You may write your notes in the fields below as the dialogue unfolds, or at the end. When finished, please click the blue, arrow button to complete the entry. Only click this button when you are completely finished with your note and trainee feedback.
Prompt: Imagine that you are observing an in-person trainee-patient interaction through a live video feed. Please enter observational notes about the clinical interaction from whatever perspective you most often hold in clinical interactions—e.g. as a clinician/educator writing a chart note, as a patient/family member note-taking, etc.
Background: This 87 year old woman is known to the supervising physician. She has been the physician's patient for several decades. She used to come see them more regularly, but with the pandemic she has had limited contact with the medical system. The reason for the visit according to the appointment sheet is “follow up joint pain”.
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Trainee: Hi Marie, my name is Ateeka and I’m the resident working with Dr. Jones today
Marie (looks uncomfortable): I thought I was here to see Jones….
Ateeka: You are–I am the resident working with her. She will join us later.
Marie: Oh… but she knows me and I’ve barely had a chance to see her in the past two years.
Ateeka: Don’t worry, she will definitely come to see you too. Since it has been a while since you’ve seen her, perhaps you can let me know how things have been going since your last visit with her?
Marie: Tell me your name again please
Ateeka: Ateeka
Marie: Ah tee kah… where are you from Ateeka?
Ateeka (appears slightly disconcerted): I’m from Brampton
Marie: But your name–that doesn’t sound Canadian.
Ateeka: never mind, I was born and grew up in Brampton. Perhaps you can tell me how you are doing? I see from your chart that you have osteoarthritis. How are you managing with that?
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Marie: I take my medications and do the best I can. I don’t know why Dr. Jones thought I needed to come in to follow up on this –it is hard to get out these days with my walker.
Ateeka: Yes it must be. I think she wanted to make sure we are doing everything possible to help you. How is your mobility?
Marie: How do you think? My knees hurt. I was supposed to have a knee replacement in early 2020 but so much for that. There is construction outside my apartment building so waiting for wheeltrans is hard. It is not safe to walk outside with the construction and I’m scared of walking in the hallways because of COVID.
Ateeka: So you are having more trouble staying active?
Marie: What do you think? Of course I am. And I am in a lot of pain.
Ateeka: What are you taking for your pain?
Marie: Well Dr. Jones says lots of pain medications are not a good idea at my age but my age does not mean that I have less pain…I use acetaminophen 4 times a day which does nothing, and a cream that I put on my joints that does nothing and she has told me to do physio but there’s no safe physio available and it is hard to get around to the exercises I’ve been taught in the past.
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Ateeka: Well, Dr. Jones is right, many medications can cause problems as people get older, so we need to find ways to help you with your pain that are safe for you.
Marie: My age, my age, what do you know about age? You look like a teenager.
Ateeka (visibly irritated): Marie, I am a fully trained doctor in my last 6 months of family medicine residency.
Marie (slightly huffy but calming down): Oh okay. You young folks all look so young these days, and I never see anyone except the people in my senior’s apartment except my grandson when he drops off groceries for me. So in terms of safe medications, here is a question: he brought me a gummy thing to try for my pain and it seemed to help. Is that safe? Can you prescribe those for me?
Ateeka: A gummy cannabinoid?
Marie: Is that CBD? I think that’s what it is.
Ateeka: How often do you take it?
Marie: Just when I need it, but I find that’s been every day recently. It helps better than any of the other stuff.
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Ateeka: Do you experience any side effects from it? Falls, sedation, confusion, reduced concentration?
Marie: No, I feel perfectly fine. I’ve heard you can prescribe it for me - could you do that?
Ateeka: Well, there’s limited evidence for chronic pain, and we’re still getting to understand the risks of CBD, especially in older folks.
Marie: Us older folks with chronic pain are always the last to be studied and the first to be dismissed.
Ateeka: I’m so sorry you feel this way. It must be really hard to be so limited in your activities due to your pain. I can understand why you would want to try something new, but I would worry that it could increase your confusion or put you at a risk of a fall, which could lead to a fracture and hospitalization. So I wouldn’t feel comfortable prescribing this for you today, but I’m happy to look into it more for you. How does that sound?
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Marie: Sure, I would appreciate that. I definitely don’t want to fall or get a fracture, but feeling the way that I do…it’s just not sustainable.
Ateeka: I understand and I want to help you as best I can. Would it be ok if I do a quick exam?
Marie: Can you just do it while I’m sitting; I find it really hard to get up onto those silly tables!
Ateeka: Sure, no problem, I agree the exam tables really aren’t great for those with mobility issues.
Ateeka: I can tell you definitely have some pretty severe osteoarthritis. It’s no wonder you feel the way that you do.
Marie: Like I said, it’s not sustainable to live this way.
Ateeka: I would suggest that you continue your physio exercises and that we consider a joint injection for you. Is that something you would be interested in?
Marie: Sure, if it helps. But like I said, those CBD pills seem to work - I’d like to try that too.
Ateeka: Ok, I’m going to go review with Dr. Jones and come back to discuss with you.
Marie: Thanks Ateeka - I’m sorry for being so abrupt at the start. I’m just an old woman in pain and sometimes I take it out on others.
Ateeka: That’s ok, I understand. Be back soon.
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