PBL Case Discussion: Behavioral Health and Cultural Diversity

PBL Case Discussion: Behavioral Health and Cultural Diversity in Primary Care Part One

Setting: urban area, medium sized city

Family practice clinic near a college which employs nurse practitioners and physicians

Part 1: Your next patient is here with complaints of not feeling well.

This is the first visit for Ed, a 19-year-old student at the nearby college. You enter the room and introduce yourself to Ed. Ed is unshaven and not well groomed. He appears to be uncomfortable as he reaches forward to shake your outstretched hand and does not make eye contact.

CC: Ed states he is here because has been having difficulty getting up for class, feeling down and is not doing well in his courses. He says, “I just feel like I don’t enjoy the activities that I used to. So I go out at night with my friends same as always, but I just don’t have the energy to get up in the morning anymore. My friends can get up and they’re doing fine in class, so I think I must be sick.”

HPI: Ed states he is in general good health and denies any health conditions. He is a second semester college student with new onset fatigue and difficulty enjoying social events for the past 2 months since college classes started and decreased grades in school.

PMH: Describes health as good. Has hay fever, not using any medications at this time. No previous injuries. No herbal medication use. No surgeries. He had a previous hospitalization for a broken leg requiring traction at age 8. He smokes cigarettes—a pack a day. He reports drinking alcohol three to four times per week and coming home after 2 am on those nights. He sleeps 4 to 6 hours a night. NKDA; immunizations UTD

Social: Single full-time college student. He is not employed at this time.

Family: Reports parents and siblings alive and in good health.

Discussion Questions Part One:

• What further questions do you have for Ed at this visit? Why?
• What is your differential diagnosis list for this visit thus far with rationale?
• Based on your differential diagnosis list, identify what body systems you’d examine along with pertinent positive/negatives in each system.
• What diagnostic tests will you perform? If none, why?