Patient history and the signs and symptoms

A 28-year-old soldier returns from Iraq and begins experiencing periodic bouts of anxiety. She complains that she wakes up frequently and cannot get a full night of sleep. Recently, she also has been getting frequent headaches and noticed a few ulcers in her mouth. A physical examination and lab tests do not reveal any local or systemic disease.

Discussion Questions

Based on the patient history and the signs and symptoms, discuss how stress is related to her condition.
Discuss other stress-related problems that this patient might experience if her coping strategies are not effective.
Discuss the potential strategies for coping with the stress.
Mr. K is a 32-year-old man who was found in his apartment at 2 AM, babbling incoherently and apparently experiencing hallucinations. His friends report that he had been to a party that night and, since the recent breakup of his marriage and loss of his job, he tends to overdo it at social events. They report that during the evening, he consumed very little alcohol but did take a small pill given to him by another partygoer. Paramedics could find no puncture marks and no powder in or around the nose, but his blood pressure was elevated, as was his body temperature. He appeared dehydrated and agitated.

Discussion Questions

Based on patient history, reports from his friends, and the signs and symptoms noted by the paramedics, identify substances that Mr. K might have consumed.
Based on patient history, discuss the social factors that predisposed him to substance abuse.
Discuss any additional problems that he might encounter if he continues his present course of substance abuse.

Sample Solution

It is widely held that the patient’s history reveals the diagnosis. ‘Listen to your patient; they are telling you the diagnosis,’ is a well-known adage. Good communication between doctor and patient is the foundation of a truthful history. When discussing their history, the patient may not be looking for a diagnosis, and the doctor’s quest for one is likely to be futile. The patient’s problem, whether or not it is associated with a medical diagnosis, must be identified. It is critical for doctors to develop consultation skills that extend beyond the prescriptive history taking that is taught as part of the comprehensive and methodical clerking procedure specified in textbooks.

here Coleridge saw veneration for the monarchy, Chartist publications worked to uncover subversive undercurrents of disapproval. In ‘CHARTISM FROM THE POETS’, selective quotation from H5 suggest an alternative re-reading of the play which privileges and extends potentially subversive moments (Northern Star, 06/07/1840: 7). Andrew Murphy has commented that this method had the effect of ‘flattening’ the text, losing ‘the highly textured ambiguity of the original’ (2008: 140). Although they certainly remove ambiguity, I would suggest that, to borrow Michel de Certeau’s expression, it is an act of ‘poaching’, the reader travelling ‘across fields they did not write’ (2011: 174). The radical reader takes the plays, ‘combines their fragments, and creates something un-known in the space organized by their capacity for allowing an indefinite plurality of meanings’ (de Certeau, 2011: 169). More than a flattening, it is a self-conscious act of dissection, quite literally combining fragments to support a preconceived idea of Shakespeare as a poet of the people. Act 4, Scene 1 of H5 is quoted alongside notoriously political writers: John Milton, James Thomson, and Charles Churchill. The Chartists only quote King Henry when he disguises himself as one of his soldiers to hear more candidly what his soldiers think of his decision to take the country to war against France. Henry emphasises the lack of genuine difference between himself and his soldiers to defend himself against Williams’s criticisms: ‘The King is but a man, as I am; the violet smells to him as it doth to me”’(4.1.97). In its context, the line is defending the King by highlighting his vulnerability; out of context, it echoes the reformers questioning why ‘A man, fallible and erring as ourselves, is invested with hereditary powers… apt to forget that he is but a poor perishing wreck of humanity’ (‘The Politics of Poets. No. II’, Chartist Circular, 25/07/1840: 178). Though Henry is emphasising a fraternal relationship between the King and his soldiers, the statement in a Chartist context instead critiques the uneven dynamic that kingship necessitates.

The scene itself, in which Henry’s soldiers criticise his authority and motives, is structured to prompt Henry’s subsequent soliloquy on the emotional burden placed upon him, being ‘but a man’, by the crown. As Thomas Cartelli has observed, rather than working to ‘cancel or, at least, qualify’ the artificial divisions that ceremony enforces between men, this speech ‘eventuates in the king’s reconsecration of the same hierarchical ideology to which, he would lead us to believe, he is himself royally subjected’ (1986: 7). The lines therefore prompt Henry’s deconstruction, reaffirmation, and privileging of his royal burden, with the institution of monarchy interrogated but accepted. Instead of including Henry’s reflections on ceremony at

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