Today is a busy day at the community health center since yesterday was a holiday. I am seeing walk-ins, and my three examination rooms are full. I hope I will be able to see more than 20 patients todaythe expectation of managementand will be rewarded with a productivity bonus. My next patient is John, a 42-y.o. man I have known for several years. He is accompanied as usual by his wife Mary. Today, John is complaining of lower extremity swelling and pain in most of his joints. He is worried about losing his job as a truck driver, because he is having difficulty climbing in and out of his truck. He is afraid that he may have lupus, because all of his siblings and his mom have this disorder. He also requests a refill on his antidepressant, which doesnt seem to be working as well as it did a month ago. While reviewing his chart, I notice that John has gained weighthe now weighs over 300 lbs. In reviewing his medications, I see that the antidepressant he is taking may be contributing to his weight gain. Johns physical examination is unremarkable. His heart rate is regular without murmur or irregularity, and his lung sounds are without wheezes or crackle. Since John is a large man, all of his joints areas are large, but they are all symmetrical, with good range of motion and only mild palpation tenderness in his wrists. His ankles are large but without erythema or other skin discoloration or disruption, and his pedal pulses are strong and equal bilaterally. I ponder how to manage this visit. Do I take the time to investigate Johns depression more thoroughly, wondering about his 11 y.o. daughter, who at his last visit was on chemotherapy for a neuroblastoma? Should we discuss the pros and cons of different antidepressants? Should we discuss the possibility of a gastric bypass again, even though I know the thought of anesthesia terrifies him? Do we again discuss the importance of a healthy diet and increased exercise, giving consideration to his joint pain? I am torn between what I feel this patient deserves and the call of the clock. Would it be unreasonable to order the necessary lab tests to investigate the possibility of lupus, hypothyroidism, or some other disorder and postpone these time-consuming discussions until his next visit? If I am expedient with this visit, the other patients waiting also will be grateful. Maintaining a caring practice in an economically driven discipline requires skill and grounding in those values that are essential for quality patient care. In the context of the caring theory and analysis of the Advanced Practice Nursing Situation above, lets discuss this situation using multiple ways of knowing.
Questions for this weeks Postings:
In your posting this week please provide a word metaphor that might express the meaning of this situation as described above?
Remember this is your opportunity to tap into the aesthetics of knowing that is seeing the beauty and uniqueness in this situation so think about it a bit before responding.
Make it your own word and not just what someone else said.
Please explain why you chose this word and if you have experienced this type of situation before and what did feel about that situation? Make sure to respond to your fellow classmates postings as well and challenge each other to go beyond just the surface.
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