Case 19: You Decide the Case of Fred
Dr. Nazworth: Fred and Maggie?
Fred: Right here!
Dr. Nazworth: Hello, welcome, it is a pleasure to meet you. You all can come on back now.
Fred: Nice place you’ve got here.
Dr. Nazworth: Thank you, Fred. Come on in and make yourselves comfortable wherever you wish and then we will get started.
**Fred and Maggie sit together on the oversized love seat**
Dr. Nazworth: So Fred, I know that you filled out the biographical form, but why don’t you try and tell me what brought you in to see me today?
Fred: Well, um…I’m sorry, what was the question?
Dr. Nazworth: That’s okay, Fred. What brought you in to see me today?
Fred: Right… Well, I’ve been having some problems with, um, remembering things.
Dr. Nazworth: Okay, can you tell me a little more about that?
Fred: Well, Maggie could probably tell you better, but I just know that I forget words, people’s names, and I misplace a lot of stuff and can’t remember where I put them.
Maggie: Fred has been having a hard time with remembering things that, before all this started, he never forgot…like our anniversary. It was little stuff at first, like saying he made a “revision” when he meant “decision,” things like that. Then he started losing things, like his wallet and we would find it in random places, but he would swear that he hadn’t been in those places in a long time. My husband used to be so organized and a “neat-freak,” if you will…now he forgets half-full glasses of juice on the living room floor. It just seems that his forgetfulness is getting worse and worse. I mean, it’s gotten to the point where I have to drive him to and from work, he will go to mow the lawn and only cut half of it, can’t remember our grandchild’s name a lot of the time… the list goes on and on.
Dr. Nazworth: Alright, can either of you tell me when these symptoms first began?
Maggie: It’s been about two almost three years since it first started.
Dr. Nazworth: Wow, that’s quite a bit of time. I know this can’t be easy on either one of you and want you both to know that I am going to do everything I can to get Fred the help that he needs. In order to do that I am going to need a great deal of information, some of which you might not be able to relate to me Fred; therefore, are you willing to sign a release of information so that I can get the required information from Maggie, Fred?
Fred: You want me to release what?
Dr. Nazworth: Sign a release of information form so that Maggie can speak on your behalf and tell me how you are doing when you can’t.
Fred: Oh, I think that is probably best since I seem to be losing my mind.
Dr. Nazworth: I know this is difficult, but we are going to do everything we can to help you through this process, Fred. I would like to setup a follow-up visit with both of you so that we can discuss Fred’s situation more at length and so that we can run some quick assessments. Would that be something you’re willing to do, Fred?
Fred: What do you think, Maggie?
Maggie: I think it is necessary, Dear.
Fred: Okay then, looks like I’ll be seeing you again, Doc.
Dr. Nazworth: Wonderful Fred. Now, before we part ways, let’s get you to sign that release of information document granting Maggie permission to speak on your behalf and provide information that you may not be able to, okay?
Fred: Sounds good!
**Session ends**
Three Questions Proposed and the Rationale:
What brought you in to see me?
This open-ended question was proposed to the patient in a way that invites him to talk about and relate to me in a personally and culturally relevant fashion what he believes the reason(s) are that necessitated his visit. Although I have some background information from the initial phone call and the biographical report, it is important that I hear from the patient why he or she has found it essential to meet with me. This also gives me time to observe the patient for any evidence of mental or physical disorders, cognitive issues, thinking perception, emotional expression, etc.
Can you tell me a little more about that?
This question is proposed to encourage the patient to go a bit more in-depth about why they have sought assistance. This kind of question is also open-ended and enables the patient to express in their own words what they feel their issues are and can provide information on specific symptoms that the patient might be experiencing. This is another great opportunity to observe the patient as he or she responds and document things like emotional expression when talking about their issues.
When did these symptoms first begin?
This is an extremely important question to pose, because it is crucial to know how long the symptoms have been present. By knowing when the symptoms began, we are better able to predict the severity and progressiveness of the condition and take the necessary steps to conduct further assessments in an effort to implement therapeutic interventions as soon as possible.
In addition to the aforementioned questions, I asked Fred if he would be willing to sign an information release form so that his wife Maggie could speak in his stead. This is an important step in cases where patients present with severe neurocognitive dysfunction. It ensures that information about the patient is still provided from a reliable source so that the patient can receive the best quality of care. This is known as “collateral information.”
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