Posted: September 8th, 2023

Shawn Billings, a 28 year-old African American patient

Respond to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

-Please use at least two current resources include outside meterial other than the school resources.

-A minimum of 200 words is required for each reply

I had trouble accessing your link so I’m going to try to continue without it.
Thank you for the opportunity to and update this case study reviewing it further, here are a few:
1 Provide more context Shawn’s determinants of health any barriers faces accessing care.ors income, status, transportation, ability to time off work etc all impact someone’s and utilization. Understanding these elements will help a more-
Inquire gently and non-judgmentally any chronic conditions health issues may be contributing to Shawn’s frequent migraines. Ask open-ended questions to learn more making assumptions.
Acknow “frequent flyer” label can promote a stigma, so avoid using that term directly and focus instead on understanding Shawn’s healthcare needs and challenges.
4)uss any alternative treatment options that may help prevent emergency department visits like improved accesspreventive prescription medications, techniques, Does he feel these have been or would be helpful for him?
Inquire aboutawn’s experience at previous visits – did feel heard for bias or discrimination, like his concerns were seriously? Lack in the can influence healthcare behaviors.
Shawn, speak to father to gain additional socio-cultural into situation and any other factors that would aid in Shawn’s.
The goal is to approach this sensitively- through active listening, empathy and avoiding assumptions. Please let me know if any part of case study or context after our discussion. I aim to provide thoughtful feedback update it in a culturallyinformed.

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.

1) Post1
Understanding Frequent Utilization of Healthcare Services
Frequent utilization of emergency healthcare services, sometimes referred to as “frequent flying,” is a complex issue with both social and clinical factors. A case study of Shawn Billings provides an opportunity to explore this issue with empathy, care, and a systemic perspective.
Shawn’s agitation upon arrival likely stems from pain as well as anxiety about receiving adequate treatment. As someone who has accessed emergency care multiple times in a short period, he may feel a lack of control over his condition or doubt in the healthcare system’s ability to help. For clinicians, it can be easy to view such patients with frustration rather than seeking to understand their experiences and challenges (McCormick et al., 2016).
However, frequent use is often tied to underlying social determinants of health rather than patient behavior alone. Research finds associations between high utilization and factors like low income, lack of insurance, limited access to primary/preventive care, and unmanaged chronic conditions (LaCalle and Rabin, 2010; Shah et al., 2016). For some, emergency departments become a regular source of treatment when other options are unavailable (Ruger, 2004). This suggests the need for systemic solutions beyond any one patient.
In Shawn’s case, addressing the root causes of his migraines may help reduce the need for emergency interventions. Providing affordable treatment alternatives and helping to navigate social services could allow his healthcare needs to be met earlier (McCormick et al., 2016). Clinicians caring for high utilizers may find benefit in taking a non-judgmental, trauma-informed approach that acknowledges the real challenges patients face and aims to partner in developing long-term wellness plans (Shah et al., 2016). With compassion and an eye toward systemic barriers, the frequent flyer cycle can potentially be broken.

The etiology and progression of diseases are multifactorial. Therefore, it is essential to understand the social determinants of health and how they influence a patient’s well-being (Ball et al., 2023). The case provided describes Shawn Billings, a 28-year-old African-American patient who comes into the clinic with a chronic headache. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and four days ago with a migraine; he was given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache and is very agitated. He is here with his father and is worried he will not get any medication. Understanding the factors associated with the patient’s treatment-seeking behavior and current health status will provide a rich history that can be used to provide an accurate diagnosis and a patient-centred treatment plan.

Healthy People 2030 defines social determinants of health (SDOH) as environmental conditions that impact individuals’ quality of life, functioning and health (Office of Disease Prevention and Health Promotion, 2022). The main classifications of SDOH are the social context, the built environment, access to and quality of healthcare, the quality of and access to education, and economic stability. For the patient, his race may contribute to a lower socioeconomic status, resulting in lower access to nutrition and lower amounts and quality of sleep due to a noisy neighborhood. Therefore, it is essential to ask the patient about his diet and exercise patterns, where he lives, and how many hours of sleep he gets. The patient’s occupation can also provide information on his day-to-day activities, which might trigger the headache. Moreover, the patient is more prone to discrimination even in healthcare services. According to Morden et al. (2021), black patients often get undertreatment for pain and are more likely to be denied painkillers due to the stereotype that black patients are likely to be addicted to pain medication. Still, there is a risk of addiction to prescription opioids and other habit-forming medications. Therefore, ensuring that the patient gets appropriate treatment without discrimination is crucial. Asking the patient about the abovementioned factors is essential for accurate diagnosis.

It is important to address sensitive issues in a nonjudgmental to ensure that a patient is comfortable when sharing information. Among sensitive issues for the patient include potential prior bias and discrimination due to his ethnic and cultural background. The patient is already hypervigilant, as evidenced by bringing his parent to the hospital despite him being a grown man. The caregiver should ask about any worries and concerns of discrimination and provide reassurance and a commitment to providing culturally sensitive and non-discriminatory care (Ball et al., 2023). Cultural adaptations to screening tools, providing culturally competent responses, and understanding the impact of culture on illnesses and treatment are crucial for holistic treatment. The patient is also at risk of addiction to painkillers. Therefore, education on the importance of providing a comprehensive history can help uncover the cause of the headaches and gear treatment towards the cause of the symptoms instead of the symptoms. The use of drugs for recreational purposes is also a sensitive issue that can offend the patient. However, asking the patient about potential drug use is necessary to avoid drug interactions and encourage patient-centred care.

Here are five targeted questions I would ask the patient to build his health history and assess his health risks.

Are there any prescription, over-the-counter, or herbal medications you are currently taking, and are they useful in relieving symptoms?
Can you show me the specific area of your head that hurts and describe the pain you feel?
What is the duration and frequency of the headaches, have you noticed specific triggers and patterns that seem to contribute to the migraines?
Are there any medical conditions you have been previously diagnosed with?
Are you experiencing significant changes or stressors at work or in your personal life? 2. Post by Laur Bahar Considering this patient, a young African-American male who has been labeled a “frequent flyer,” raises a host of concerns. As a minority, it is almost certainly a given this young man has experienced racism to some degree at some point in his life. Without knowing his socioeconomic status, it is likely that he and his family have to and continue to face more obstacles and barriers than a non-minority. There is a high probability this young patient and his family have faced countless challenges, untoward behaviors, and attitudes, and come with understandable hesitancy when seeking healthcare. Inadequate healthcare and exclusionary healthcare experiences are common among racialized minorities. Racism is linked to a lack of trust in healthcare providers and delays in seeking care (Hamed et al., 2022). Before interviewing the patient, all of these points must be at the forefront of awareness to best serve the patient. What are the feelings and thoughts this patient is potentially coming to the clinic with? Fear, anger, mistrust, and doubt are probable. This patient has already been in for the same reason, seemingly without any solutions. Regardless if the providers and staff at the clinic did not have any implicit or explicit biases towards him, it is safe to assume he is going to feel that way. However, the stark reality is the prevalence of implicit racial bias in patient and provider interactions contributes to the exacerbation of health disparities among minorities (Sim et al., 2021). This patient is agitated, rightfully so. His health concern was not fully addressed, and it bears consideration that he is treated like a “frequent flyer” as well. Being treated in that manner, patients, regardless of ethnic and cultural background, are automatically dismissed based on the presumption of wanting drugs, not really being sick, and being bored, to name a few. This behavior in itself is dismissive, demeaning, and trivializes patients. Couple that with the high probability of implicit and or explicit biases this patient has faced- to mention in healthcare as well, this patient merits our first meeting with a high level of empathy and sympathy. When meeting the patient for the first time, it will be beneficial to understand that racism has been identified as one of the primary causes of poor health outcomes among racial/ethnic populations and health disparities among racial/ethnic communities (Williams et al., 2019). While this tragic reality continues to plague healthcare, it cannot be ignored. I will do my best to warmly greet the patient and his father warmly, knowing that I may not receive the same reception. I will offer a sincere handshake to both of them. When walking the patient and his father to my office, I will walk with them, not in front of or behind them. When they are both seated in my office for the interview, I will face them, seated, without any devices, desks, or barriers between us. Despite the circumstances, I want to thank both of them for returning to the clinic. When addressing the patient, I will ask how he would like me to address him and ask the same question to his father. I will introduce myself and acknowledge some potential feelings the patient and his father may have. Before we start, I will ask the patient to tell me a little about himself. This opens a pathway of relationship-building and a genuine desire to know the patient outside his ailments. The patient’s initial meeting with a new healthcare provider is of paramount importance as it has the capacity to influence attitudes and behavior that contribute to the development and strengthening of the patient-healthcare provider relationship. The judgments made in the initial minutes of an encounter can significantly affect various behavioral outcomes (Dang et al., 2017). Questions I will ask my patient: 1) How are you feeling- physically and emotionally? 2) Can you tell me what brings you in today? 3) What do you expect from today’s visit? 4) What do you expect of me? 5) Can you tell me more about the headaches you’re having? (Frequency, duration, onset, precipitating factors, what helps, what makes it worse?) 6) Do you take any medications, vitamins, or supplements? 7) Can you tell me about any illnesses you have had recently, and in the past? 8) What does health mean to you? 9) Tell me about any other concerns you may have. Building on these questions, I will ask him to tell me about his nutritional status, ability to obtain food, ability to obtain the necessities of life (clothing, personal hygiene items), economic stability, social stability, recurrent struggles in his life, surgeries, immunizations, recent travel, home life, work life, and social life. My goal is to build trust and rapport with the patient (and his father) in hopes he will continue to seek care here and break down the barriers that are seemingly already in place, using a high level of emotion with the patient.
LEARNING RESOURCES
Required Readings
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 1, “Cultural Competency”
This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 2, “Evidenced-Based Clinical Practice Guidelines”
Centers for Disease Control and Prevention. (2020, October 21). Cultural competence in health and human servicesLinks to an external site.. Retrieved from https://npin.cdc.gov/pages/cultural-competence
This website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.
United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent careLinks to an external site.. Retrieved June 10, 2019, from https://cccm.thinkculturalhealth.hhs.gov/
From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.
Coleman, D. E. (2019). Evidence based nursing practice: The challenges of health care and cultural diversityLinks to an external site.. Journal of Hospital Librarianship, 19(4), 330–338. https://doi.org/10.1080/15323269.2019.1661734
Young, S., & Guo, K. L. (2016). Cultural diversity trainingLinks to an external site.. The Health Care Manager, 35(2), 94–102. https://doi.org/10.1097/hcm.0000000000000100
REQUIRED MEDIA
Module 2 Introduction
Dr. Tara Harris reviews the overall expectations for Module 2. Consider how you will manage your time as you review your media and Learning Resources for your Discussion, Case Study Lab Assignment, and your DCE Assignment (3m).

Functional Assessments and Cultural and Diversity Awareness in Health Assessment – Week 2 (10m)

Walden University. (n.d.). Instructor feedbackLinks to an external site.. https://cdn-media.waldenu.edu/2dett4d/Walden/WWOW/…

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