Shawn Billings, a 28 year-old African American patient

Shawn Billings, a 28-year-old African American patient

Case Study 2

Shawn Billings, a 28-year-old African American patient, visits the clinic today. He has been labeled as a “frequent flyer” by the clinic staff, having visited the clinic last week and again four days ago due to a severe migraine. On those occasions, he received a shot of Toradol and Ativan and was then sent home. Today, he is back at the clinic with another extreme headache, accompanied by significant agitation. He has come to the appointment with his father, expressing concerns about receiving medication.

Module 2 Week 2 Discussion: Main Post

Mr. Billings has presented at the clinic once more for his recurring migraine. Despite being labeled as a frequent visitor, it’s essential to consider the broader context of his condition. According to Henderson et al. (2020), as healthcare providers, we should embrace the beliefs, values, and expectations of our patients to deliver high-quality care. In Mr. Billings’ case, while he has received medication for his migraines, there has been limited investigation into the root causes or long-term management of his chronic condition. It’s crucial to acknowledge that African Americans suffering from chronic pain may face undertreatment compared to non-Hispanic Whites (Maly & Vallerand, 2018). This disparity may be attributed to various health disparities and social determinants of health (SDoH) faced by African Americans, such as poverty, limited access to healthy food, environmental factors, and heightened stress levels (Singu et al., 2020). These factors could contribute to the development of migraines.

Regarding the presence of Mr. Billings’ father during the appointment, it’s vital to include him in the patient’s care. Family members, especially in the African American community, often play significant roles in providing personal or spiritual care (Núñez et al., 2021). Excluding the father from the healthcare process could hinder vital support mechanisms and exacerbate the patient’s agitation, ultimately affecting the quality of care and patient experience.

Health History Assessment

To gather a comprehensive health history for Mr. Billings, I would inquire about potential health disparities and SDoH that could be linked to his chronic migraines. It’s crucial to explain to Mr. Billings that this assessment aims to identify the sources of his physical concerns and is not intended to pass judgment. This approach is essential to avoid worsening his agitation, as some questions may touch on sensitive topics. Here are the questions I would ask:

1. What is your occupation, and do you find it financially sufficient to cover your expenses?
2. Do you have access to a consistent source of healthy and nutritious food?
3. What is your highest level of education completed?
4. Have you experienced significant stress in your life recently?

By asking these questions, I aim to uncover areas of need or potential causes for Mr. Billings’ physical symptoms. Additionally, it may help rule out health disparities or SDoH as contributing factors, leading to further testing, treatment adjustments, or referrals for specialized migraine management.

References

Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: A concept analysis. Health & Social Care in the Community, 26(4), 590–603. https://doi.org/10.1111/hsc.12556

Maly, A., & Vallerand, A. H. (2018). Neighborhood, Socioeconomic, and Racial Influence on Chronic Pain. Pain Management Nursing, 19(1), 14–22. https://doi.org/10.1016/j.pmn.2017.11.004

Núñez, E., Villa, G., McFadden, R., Palmisciano, A., Lanini, I., O’Mahony, S. M., Curtis, J. R., Levy, M. M., & Amass, T. (2021). Differences in Family Involvement in the Bedside Care of Patients in the ICU Based on Self-Identified Race. Critical Care Explorations, 3(3), e0365. https://doi.org/10.1097/cce.0000000000000365

Singu, S., Acharya, A., Challagundla, K. B., & Byrareddy, S. N. (2020). Impact of Social Determinants of Health on the Emerging COVID-19 Pandemic in the United States. Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.00406

Discussion 2_Response 1

Great post, Kasondra. Pain is subjective, and it is what the patient says it. Chronic migraine is debilitating; it affects the person’s ability to function normally in the community (Dahlhamer et al., 2018). The patient’s physical and psychological conditions must be considered, in addition to the impact of chronic pain on the patient’s quality of life (Dahlhamer et al., 2018). Indeed, there is a need to do a comprehensive health history and physical assessment so that the nature of pain can be determined and treated accordingly. Sometimes, like today, I had migraines. In general, it affects me when I do not sleep enough. Migraines are excruciating.

Musculoskeletal Shoshanna Tillman Follow Up Sick Visit Shadow Health Treatment Plan

Moreover, a migraine that evolves into chronic migraine is intolerable. The pathophysiology of migraine involves the peripheral and central parts of the trigeminal system as well as several subcortical and cortical of the brain structure (Coppola et al., 2020). Mungoven et al. (2022), using a functional magnetic resonance in their research, found that the variation of brainstem pain modulatory regions by higher cortical zones may be abnormal when pain occurs, and these changes in this descending modulatory route display only before the development of a migraine attack. From their data, the authors derived that understanding the functional changes of the descending pain modulation may lead to the development of treatment methods that will contribute to reducing pain before a migraine attack.

References

Coppola, G., Parisi, V., Di Renzo, A., & Pierelli, F. (2020). Cortical pain processing in migraine. Journal of Neural Transmission (Vienna, Austria: 1996), 127(4), 551–566. https://doi.org/10.1007/s00702-019-02089-7

Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., Kerns, R., Von Korff, M., Porter, L., & Helmick, C. (2018). Prevalence of chronic pain and high-impact chronic pain among adults – United States, 2016. MMWR. Morbidity and mortality weekly report, 67(36), 1001–1006. https://doi.org/10.15585/mmwr.mm6736a2

Mungoven, T. J., Marciszewski, K. K., Macefield, V. G., Macey, P. M., Henderson, L. A., & Meylakh, N. (2022). Alterations in pain processing circuitries in episodic migraine. The Journal of Headache and Pain, 23(1), 9. https://doi.org/10.1186/s10194-021-01381-w

Response 2

Your post was informative and highlighted some stressors contributing to this patient’s migraines. A lack of the basic necessities for living, such as clean water, healthy food, financial security, housing, education, and access to quality healthcare creates health disparities that can severely influence a patient’s health outcomes. African Americans face health disparities due to poverty, racism, low education level, a lack of medical insurance, and mistrust of healthcare providers (Nair & Adetayo, 2019). Mistrust with healthcare providers results in avoidance to seek out primary care services and contributes to more emergency room visits by African American patients (Alsan et al., 2019). In the US, migraine headaches affect approximately 1 million African American men and can be severely disabling (Charleston et al., 2020). Taking the time to properly address this patient’s concerns, while also being sensitive to his cultural and social differences can help build more trust and fewer feelings of judgment (Andermann, 2016). Getting an official diagnosis of “migraines” for this patient can put him on the path to receiving appropriate evidence-based treatment and neurological care for this condition to prevent or reduce these episodes (Eigenbrodt et al., 2021).

I thought your questions were probative and will be helpful in gathering information for your health assessment. As healthcare providers, I feel we sometimes can become so busy that we rush through things and do not take the time to explain that our questions are not meant to offend or be judgmental but to help find solutions and provide the best care for our patients. So, I love that you included taking the time to explain the importance of your questions so as not to further aggravate the patient. Having the patient’s father present during the assessment (as long as there is patient consent) can help provide information about family history that the patient may not know. Great post! I really enjoyed your perspective on this case scenario.

References

Alsan, M., Garrick, O., & Graziani, G. (2019). Does diversity matter for health? Experimental evidence from Oakland. American Economic Review, 109(12), 4071–4111. https://doi.org/10.1257/aer.20181446

Andermann, A. (2016). Taking action on the social determinants of health in clinical practice: A framework for health professionals. Canadian Medical Association Journal, 188(17-18), E474–E483. https://doi.org/10.1503/cmaj.160177

Charleston, L., Spears, R. C., & Flippen, C. (2020). Equity of African American men in headache in the United States: A perspective from African American headache medicine specialists (part 1). Headache: The Journal of Head and Face Pain, 60(10), 2473–2485. https://doi.org/10.1111/head.14004

Eigenbrodt, A. K., Ashina, H., Khan, S., Diener, H.-C., Mitsikostas, D. D., Sinclair, A. J., Pozo-Rosich, P., Martelletti, P., Ducros, A., Lantéri-Minet, M., Braschinsky, M., del Rio, M., Daniel, O., Özge, A., Mammadbayli, A., Arons, M., Skorobogatykh, K., Romanenko, V., Terwindt, G. M.,…Ashina, M. (2021). Diagnosis and management of migraine in ten steps. Nature Reviews Neurology, 17(8), 501–514. https://doi.org/10.1038/s41582-021-00509-5

Nair, L., & Adetayo, O. A. (2019). Cultural competence and ethnic diversity in healthcare. Plastic and Reconstructive Surgery – Global Open, 7(5), e2219. https://doi.org/10.1097/gox.0000000000002219