PROTECTING PATIENT SAFETY AND IDENTITY

Protecting Patient Safety and Identity

Protecting Patient Safety and Identity

Question 1

Heartburn is highly prevalent and can vary in frequency and severity. For some patients, it is merely an occasional nuisance. Among clinicians, frequent heartburn is widely acknowledged to be the most common symptom of gastro esophageal reflux disease (GERD). In Melissa Kain case roundtable discussion was not to provide a comprehensive overview of the diagnosis and management of GERD. Rather, it was to formulate a rational, cost-effective approach to the treatment of heartburn that would be applicable to primary care providers in a variety of practice settings while keeping in mind the need to satisfy patient expectations about improvement of symptoms.

Question 2

Melissa Kain does not respond well, or at all, to medications, as powerful as they may be. And, while some of the PPIs are available over-the-counter, most are expensive prescription drugs that pose a financial burden for patients. Other patients simply don't like the idea of taking any medication for the rest of their lives and want options. So, we look for a burning sensation rising up in the chest. Typically it is associated with meals; sometimes it occurs at night. Regurgitation, as you pointed out, is a separate symptom. This description fits the case study that can be a starting point for our discussion.

Question 3

When recommending and explaining treatment to patients, we need to make a distinction between symp- tom improvement and total symptom relief. So many people are dissatisfied with their heartburn treatment. Part of the problem is that patients' expectations for treatment have been increased considerably. Also, people often diagnose themselves, self-medicate for conditions they don't have, and find that they're not getting better. They may be unaware that they've chosen an inappropriate treatment that may temporarily improve their symptoms but will not offer complete symptom relief.

Question 4

There are 2 characteristic problems: (1) a burning discomfort centered in the chest that radiates in an upward direction and (2) a mechanical sensation that something is coming up the esophagus. Many people incorrectly equate any discomfort between the xiphoid process and umbilicus with heartburn. But heartburn isn't consistently below the xiphoid, and it usually does not spread out across the chest or radiate to an extremity. Nor is it predictably associated with physical activity, although it can be. It isn't constant. In most people, heartburn seldom lasts beyond a few minutes.

Most patients ...