DR. RODGERS: Good morning, Antoine. I’m Dr. Rodgers. It’s nice to meet you.
ANTOINE: Hi.
DR. RODGERS: I see you’re here today for back pain. Can you tell me more about it?
ANTOINE: Yeah, I’m having this pain in my lower back – it’s really bad. Pretty much hurts all the time. I can barely work. I really just need some meds for it. Hurt it a while ago and I was taking Percocet. That made it feel better; but I ran out, so I just thought I’d come in, get some more.
DR. RODGERS: I’m sorry to hear you’re in pain. Does the pain travel down into your buttocks, into your hip or lower leg?
ANTOINE: A little down my legs, but mostly just in my lower back. Hurts to stand, it hurts to walk, it hurts to climb the stairs. It's a sharp, burning pain.
DR. RODGERS: I understand. Back pain can be really bothersome.
ANTOINE: No offense, Doc, but this pain is god-awful. It’s more than just ”bothersome.”
DR. RODGERS: You’re right, I’m sorry. Well, let me ask you some questions to learn more about your situation.
ANTOINE: Okay.
COACH ADVICE: By calling his pain “bothersome,“ you made Antoine defensive, giving him the impression that you don’t understand the severity of his pain.
DR. RODGERS: So, when you first injured your back, who gave you the Percocet?
ANTOINE: Uh, I saw this doctor a while back because I tweaked my back carrying some heavy stuff. He gave me some Percocet and it worked like a charm.
DR. RODGERS: Did that doctor do any x-rays or a MRI?
ANTOINE: Yeah, they said it was a herniated disc or something? I don’t really remember. But now it’s hurting again and I gotta get this fixed so I can get back to work.
DR. RODGERS: How long ago did you injure your back?
ANTOINE: About eight months ago.
DR. RODGERS: So you’ve been taking the Percocet ever since?
ANTOINE: Mm-mm. My prescription ran out a few months ago. Then I got some here or there from my buddies, you know. It’s the only thing I’ve tried that works, which is why I came in.
ANTOINE INNER THOUGHT: My buddies are all running out of their meds, too…
DR. RODGERS: Antoine, acquiring Percocet without a prescription, even if you’re getting them from friends, is illegal. You shouldn’t do that.
ANTOINE: If you’re not going to help me out, alright then, no problem. I’ll take care of it myself.
COACH FEEDBACK: Giving your opinion about Antoine’s illegal use of Percocet made him feel judged. Instead, save your opinion until later in the conversation, when he’s more comfortable with you. Undo this decision and select a different option.
DR RODGERS: Did something happen recently to make the back pain worse?
ANTOINE: (laughs). Yeah. You’re going to think this is crazy, but a few weeks ago I fell outta bed while I was sleeping and I landed smack on my lower back. I know right, it sounds crazy.
DR. RODGERS: Have you had problems falling out of bed in the past?
ANTOINE: Well, I… um… I’m sorry, could you repeat that?
DR. RODGERS: Have you ever fallen out of bed before?
ANTOINE: No, this was the first time. I was just having one of my nightmares, you know?
ANTOINE INNER THOUGHT: So embarrassing. Falling out of bed and hurting myself like an old man…
DR. RODGERS: That must have been a horrible nightmare to make you fall out of bed like that. How frequently do you have nightmares?
ANTOINE: Well, my wife says that I have them a lot because it wakes her up and she sees me flailing around and stuff, and I’m sleeping like crap, I’m tired… so I guess it makes sense.
DR. RODGERS: What are they like?
ANTOINE: Well, I served in Afghanistan, so I have plenty of ugly pictures floating around in my head
DR. RODGERS: So the nightmares are about your time in the service.
ANTOINE: I think so… Sometimes it’s like images from Afghanistan and other times it’s just weird, like being chased or someone is trying to kill me, but I never see them.
COACH ADVICE: Veterans are a particularly at-risk population because they have a higher likelihood of experiencing trauma, which is a risk factor for PTSD and other mental health disorders.
DR. RODGERS: How does your back pain affect your sleep?
ANTOINE: Yeah, I mean that’s what I’m saying here. My back hurts all the time. My sleep is terrible, that’s what I’m trying to tell you. I need this medication because it helps me sleep; it helps me with my back.
DR. RODGERS: So, in addition to helping with your back pain, the Percocet also helps you sleep better.
ANTOINE: You got it.
COACH FEEDBACK: Great job summarizing what Antoine says and showing him that you're listening. Antoine seems to be using Percocet not only to manage his pain, but also to help him sleep better. This could be a sign of a drug habit.
DR. RODGERS: Okay, I can write you a small prescription and we’ll see how you’re feeling in about two to three weeks. And then we can talk about next steps if necessary.
ANTOINE: That’s it? I think I need more pills and maybe a stronger dose. I am really in a lot of pain, Doctor.
DR. RODGERS: Let’s start with this and see how you feel when you finish the prescription.
COACH FEEDBACK: Antoine’s insistence on a new prescription could be a sign of a drug habit. Rather than write him a prescription now, ask a few more questions to find out more about his situation. Undo this decision and select a different option.
DR. RODGERS: How long have you been having these nightmares?
ANTOINE: Well (nervous laugh)… my wife kicked me to the couch the other day because she says she can’t take it anymore, all the sweating and thrashing around. I guess I’ve been having them ever since I got back, which is… like six months ago now.
DR. RODGERS: About six months, okay. I bet the couch doesn’t help with your back pain, either.
ANTOINE: Aw, hell no.
DR. RODGERS: I want to examine your back and then we’ll talk about what to do to help you feel better.