Shawn Billings, a 28 year-old African American patient

CASE STUDY 2

Shawn Billings, a 28 year-old African American patient comes in to the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication.

 

Module 2 Week 2 Discussion: Main Post

Mr. Billings has presented to the clinic today for another migraine. The clinic staff has deemed him a frequent flyer. However, Mr. Billings is suffering from chronic migraines. He worries about receiving medication and has brought his father to the visit today. According to Henderson et al. (2020), as a healthcare provider, one must look at the whole patient when providing care, which includes embracing their beliefs, values, and expectations to provide high-quality care. Based on the information provided, which is limited, the patient has received medication to treat his migraines. However, little has been done to investigate the cause or help manage a chronic condition. African Americans suffering from chronic pain are undertreated more severely when compared to non-Hispanic Whites (Maly & Vallerand, 2018). Unfortunately, African Americans suffer more from health disparities or social determinants of health than other ethnic groups. According to Singu et al. (2020), African Americans are more likely to live in poverty, have limited access to healthy foods, live in areas with higher levels of pollution, and experience stress at a higher level due to socioeconomic status. These health disparities and SDOH could present potential causes for the development of migraines.

Regarding the patient’s father attending the appointment with him, the healthcare provider should include the father in the patient’s care. Family members of African American patients are more likely to participate in patient support methods using personal or spiritual care (Núñez et al., 2021). Excluding the father would prevent supportive methods and further increase the patient’s agitation. This action would negatively impact the patient’s care and experience.

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Health History Assessment

To collect an accurate health history on Mr. Billings, I would inquire about health disparities or SDOH that may cause chronic migraines. Before asking the questions, I would explain to Mr. Billings that an accurate assessment of health disparities may reveal the source or sources of his physical concern. Without explanation, Mr. Billings agitation may become worse. For example, the patient may take offense to questions about poverty or income, especially when he is being seen for a migraine. Without explanation, the patient may feel as if the provider is placing judgment.

 

Questions to ask:

What do you do for work?

Do you make enough money to pay your bills?

Do you have access to healthy food?

What is the highest level of education that you completed?

Do you experience stress?

 

       By asking these questions, it would help the healthcare provider determine areas of need or potential causes for the physical symptoms the patient is experiencing. Furthermore, it could help the provider rule out health disparities or SDOH as a cause. Indicating the need for further testing, change in treatment, or referral to a specialist that can provide appropriate long-term management for migraines. 

 

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 Community26(4), 590–603. https://doi.org/10.1111/hsc.12556Links to an external site.

Maly, A., & Vallerand, A. H. (2018). Neighborhood, Socioeconomic, and Racial Influence on Chronic Pain. Pain Management Nursing19(1), 14–22. https://doi.org/10.1016/j.pmn.2017.11.004Links to an external site.

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 Explorations3(3), e0365. https://doi.org/10.1097/cce.0000000000000365Links to an external site.

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 Health8https://doi.org/10.3389/fpubh.2020.00406Links to an external site.

Discussion 2_Resonse 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.

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/s00702-019-02089-7Links to an external site.

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 report67(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 Pain23(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 Review109(12), 4071–4111. https://doi.org/10.1257/aer.20181446Links to an external site.

Andermann, A. (2016). Taking action on the social determinants of health in clinical practice: A framework for health professionals. Canadian Medical Association Journal188(17-18), E474–E483. https://doi.org/10.1503/cmaj.160177Links to an external site.

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 Pain60(10), 2473–2485. https://doi.org/10.1111/head.14004Links to an external site.

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 Neurology17(8), 501–514. https://doi.org/10.1038/s41582-021-00509-5Links to an external site.

Nair, L., & Adetayo, O. A. (2019). Cultural competence and ethnic diversity in healthcare. Plastic and Reconstructive Surgery – Global Open7(5), e2219. https://doi.org/10.1097/gox.0000000000002219Links to an external site.