SOMATIC DISORDER
28 yr old man presented with a lump on chest and mole on hand
Had some investigation and everything came back normal
Now presented with a neck lump
Talk to the pt
Background info
Doctor Iam worried about cancer?
Is it cancer?
How you rule out it is not cancer?
Will you not take a sample?
Approach
Pt. I have cancer
Doctor. I can see that you look worried and anxious. Is there is any thing specific that make you feel that It is cancer?
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Explore presentening complain … when did you notice the lump? Where exactly the lump is? How big it is ? Is there any pain dischare bleeding from it? Have you developed any pain in the pasy?
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Family history of cancer
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Systemic reveiw
Headache or fever?
Cough or chest pain?
Problem with you gut diarrhea constipation?
Any problem with your waterworks?
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Ask about previous visits
â—Ź I have going through your notes and I noticed ypu habe visited the practice twice in the last week.
â—Ź can you please walk me through those two visits?
What did they tell you what was wrong?
Did they do any tests?
Did they tell you the results of the tests?
If No, tell that every test is normal
Now USE “BATHE” technique
BACKGROUNG > HOW WOULD YOU DESCRIBE WHAT IS HAPPENING OR GOING ON IN YOUR LIFE AT THE MOMENT ?
AFFECT > HOW DO YOU FEEL ABOUT WHATS HAPPENINH ?
TROUBLE > WHAT TROUBLES YOU THE MOST ABOUT THE SITUATION?
HANDLING > WHAT HELPS YOU HANDLE THIS SITUATIONS AND FEELINGS ?
EMPATHY > THIS IS TOUGH SITUATION TO BE IN. AND YOUR REACTION/ YOUR WORRY / YOUR CONCERN MAKES SENSE TO ME.
Effect of symptoms (panic)
Do you feel any chest pain ?
Shortness of breath?
Palpitations?
Tingling or numbness around mouth?
Feeling anxiety?
Sleep (has it affected? How many hours do you sleep?)
Job(what do you do for living? Has this situation affected you job)
Social life(has you talked to anyone in family or friends about it? Has this situation affected the way you spend your free time?)
Alcohol (do you smoke or drink alcohol? Would you say you have increased smoking or drinking since this started worrying you? )
MOOD ? SCALE? FOR HOW LONG YOUR MOOD HAVE BEEN LIKE THIS?
REFLECTION QUESTION
- WHAT DO YOU THINK ABOUT WHAT OTHER DOCTORS TOLD YOU IN THE LAST VISITS?
- WHAT DO YOU THINK ABOUT THE FACT THAT THE TESTS DONE LAST TIME CAME BACK NORMAL ?
EXAMINAION
NO LUMP
NO SWELLING
SOME SCRATH MARKS
DIAGNOSIS
all my examinations are normal and the tests that have been done last time were also normal.
This shows that there is no life threatening illness that could put your life at risk
But you have a serious and impairing condition that we do see very frequently but doesnt completely understood.
You have a worry that you may have cancer. This worry is affecting your health and quality of life.
Although there is no cure of this but we have some options which can help you deal with situation in a better way
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We can offer Counselling session known as cognative behaviour therapy that can help you cope with this. It can help you understand this condition and also give you strategies. Would that be ok if you could go to counselling sessions they can be really beneficial.
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We highly encourage you to exercise. It will help improve your worry.
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Let me reassure you that this is highly unlikely to be cancer. But we will call you on regular visits to test you time to time tp see everything is fine and there are no changes. And if there any, we can pick it up early.