You pick up the chart for Mr. Lowe, a 78 year old man. His chart reads “Anxiety/Multiple Complaints”. The nurses notes show he has normal Vital signs. Mr. Lowe’s physical exam is unremarkable and in addition, his blood work, ECG/cardiac markers and CT abdomen all show normal results.
- Watch the video below and answer the questions that follow.
- What do think is missing from this assessment? What would you do differently?
This patient went home and that night took a mixed overdose of all his medication, spent seven days in the ICU, and eventually required long-term care because of his hypoxic acquired brain injury. A legal action was commenced by his family.
- What would happen if you took 30 seconds longer with this same patient? Watch the video below for an example, and answer the question that follows.
- What do you see the doctor doing well here?
This patient was referred for emergency assessment by a psychiatrist. He was admitted to hospital on an involuntary basis because of his high suicide risk. He started on anti-depressant medication, and was followed by his family doctor after discharge to the resolution of his depression at six months. He later sent a note of appreciation for the doctor’s compassionate care.
- New mental status changes (in this case anxiety) are not normal at any age.
- A significant change from a person’s baseline (in this case increased anxiety and psychosomatic pre-occupation) need further exploration because it may be a symptom of significant even life-threatening disease.
- Anxiety and a preoccupation with physical symptoms are common symptoms of depression in the elderly.
- The elderly are the highest risk group for completion of a first suicide attempt in depression