Case 1: Ms. Carter

Provider

History

Ms. Carter is a 42 year old woman who is a bank vice–president. She was sent to the ED because of her abdominal pain. It is epigastric and associated with nausea, no vomiting. It has been getting worse over the past few weeks, and today it was so bad she called her doctor and he told her to come to the ED.

Physical Exam

Mrs. Carter is in generally good health. She is a little overweight. Her blood pressure is 130/88, higher than normal which always has been 120/80. Her abdominal exam reveals some tenderness in the epigastric area, no rebound or guarding. Her stool shows no occult blood. Her LFTs are slightly elevated.

Alcohol Screen

She drinks daily.

She reports at least 2 Bloody Mary’s (2 drinks each) and 2–3 glasses of wine each night. Greatest amount of drinks per occasion is around 6.

Physician Advice

Abstinence for now as you think she may have gastritis. You prescribe some H2 blockers and refer her to a GI specialist who her internist recommends. You also think that this amount of drinking could be related to her increase in blood pressure, and you want her to have it checked at her primary care doctor’s office this coming week.

Patient: Mrs. Carter

History

You are a 42 year old woman who is a bank vice–president. You have a very high–stress job. You have come to the ED because you were having abdominal pain and your primary care physician referred you. You have no vomiting and no change in bowel patterns.

Alcohol Screen

You drink every day. You have at least 2 bloody mary’s (2 shot glasses of vodka in each) while making dinner, and 2 or 3 glasses of wine during dinner. The most number of drinks that you have on any occasion is 6.

Negotiation

You don’t see the connection between your drinking and your abdominal pain. On a scale of 1–10, you choose a 4.

Pros

Drinking relaxes you, and you look forward to it. You do not drink during the day. Drinking makes you tired and helps you to fall asleep at night.

Cons

You fall asleep on the couch and are not available to your kids to help them with their homework in the evenings. You are not sleeping well at night and have disrupted sleep patterns.

Patient Goal

You will try to have no more than 1 drink per night.

You will not drink and drive.