PATIENT’S GUIDE

CEA Workshop

Case 1
Hx: 25/F who has been experiencing on and off headache for 10 years. Headache was not to be unilateral and
sometimes associated with flashes of lights or loud sounds. It is also relieved by rest or by taking Paracetamol.
PE: unremarkable including neurological exam.
Dx: Migraine Headache
Plan: Pain management (Higher NSAIDs/Sumatriptan)
 ECM: she has brain tumor
 Emotion: fear of dying
 Context: her officemate died a few weeks ago due to severe headache, fever and neck rigidity

Case 2
Hx: 36 y/o male, asymptomatic came in due to a positive HBsAg during his pre-employment
examination.
PE: Unremarkable
Dx: Hepatitis B Infection
Plan: Repeat HBsAg after 1 month including Anti-HBs to check if antibodies have developed.
 ECM:
1. “I might have Liver Cancer”
2. “I will not be able to pass the pre- employment exam and will not be able to work anymore because of the
result”.
 Emotions:
1. Fear of Cancer
2. Sadness because of inability to work
 Context: He is the major breadwinner of the family. If he will get cancer and will not be able to work, how
will his children be able to finish school

Case 3
Hx: 50/M from Makati is a CEO of a multimillion company. During his Executive Check-up , his 2D Echo
showed mild mitral valve prolapsed. He narrated that he has no symptoms at all
PE: Normal
Plan: Annual 2D Echo for monitoring
 ECM: He has a heart problem and that he has to give up his new job that he has been just recently promoted
to.
 Emotion: very sad
 Context: It is his dream to be a CEO since he started in the company. The job means so much to him because
this means he will be able to send his children in a prestigious school that he himself was not able to have,
he will be able to satisfy his wife’s luxurious needs like going in a vacation abroad, and he will be able to buy
a new house for his family.
Case 4
Hx: 59/M had a chronic cough for 3 months already. He also noted that he had weight loss and
intermittent fever in the afternoon. His X-ray findings showed suggestive findings of Pulmonary
Tuberculosis. Sputum AFB was done and result was consistent with PTB.
PE: BMI of 16.7, E/N chest findings
Plan: Start anti-koch’s therapy
 ECM: his family might kick him out of the house
 Feeling: anxiety, fear
 Context: He is not in good terms with his family. Because he retired early and the pension he is getting is just
enough to pay his loan he used when he had an affair with a younger woman, he’s not able to contribute
much with the daily family needs. He is afraid that when his family finds out about his illness, they will have
a reason to kick him out of the house because he can be infectious

Case 5
Continuation of Case 4
Other members: Wife and Daughter
ECM, Emotions and Context of Wife: She is still mad about his husband because of his history of being a
womanizer at some point of his marriage. She thinks that she might get infected or that she was already
infected snce they sleep together in one room. She thinks that she might need to isolate all the things
his husband uses.
ECM, Emotions and Context of daughter: She feels bad because she might get infected and that this
may reflect on her annual physical exam in the call center company she is working. She might lose her
job. Also, she feels bad that since both her parents don’t have work anymore, she will have to shoulder
his father’s medicines.

BEHAVIORAL CHANGE (Pre-contemplation and Contemplation Stage)

o Case: CM, 45 y/o, male, from Pasig City is a smoker since high school. He usually smokes an
average of 8-10 sticks per day. Few minutes upon waking up and every after breakfast, he never
fails to smoke a stick or two. He said that he even goes in the office’s fire exit to smoke after his
AM Snack. However, he denies smoking in the church, cinema or other forbidden places. There
was a time he was brought to the hospital due to difficulty of breathing because he smoked
when he was sick. The doctor explained to him that he needs to quit smoking but his decision is
exactly the opposite. He narrated that his smoking made him more relaxed and decreases his
anxiety and stress level. It is also his way of bonding with his officemates. He said that he gained
new friends with smoking with them. However he is still afraid that this could affect his health
since he has an uncle who had lung cancer. Although at some point , he thought of quitting so his
breathing will be better and he can avoid getting cancer, he still thinks that it was a bad idea
because his officemates who tried to quit had withdrawal symptoms like tremors, depression and
chest pains.