Background (085-028-01-2) Michael and Aviezer
The patient aspired to be an historian but became a tour guide. Later, he was forced by difficult economic circumstances to work for his brother-in-law as an overseas salesman of irrigation equipment, exclusively to accounts in third world countries.
Although he had one period of bowel dysfunction associated with stress while a university student he had been symptom free in the subsequent 18 years. However, in the last 3 years, since travelling frequently abroad he has started having intermittent pain and diarrhea- usually while away from Israel.
He hates his job, hates travelling and finds great difficulty in the task of meeting with foreign clients- usually at long, ceremonial and boring meals at restaurants. In his mind it is the level of hygiene in these foreign countries that is causing his bowel disorder. And so he plans this visit to the doctor to get some preventive medicine and something effective to take should the symptoms recur on his up-coming trip.
The action
This clip begins with the doctor asking about the patient’s symptoms in an open- ended question. The patient supplies a few clear symptoms but soon veers back to talk about his dislike of the conditions of his work.
Educational opportunities
Possible talking points:
- What additional CASE material did the patient reveal to the doctor in this clip? { he has to socialize at length with his clients and he’s working for his brother-in-law. ] How would you classify these? What’s their importance ?
- In his response to the doctor’s question the patient raises issues of “problem-solving” (symptoms) and “connecting” (his distaste for his work). What are the doctor’s options in selecting his next response? and which option would you recommend. [ I think the doctor should continue his collection of biomedical details of the illness but only after acknowledging having heard the patient’s CASE]
- This clip demonstrates doctor – centeredness. How?
For lower level students: the opening statement represents an example of an open question
