HPI:
Considering this patient’s level of wellness and any past medical history, do you believe there was enough information in the HPI? Why or why not?
Based on the level of wellness and past medical history, I believe the HPI was sufficient since nothing in the other part of the wellness exam demonstrated the need for a more comprehensive HPI. In addition, HPI ought to be the patient’s own report on a complaint which I believe was well explained in the HPI.
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ROS:
Were all systems covered in this ROS? If applicable, name a system you feel is missing and why it is important. (if not applicable, just answer the first question and move on)
In the ROS, the genitourinary system was not covered. I believe it is important to ask about the system to rule out any symptoms of a urinary tract infections which could easily be treated when noted early. Also, the patient is a teenager who may have an active sexual life (though this was later ruled out in the social history), hence it is important to ask for any symptoms on an STI as this may present an early chance for diagnosis and treatment for the same. Also, wellness checks provide an opportunity for patients to know what to look out for in their bodies. Hence, leaving out a system denies the patient a chance to know what symptoms to look out for in the genitourinary system.
Do you see any warning signs in the ROS that would need follow up questions or exams? If yes, what system and signs do you see? Please note: you do not need to be overly detailed, but you need to recognize if there is something in the ROS which is concerning and answer why you feel it is a concern.
In the ROS, the patient denies the presence of any symptoms. The only positive finding is the tired-looking eyes as observed by the health practitioner. The observation, however, ought to be included in the examination section since the ROS should be the patient’s subjective answers pertaining their health.
Medications/Allergies:
Do you believe the information in this section is complete? If not, why? (if not applicable, just answer the first question and move on)
I believe the information in this section is complete as provided. While there were no details as to what was asked concerning allergies, I believe the examiner exhaustively asked the question and the answer was none for both medications and allergies.
Past Medical History:
Was a complete medical history was taken? Why or why not?
I believe some things were lacking in the past medical history. One of the components of a comprehensive past medical history is history of blood transfusions. This, I believe is important to ask especially with the history of surgery. Also, a history of any complications or notable events after the surgery ought to have been asked.
Does anything concern you about this patient’s past medical history that you need to keep in mind while performing a wellness physical exam or when making recommendations? (if not applicable, just state this and move on)
According to the patient, the only positive history is a history of appendectomy, which has minimal complications in the long term. Hence, an abdominal examination would most likely be unremarkable.
Family History:
Is the family history a complete one? If not, what is missing and why is it important? (if not applicable, just answer the first question and move on)
Yes, it is complete
If applicable, do you have any concerns related to this family history which might impact this patient?
According to the CDC, risks for hypertension include family history and lifestyle. The patient has a familial history of hypertension. His paternal grandfather has hypertension and there is limited medical knowledge of the parents. Hence, the patient has a risk of hypertension. Coupled with a sedentary lifestyle, the risk is higher. Hence, this patient may need more focused nutritional follow-up, education on exercise and BP measurements during every visit.
Social History:
For a wellness exam, do you believe a complete social history was taken?
Yes, I believe a complete social history was taken. The history covered all the areas of a person’s social life including: occupation, academic, nutrition, exercise, sexual and relationship history.
If applicable, name something you think is missing and why it might be important to ask about? (if not applicable, just state this and move on)
Nothing is missing.
Objective:
Physical Exam:
Are any systems missing from this physical exam?
Yes, the genitourinary system is missing. This is important for a teenager in revealing any abnormalities in the genitourinary system. It is important for detections of congenital anomalies such as cryptorchidism and diseases such as UTIs and STISs in young adolescents.
If applicable, name a finding in the physical exam that might need follow up? (if not applicable, just state this and move on)
Not applicable.
Assessment:
Do you think the diagnosis/diagnoses are appropriate? Why or why not?
I think the diagnosis was right based on the history and physical exam. Both examinations were not revealing of any physiological problem. Most of the issues noted were mainly lifestyle, with no particular diagnoses for them. Hence, a diagnosis of routine Child Health exam without abnormal findings is right.
Plan:
For this section, focus mostly on the wellness portion of the plan . However, do not ignore the other diagnoses and plans
as you need to consider the entire patient when determining risk factors and answering the questions. Some of these questions ask you to support your answer with evidence. You do not have to put in APA in-text citation, but you will need to list your source on your reference sheet.
Pharmacology:
Do you agree with the pharmacologic plan in the wellness diagnosis? Why or why not? Support your answer with evidence – remember you do not need in-text citations but you need the source listed in your references.
I agree with the pharmacological plan provided for the patient. Based on the physical examination and history findings, there was nothing remarkable enough to warrant the need for pharmacological treatment.
Non-Pharmacologic:
Do you agree with the nonpharmacologic plan in the wellness diagnosis? Why or why not? Support your answer with evidence – remember you do not need in-text citations but you need the source listed in your references.
I agree with the nonpharmacological plan provided in the wellness plan for the patient. According to the history provided, the patient does not engage in any physical exercise. According to the CDC, regular exercise is an important means of improving caloric balance and preventing obesity. While exercise may increase caloric intake, it also increases caloric expenditure. Also, exercise helps improve mental health by improving a person’s affect. For an age group prone to mental health from adolescent changes, exercise serves to improve mental health.
While I agree with nutritional counselling for the patient, I think he needed more information on nutrition. According to the CDC, clinicians ought to provide periodic counselling on intake of calories, fat (mostly unsaturated fats), cholesterol, starches and fiber. Hence, counselling the patient on intake of just fruits, vegetables and fiber is not sufficient. The counseling needs to be all-rounded.
Diagnostics/Screenings:
Which tests or screenings performed during the visit or ordered/recommended are not supported by evidence? Support your answer with evidence – remember you do not need in-text citations but you need the source listed in your reference.
The screening tests that were done include BP measurements and Patient Health Questionnaire (PHQ) for screening of depression. Regular measurement of BP is recommended in people aged 3 years and above. Measurement of BP using the blood pressure cuff is the most appropriate screening method for hypertension in asymptomatic patients. Hence, it is necessary that screening is done during every check-up.
Routine screening for depression in patients with no symptoms is not recommended. The best standard for diagnosis of depression is the opinion of an examining psychiatrist which determines whether the patient’s symptoms meet the criteria for depression. Hence, in this case, PHQ is not an effective method of screening. Furthermore, the tool has been found effective only in detecting extreme forms of depression but not mild ones.
Were any tests or screenings missing and should have been recommended? Support your answer with evidence – remember you do not need in-text citations but you need the source listed in your references.
Based on the patient’s history and physical examination findings, the patient does not meet criteria for any further tests or screenings as recommended by the CDC.
Referrals:
Was this patient referred to any specialists? Do you agree with the referral? If applicable, please explain. (if not applicable, just state this and move on)
The patient was not referred
Patient Education:
List three wellness education suggestions pertinent to this patient (you can consider their other diagnosis/diagnoses or history if applicable to help you answer this). Briefly state why your recommendation is important. Support your answer with evidence – remember you do not need in-text citations but you need the source listed in your references.
Education on exercise, its benefits and connection to disease and its prevention. CDC recommends that patients are taught to understand the connection between a specific behavior and illness. It is important that the session is more of educative than instructive.
Nutritional education. Similarly, nutritional education ought to involve tying up the interventions suggested with the benefits in terms of disease prevention. It is important to inform the patient on the risk unhealthy eating brings, the severity of the problems that could come and the benefits of eating healthy. The patient ought to understand the connection between cardiovascular disease and unhealthy eating.
Reduction on screen time and adopting other ways of socializing physically to help improve relationships, visual acuity and mental health.
Follow up/Health Maintenance:
Give a brief summary of recommendations regarding follow-up for this patient (things to consider are next wellness visit, next immunizations due, next screenings due, etc…). Support your answer with evidence – remember you do not need in-text citations but you need the source listed in your references.
Based on the history and physical examination findings, the patient does not need any other check-up before the annual check-up. Hence, the patient’s next visit is recommended to be the annual wellness check-up. The next immunizations ought to be a booster tetanus-diphtheria vaccine which is recommended between 14 and 16 years of age and every ten years thereafter. Hence, the patient can receive the next vaccine in his next visit at 15 years of age.
Some sources state wellness exams are not evidence based or supported by the literature. What are your personal thoughts on wellness exams?
I think that wellness examinations are important as a way of monitoring health. Most diseases in their primary stages are asymptomatic, or presents with mild symptoms which may not prompt hospital visits. A habitual wellness exam gives the patient and practitioner a chance to detect most problems early enough. Conditions such as hypertension and diabetes cause end-organ damage when left uncontrolled. Hence, it is important that they are detected early and controlled. Others such as cancer have better treatment outcomes in the early stages. Hence, a wellness exam is necessary to unearth some of these hidden problems.
References
Beran, M. S., & Craft, C. (2015). Medicare Annual Wellness Visits. Minnesota Medicine .
Center for Disease Control. (n.d.). Retrieved June 06, 2020, from https://wonder.cdc.gov/wonder/prevguid/p0000109/p0000109.asp#head061000000000000
Meegan, A. P., Perry, I. J., & Phillips, C. M. (2017). The association between dietary quality and dietary guideline adherence with mental health outcomes in adults: a cross-sectional analysis. Nutrients , 9 (3), 238.
O’Connor, E. A., Evans, C. V., Burda, B. U., Walsh, E. S., Eder, M., & Lozano, P. (2017). Screening for obesity and intervention for weight management in children and adolescents: evidence report and systematic review for the US Preventive Services Task Force. Jama , 317 (23), 2427-2444.
