Howard’s subjective diagnosis is important for clinical assessment but it is of less significant value and further measurable objective data is needed to support his claims (Koehler et al., 2011) . As a medical practitioner, I would analyze Howard’s medical history to understand the prior professional diagnoses as they appear in his documents. He claims that he has ulcer and cannot take ibuprofen (Motrin). He also states that he suffered an accident in 2012 and needs the pain medications. He further boasts of high pain tolerance and requires the strongest doses available. Prior to prescribing any medication, I would examine his medical history.
Howard’s history with drugs seems to trace back to a long past deducing from the fact that he had a car accident eight years ago and still registers the pain. The major question is therefore: is Howard abusing drugs? Is there evidence to support this? I would first ask if he is currently abusing any legally prescribed or illegal drugs (Lohman & Barrett, 2020) . The FDA has five schedules for various drugs, and these include the obviously illegal schedule one drugs like heroin and other non-harmful legal gastrointestinal drugs like Parepectolin (Lopez, 2016) . Based on his insistence, I would inquire about his prior prescriptions and then decide on a prescription.
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I would prescribe a long acting narcotic because he states that he is in severe pain and needs a pain reliever (Argoff & Silvershein, 2019) . This decision is also informed by the relevance of long acting narcotics (Michigan Medicine: University of Michigan, 2020) . These drugs are suitable for long-term severe pains, like Howard’s. Although they do not cure any disease, they help patients manage pain relatively well and this will give me time to prepare a treatment plan for Howard.
References
Argoff, C., & Silvershein, D. (2019). A Comparison of Long- and Short-Acting Opioids for the Treatment of Chronic Noncancer Pain: Tailoring Therapy to Meet Patient Needs. Mayo Clinic Proceedings , 84 (7), 602-612. https://doi.org/10.1016/s0025-6196(11)60749-0
Koehler, M., Koehler, K., Koenigsmann, M., Kreutzmann, N., Fischer, T., & Frommer, J. (2011). Beyond diagnosis: subjective theories of illness in adult patients with acute myeloid leukemia. Hematology , 16 (1), 5-13. https://doi.org/10.1179/102453311x12902908411599
Lohman, D., & Barrett, D. (2020). Scheduling medicines as controlled substances: addressing normative and democratic gaps through human rights-based analysis. BMC International Health And Human Rights , 20 (1). https://doi.org/10.1186/s12914-020-00231-1
Lopez, G. (2016). The federal government won't change marijuana's "schedule." Here's what that means. . Vox. Retrieved 31 August 2020, from https://www.vox.com/2014/9/25/6842187/drug-schedule-list-marijuana.
Michigan Medicine: University of Michigan. (2020). Safe Use of Long-Acting Opioids | Michigan Medicine . Uofmhealth.org. Retrieved 31 August 2020, from https://www.uofmhealth.org/health-library/abo7833.
