Thu

DIET 1/2024 COMMUNICATIONS COLLECTIONS

1. Myotonica dystrophica counselling

She has a baby 4 months ago which was diagnosed with MD.
His brother’s age is 7 and doing well.
Her mom had cataract at age of 52. She is asymptomatic apart from mild stiffness.
Her sister is fine and has 2 kids with no symptoms.
Task – council and discuss further.
Concern – I gave the disease to my children and …

2. H/O TIA and AF – given warfarin, stable for 6 years - developed anaemia - treated with
iron and improved – further colonoscopy and biopsy confirmed ascending colon cancer –
CT CAP was negative
Discuss – refer to surgeon
Concerns : - mother died and he will not go for surgery
- Stoma
- Stroke if stopped warfarin

3. DM with hypoglycemic unawareness on metoprolol as well

4. PCKD – BBN and further plan, (genetic explanation), address concerns and prognosis of
the disease

5. Patient was Parkinson with pneumonia and admitted in ward for 3 days now, confused and
drowsy as anti-parkinson medications were missed during hospital admission.
Improved so missed dose of anti-parkinson medicines and now drowsy
Concerns like error
(PD, staff nurse not given one dose, IR, apologies)(error)

6. Pheochromocytoma was same repeat, Delayed diagnosis

7. Hepatitis B scenario
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8. MRSA – leg cellulitis was treated in hospital with IV A/B, junior dr changed IV cannula
without gloves and he got MRSA infection in arm as well, So dealing with angry patient

9. Sulphonylurea overdose – DAMA

Young lady took gliclazide
Was managed with dextrose
Mx team decided to take mood dr review for her
She was angry and was will DAMA as mood dr was involved without her consent

10. Angry patient, Son was concerned regarding steroid induced psychosis i.e. steroids was
given in suspicion of GCA, However, the consultant proven that it’s not the diagnosis and
patient was stopped from steroid and then admitted to the hospital

11. SLE diagnosis, piano teacher with arthritis

12. Son of a patient who has CA bladder, now presented in ER with drowsiness and deranged
RFTs, treatment nephrostomy planned

13. Angry daughter whose father developed amiodarone associated lung fibrosis

14. Stroke patient done thrombolysis, found to have AF and started on anticoagulant. Now,
came for F/U regarding his condition, To manage risk factor and for prevention of stroke.
Pt BP good, no DM, LDL good, still got some homonymous quadrinopia.
Patient concern – Can I drive? - I said, still got vision problem, not safe yet.

15. Oncology pt? /

16. DNR on 90 years old lady found on floor and got ICH. Neurosurgeon – no active
intervention and patient is dying. Talk to the daughter.

17. Counselling with son, mother developed AKI with gentamicin due to medical error

18. Penicillin allergy, given penicillin and now she has pneumonia, delirium and error
Thu

19. Medication error – Known DM came in ward with pneumonia. Dr prescribed short acting
insulin was written 20 units twice a day of short acting on got hypoglycemia, 3rd post
admission day got that at home mixed 20 units twice a day, pharmacist told he should be
taking mixed rather than short acting.
Concerns – what could happen, what will be long term effects

20. K/C/O old came with pneumonia already on maximum treatment, consultant decided he is
already on oxygen and maximum treatment, so tell patient about DNACPR and comfort
care, premorbid he was bed bound at home and maximum oxygen support as well

21. Advanced Parkinson’s with dementia, H/O recurrent aspiration pneumonia, SALT
assessed swallow issues, no oral feeding, primary consultant not opting for invasive
procedures, nephew wants to know further options for enteral feeding.

22. RA on MTX, now with MTX induced pneumonitis, PFT – mild restriction, currently on
steroids and worsening of RA after stopping MTX. Patient adamant on restarting MTX as
had benefit with that.
Dr start him on steroid, he wants to stop steroid bcoz afraid from side effects.

23. Uncontrolled DM not willing to take insulin injection

24. 78 years old female with CAD H/O now Angina at rest, CABG planned and patient
refused for it as explained by the interpreter coz she does not know English, she refused.
Son insisting on signing the consent and asking if he can explain this to the patient about
instead of interpreter and was angry, why we talked to the patient about surgery without
involving him first.
Son is angry, why you tell her all the details?
I will sign the consent instead of her?
She does not want to stay in hospital cos of her husband do procedure and die
Just to do the procedure
Thu

25. Advanced COPD, DNR – patient had COPD with chest infection and recent decrease of
exercise tolerance, Discuss DNR with daughter

26. AF, TIA, after release of his 24 hour holster result – counselling about anti-coagulation,
Apixaban

27. Lost report of FNA in advanced cancer, Medical error

Angry patient, Lost of biopsy, have suspicion of cancer, refuse to do other biopsy

28. Old age patient but competent, she had weight loss and iron deficiency anaemia and
suspected to have cancer, need workup but after discussing with the patient, patient
refused to do any procedure and agreed only in taking iron tablets. Discuss with the son.
The son asked to do investigation

29. Palliative and DNAR

30. BBN to the son, his father has brain tumour and consent for MRI for further
assessement

31. Palliative care for interstitial lung disease

32. Drug error – Patient 30 years admitted with pneumonia 2 days back and 2 h back had
seizures because the epilepsy drug was missed, he is known epilepsy and well controlled
since years and concerned as he works as a driver.

33. K/C/O Ulcerative Colitis patient, student, got diagnosis from biopsies 9 months ago, have
been on mesalazine, symptoms getting worse, ESR high, opens bowel more than 6
times/day, have impacts on school life, Counsell for steroid.

34. Old patient, candidate for ICD, convince him and check competency

35. 45 years Female, Recently diagnosed Type 2 DM with high BMI and has had GI side
effect on metformin. She currently has osmotic diuresis and blood glucose not well
controlled.
Discuss: further management regarding her DM and rationale for bariatric surgery
Concern: I am frustrated, people are looking down on me
I need bariatric surgery
Thu

36. 37 years physiotherapist recently joined the stroke team for the last 3 months admitted with
right sided upper and lower limb weakness, examined by different doctors but the finding
are not consistent with each other, CT normal, MR scan done, she declined to be informed
about the results when the register attempt. One of the nurses informed her that the doctors
believe that she is faking her symptoms, the diagnosis made by the team is functional
weakness.
Inside she disclosed that she is very stressed at work and at home has financial problems
as well.
Concerns: Am I faking my symptoms? What you will do for me? Will this weakness
resolve?

37. DNAR (Ca breast with metastasis)

38. Counselling regarding warfarin

39. Patient with déjà vu phenomenon and sleep walker, presented to ER coz of generalized
seizure, CT done, there is temporal lobe lesion with possiblility of tumour. Consultant
decided to do MRI scan to make sure

Concerns: Do I have a cancer?

What about driving?
Can I go now then comeback for the image?
I am worried.

40. Hickman line and Chemotherapy

41. Admitted patient, had black heel ulcer developed, 2 days. Apologies, IR
(Delirium and Dementia pt, urosepsis, admitted then developed bed sore)

42. Advanced Parkinson with dementia for feeding options

43. Advanced COPD with type 2 RF, patient competent, decided not to continue NIV, CS
agreed to continue treatment but stop NIV. Talk with daughter about decision.
Thu

43(b). Daughter disagreed with decision of discharging her mother home with
community palliative care, Mother COPD on home oxygen, currently with chest infection, type
2 RF, didn’t respond well to NIV, mother has capacity, wants to go home

44. Counsel for IBS

45. Medical error- colonoscopy postpone, Pt son angry

46. Aspirin S/E, concern is allergy, pt did angioplasty yesterday, he thinks he is allergic, but
its gastritis

48. Fire fighter with asthma, admitted with Severe asthma attack, task - advice to change job

49. BBN - Metastatic brain cancer

50. GB$ - explain poor prognosis