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Material by Professor Omar Hasan Kasule Sr. for PBL on 25th August for Year 1 Semester 1 PPSD Session
Background
Joel was forced by his employer to seek treatment for his alcoholism. Joel Eduardo continued complying with treatment for 2 months. He however started missing the company of his friends with whom he used to socialize and drink alcohol. He gradually started drifting back to their company. He started drinking a little at a time but as time went on he drank more alcohol and started missing meals. His employer noticed deterioration in his behavior and asked him what was going on. Joel was evasive and denied any drinking problem. He however was more open with his workmates. He told them that being a foreigner with no family he had no social interaction and needed his drinking companions. A few days later Joel called in sick. His employer told him that he had to go the hospital, see a doctor and get medical certification before being granted sick leave. Joel had no choice but to go to the hospital.
Q1. Summarize issues raised by the information above
Hospital visit
The doctor concluded after a cursory look at Joel that he has started drinking again. He refused to examine or treat him on the grounds that he had failed to abstain from alcohol. He said that government resources should not be used for people who voluntarily choose lifestyles that are risky to their lives. Joel tried to explain something to the doctor but the latter just walked away.
Q2. What is your opinion about the conduct of the physician? Give reasons supporting your view and try to identify reasons that could justify the opposite view
Medical records
Joel went to the medical records department to ask for a copy of his records. The officer in charge refused saying that the records belonged to the government and could not be released to a patient. Joel had a friend working as a clerk in the office and agreed to copy and hand over the records without the knowledge of the officer in charge. The records showed the following:
Measurement | Patient value | Normal range |
Hemoglobin | 95 g/Liter | 130-180 g/Liter |
Total protein | 45 g/Liter | 60-80 g/Liter |
Albumin | 28 g/Liter | 36-47 g/Liter |
Ethanol | 10mmol/Liter | 65-87 mmol/Liter |
Glucose | 3.0 mmol/Liter | 3.6-5.8 mmol/Liter |
Iron | 10 umol/Liter | 14-32 umol/Liter |
Vitamin B12 | 100 pg/Liter | 130-770 pg/Liter |
Q3. What conclusions do you make from the records?
District medical officer
Joel then went with his medical records to the district medical officer. He presented his arguments as follows. ‘I used to drink a lot and at the same time had various vitamin deficiencies because I did not eat properly. My laboratory report proves that my problem was nutritional deficiency. The doctor gave me vitamin pills and told me to stop drinking. My condition improved quickly. However I drifted back to alcohol for social reasons. However this second time around I took precautions to make sure I do not develop any vitamin deficiency. I asked my friends to make sure that I did not start drinking before eating a full meal and taking my vitamin pills. I was very angry today when I went to the doctor and he refused even to examine me because he told me it was alcohol that was the cause of my problems. I do not believe that alcohol has anything to so with this. I have taken measures to make sure that my drinking alcohol does not interfere with my good nutrition. As for alcohol it is not a disease like cancer. It is just a social behavior needed to keep friends. It does not need treatment. I cannot even understand why my employer sent me for medical examination. Stranger still is the behavior of the doctor at the hospital who refused even to touch me because I am an alcoholic’. The District medical officer referred Joel to a consultant who carried an examination and laboratory investigations
Q4. What issues/problems do you identify in this situation?
Acute abdomen
A day later Joel attended a party at which alcoholic drinks were served. On return home de developed severe abdominal pain in the upper abdomen. The pain was also felt at the back. He also had nausea and vomiting. Laboratory investigations in the emergency room showed elevated amylase and lipase levels as well as hyperglycemia.
Q5. What is the likely cause of the abdominal pain?