Case B 14-year-old biracial male living with his grandmother in a high-density public housing complex.
To start, we should always keep in mind how personal their experience with us can be. They can be coming to us with many issues as far as health both physical and mental, socioeconomic issues, potential unsafe living situations, and many other stresses that life can throw at people. These are all important things that should be discussed besides the chief complaint. We must assess home situations, access to care, social situations, etc. It is important to make sure that we are being personable and not just going through the motions.
We should always knock before coming into the room, introduce yourself and get your patient’s name, make sure that the room has good lighting and is a temperature that is comfortable to the patient, discuss what has brought them in, and discuss what their understanding of the problem is (Ball, Dains, Flynn, 2019). This will show the patient that you care and that you seem them as an individual rather than just another patient for the day. This also instills confidence and makes them more likely to open up to you about different issues. It is always important to include the patient in their care rather than just discussing only your thoughts with them while dismissing their thoughts. Including the patient in their care is known as patient-centered care and is an important part of providing safe and high quality care (Santana, Manalili, Jolley, Zelinsky, Quan, Lu, 2018). That is the reasoning behind using the listed techniques.
I think for the risk assessment instrument, I would use IHELLP. It stands for income, housing, education, legal status, literacy, and personal safety. Since my patient is only 14 and living with a grandmother in a public housing complex, I would have concerns about access to care and resources as well as their living situation and education. This would allow me to explore things like employment status, whether or not the patient has any health coverage or is on any kind of assistance, whether or not they are in safe housing, if they have any substance use disorders, proper education, and safe living situations (Berman, Patel, Belamarich, Gross, 2018). I would be interested in the patient’s chief complaint as well, but we must assess home situations also. We must ensure that our patients are in good hands and properly cared for both in and outside of the office or hospital setting.
It is difficult to narrow it down to just five targeted questions, but if I had to ask only five, they would be the following.
- Do you feel safe at home?
- How do you cope with stress?
- How do you feel about your time spent in school?
- Do you feel you have good access to care and resources?
- How do you view your health and what are your expectations for care?
I would hope that this would give me an idea of what the patient’s life is like as far as education, safety, concerns, resources, how they see themselves, and what their goals are as far as health. There would be much more to discuss. Sometimes patients of this age can have an especially difficult time expressing themselves or feel nervous about discussing certain topics or even seeking help. Great care would be needed as well as a delicate approach and close attention to all verbal and non-verbal cues.
Resources
Ball, J. W., Dains, J. E., & Flynn, J. A. (2019). Seidel’s Guide to Physical Examination (9th Edition). Elsevier Health Sciences (US). https://mbsdirect.vitalsource.com/books/9780323481953
Berman, R. S., Patel, M. R., Belamarich, P. F., & Gross, R. S. (2018). Screening for Poverty and Poverty-Related Social Determinants of Health. Pediatrics in review, 39(5), 235–246. https://doi.org/10.1542/pir.2017-0123
Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person-centred care: A conceptual framework. Health expectations : an international journal of public participation in health care and health policy, 21(2), 429–440. https://doi.org/10.1111/hex.12640
