to the hospital for medical consult. The doctors from the hospital conducted a comprehensive physical examination and found out what the main problems are; they also laid out an initial plan of action and the parties agreed with a course of action.
I encountered numerous challenges when I got assigned to work in this case. One of the challenges I encountered was regarding the type of medical consultation that I would use. I knew from the start that treating this patient was going to be a lengthy process and so a consultation process that adheres to international standards was not only necessary but also of utmost importance. In order to solve this dilemma, I came up with the idea of using the Cambridge and Calgary Guide. It is basically concerned with the systematization of the collection of data from the patient. For a brief background about the contents of the entire data collection process, they should include the establishment of initial rapport, identification of the reasons for the consultation, the actual process of gathering information, providing structure, building relationship and rapport (again), planning a course of action and explaining the rationale to the patient, and closing the decision with a forward plan and an establishment of an appropriate point of closure (i.e. summary of the case and final check) . The main goal of this process is for the assigned medical team and not just the main physician to be aware of the clinical signs and symptoms that might be observed by merely looking at the subjective part of the data. I can only imagine how challenging the entire process of dealing with the patient and keeping up with the challenges of the treatment could have been without being able to refer to the Calgary Cambridge Guide for help.
Consulting the different parts of the consultation process was just one of the many challenges. Another problem I encountered when I was handling the case with the GP was the patient and the patient’s family members’ compliance to the treatment and basically the instructions that were being given to them. As a student, I was expecting that they knew where they stand within the patient-physician relationship framework. That is, I was expecting them to know that in order for the patient, A.D., to get well, they would have to be a hundred percent compliant to the diagnostic and treatment regimen that the physician would instruct them to undergo. Part of this has something to do with trust because I thought and felt that they did not trust the GP enough to put the life and health of A.D. in his hands. I realized that the role that the physician should play in that case was to tell them their best options. The GP told them that he did not have any sort of special power to guarantee a hundred percent chance that their relative or family member would get well. After all, it was a major cardiopulmonary disease that we were dealing with.
I totally understand their situation because this illness can certainly affect the family of A.D. In fact, it can do so in my ways. For one, A.D. is an elderly patient. This means that it is unlikely for her to be able to take care of herself. She would need the help of her family to do that especially now that she is suffering from COPD. In line with this, the family doctor should consider it part of his responsibility to guide the patient and her family members through the process of adjusting. Patient and family member educations should be of utmost importance in such situations .
COPD is one of the many diseases that are easily preventable. Smoking and exposure to air pollutants appear to be one of the leading causes of this disease . Unfortunately, it appears that it is already too late for A.D. to have realized the importance of maintaining a healthy cardiopulmonary system in the process of growing old—which could be the main reason why she appears to have been diagnosed with COPD. Preventive medicine, in this case should focus on the prevention of secondary complications such as falls and other accidents that may further complicate A.D.’s condition.
The GP explained everything to the patient and her daughter. However, they were reluctant at first. This is where I remembered the importance of establishing rapport at the beginning of the treatment session. Fortunately, the GP was able to successfully do this by breaking the ice. He interviewed them carefully and this enabled me to get to know them better, especially the patient. They also asked questions about him and his career as a doctor. To make it short, the GP became not only a doctor to them but also a medical confidant. I think this solved my problem on treatment compliance with ease because I realized that the problem was hindering the progress all along was caused by lack of trust and perhaps disorientation about their condition, which is totally understandable.
It was my first time to encounter an elderly patient suffering from a presumed case of COPD. I have already known from my lectures at medical school that the choice of treatment for COPD should be focused on the relief of symptoms, slowing of the disease’s progress, improving her tolerance to exercise and activities of daily living, and improving her overall health . Lifestyle changes such as smoking cessation and calorie-restricted diets should be considered. Use of drugs such as bronchodilators and corticosteroids (administered in various ways) should also be included. If the disease is not severe enough, participation in pulmonary rehabilitation program should also be a top priority. In worse cases, surgery aimed at decongesting the airways would be necessary. This may include emphysema, congestive heart failure, and other chest and lung problems. This was the initial treatment plan for the patient. The GP knew that he had to do some adjustments because the patient’s being old, frail, and elderly could eventually become a hindrance to the treatment process. One of the things I learned was that it is important for elderly patients to be subjected to treatments that focus on the prevention of secondary complications such as fall. COPD is a highly disabling disease. It prevents the patients from being able to do their activities of daily living because of extreme susceptibility to exhaustion secondary to impaired lung ventilation. This is one of the things I considered in my proposed treatment regimen.
I also thought that a differential diagnosis for the disease had to be done. For differential diagnosis, I knew I had to be able to tell the difference between any conditions that may have a similar set of signs and symptoms. Similar conditions would be emphysema, restrictive lung disease, and congestive heart failure. Having a good background of all of these conditions, I was able to determine that what I was looking at here was indeed COPD. COPD is very common among smokers and is actually one of the life-threatening diseases that kill thousands of Americans every year. The worse thing is that it can easily be prevented yet many people still get admitted with the condition. If one is going to consider the treatment-related information about the disease that was presented earlier, one could conclude that the treatment regimens are easy and simple, this is because that is what this disease is—easy and simple.
Seeing the case as a student, I knew medical doctors can only do so much; there were other things that other medical professionals should do. For example, respiratory therapists should be the ones in charge of taking care of the patient’s pulmonary rehabilitation. The nurses should be in charge of making sure that the patient gets takes in the drugs at the prescribed time and frequency. I felt disoriented because I never was the type of person who likes to order other people around. The people from the hospital needed to be pushed in order to do their jobs and this was something I personally did not like. Nonetheless, I picked it as a challenge and talked to the persons involved. In the end, we were all able to make the patient happy and satisfied. The treatment is still ongoing but I am positive that her condition should continue to get better and better as time passes by.
All in all, I think the GP’s performance, when I was observing the entire case as a student, was more than satisfactory. He was able to address all of the challenges that came our way. I was able to observe that he was a person dedicated to his job, that he individualizes and personalizes each case that he handles so that the patient can recover the fastest and most efficient way possible.
References
Bourbeau, J., & Palen, J. (2009). Promoting effective self-management programmes to improve COPD. European Respiratory Journal, 461-463.
GP Training. (n.d.). Calgary Cambridge Guide to the Medical Interview. GP Guide.
Harris, M., Smith, B., & Veale, A. (2008). Patient education programs: Can they improve outcomes in COPD.
National Heart, Lung, and Blood Institute. (2016). How is COPD Treated. NIH.
