Long Cases Flashcards
Structure Long Case - DRPIMCO
Diagnosis and presentation Risk Factors Progress: flare ups, hospital admissions Investigations Management Monitoring Complication Outcome: current activity and impact
Social History - ABCDEFGHIJL (with explanation)
A: Accommodation.
Ministry of housing / private renal property / owner-occupied single-storey vs double-storey / residential care (with low or high needs).
Who do they live with at home? Are there carers?
A: ADLs, aids.
Current mobility status and exercise tolerance including transfers / stairs.
Personal ADLs: eating / hygiene / dressing / toileting / showering.
Community ADLs: access to community / shopping / banking.
Domestic ADLs: cleaning / cooking / gardening.
B: Business, work, occupation.
Retired / aged pension / disability support pension / actively working.
Always ask pre-morbid occupation / gauge education level.
C: Coping – links to supports / strategies in place.
Patient and practitioner perspective.
D: Driving.
Think about medical / functional restrictions regarding driving (refer to guidelines).
E: Exercise, ETOH, smoking, drugs, nutrition.
Quantify, discuss strategies in place.
F: Finances.
Pension vs private funds, how has this impacted on disease management and QoL.
G: GP and other health specialists, preventative measure (vaccines, screening).
H: home help / supports.
Identify key people supporting this patient e.g. immediate family, close friends, what is marital status?
Services in place (link with ‘ADLs’) – can mention what is ideally required.
I: Insight.
I: Impact.
Disease impact statement – how has the patient’s life changed as a consequence of the illness – e.g. until a few months ago Mr S was independent in his ADLs, he is now requiring the support of his carer etc.
J: Judgement.
L: Legal.
Will.
Enduring power of attorney.
Advanced care planning.
Social History - ABCD
A: Accommodation.
Ministry of housing / private renal property / owner-occupied single-storey vs double-storey / residential care (with low or high needs).
Who do they live with at home? Are there carers?
A: ADLs, aids.
Current mobility status and exercise tolerance including transfers / stairs.
Personal ADLs: eating / hygiene / dressing / toileting / showering.
Community ADLs: access to community / shopping / banking.
Domestic ADLs: cleaning / cooking / gardening.
B: Business, work, occupation.
Retired / aged pension / disability support pension / actively working.
Always ask pre-morbid occupation / gauge education level.
C: Coping – links to supports / strategies in place.
Patient and practitioner perspective.
D: Driving.
Think about medical / functional restrictions regarding driving (refer to guidelines).
Long Case Structure
Opening Statement Main Active Issues Inactive Issues Adherence Issues Mood Social History Physical Exam Summary Issues
Social History - ABCDEFGHIJL
A: Accommodation. A: ADLs, aids. B: Business, work, occupation. C: Coping – links to supports / strategies in place. D: Driving. E: Exercise, ETOH, smoking, drugs, nutrition. F: Finances. G: GP and other health specialists, preventative measure (vaccines, screening). H: home help / supports. I: Insight. I: Impact. J: Judgement. L: Legal: will, EPA, ACP
