Case Study: Patient O

case-study

Before I go on to present the case study, I’ve got a disclaimer: I AM NOT A MEDICAL DOCTOR! It’s hard for people in this part of the world to understand what the course I spent the last five years studying (Neuroscience & Clinical Neuroscience) entails, so they end up calling me ‘doctor’. I actually do like it as a nickname, and it won’t be long before that title manifests by the grace of God – Doctor of Science that is!

I am a neuroscientist foremost, but I didn’t become that without learning basic and advanced medical sciences. I took classes with future medical doctors; we all had to learn the basics of medicine together. I just happen to have specialized in neuroscience, without having to go to medical school. Not going to medical school means I’m not a medical doctor, but I still have the same basic knowledge they do, and even more knowledge than a GP might have in my specific field. I’m unable to diagnose and treat patients, but I understand diseases and their treatments; that’s what my research life is all about! I know ‘why?’ when a medical doctor might not be able to answer that. 

So on to our first case study! 

Patient O was diagnosed with bipolar disorder (type not specified) and was placed on Epilim 1000mg by Dr. G after one session that lasted about thirty minutes. He complained about insomnia – which his mother treated with Lexothan – and depression. He never smoked, drank or had sex. 

I doubt you’d see any red flags there, but that’s why I’m here! Dr. G didn’t explain to Patient O what bipolar disorder (BD) is,the patient didn’t understand why he was diagnosed with the disorder, and what the medication he was taking was supposed to do, so he turned to me to help him understand what was going on.

“Bipolar disorder, formerly called manic depression, causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Mood shifts may occur only a few times a year or as often as several times a week.”  Mayo Clinic for more details.

Let’s list everything wrong that happened in this situation and discuss.

  • Doctor didn’t ask for details about the symptoms stated by the patient
  • Doctor didn’t explain to the patient the diagnosis and medication 
  • Doctor diagnosed patient in one session lasting 30 minutes
  • Doctor gave a misdiagnosis 

Some patients don’t exactly understand the words they use in describing their symptoms, so it’s the job of the doctor to ask for more details so they can correct such mistakes. I asked Patient O to give more details about his insomnia and depression. Patient O stated that he could be awake a maximum of 30 hours before going to sleep and his depressive episode only lasted while he was at an orientation camp for NYSC. It is possible that this patient might have had insomnia, but it’s difficult to conclude that from the information he gave. Nevertheless, having insomnia doesn’t mean you have BD as there are a vast number of diseases/disorders that it could be a symptom for. Concerning depression, I had spent a little time with the patient when he got out of his NYSC camp, and I had just gotten out of an NYSC camp as well, so it was easier for me to understand what he called ‘depression’. He experienced what most of us experienced while at an NYSC camp; we were truly depressed for the duration of our stay at the orientation camp, but it only lasted while we were in that situation. Once we were out of the ‘hell’ called an NYSC orientation camp and had our postings settled, the ‘depression’ was gone! 

The patient didn’t meet any of the criteria used in diagnosing bipolar disorder and such a serious condition can’t be diagnosed in one session lasting thirty minutes. It’s way more complicated than that! After the misdiagnosis, Dr. G didn’t specify the type of bipolar disorder (there are about 5 categories of BD), didn’t explain to the patient what the diagnosis meant and what the medication he was given was treating. That’s another red flag right there! Here’s where it could be dangerous though: taking medication that’s not treating you and could be harming you instead. Epilim was developed to treat epilepsy, but it also treats the manic episode of people with BD. Let’s pretend for a second that the patient actually had BD and complained of depression, would you give him a drug meant to treat the manic episode of the disorder? I don’t think so! Thankfully, there have been clinical trials with the drug Epilim (1000mg) in healthy subjects and there weren’t any fatalities recorded.

The red flag that carries the most weight is the fact that after I did some digging into Dr. G, I found out that he had his license revoked in another country and he thought it was ok to keep practicing in Nigeria in a reputable and trusted hospital. He didn’t even have the decency to explain a diagnosis to a patient! All this makes me question if there’s any kind of background check in reputable hospitals in this country. I hope for the sake of you all, this was just a fluke but I think I’m being too hopeful there. 

Being a good patient, Patient O decided to continue with the medication until his next visit to the doctor which was a month after the first. I don’t know what went down in that session, but after equipping him with the right questions to ask, the diagnosis was dropped and he was taken off the medication. Up until today, Patient O continues to call me and thank me for my help, and I know that his story will be a lesson to all!

I can’t begin to imagine the number of people that have been misdiagnosed and placed on medication that’s worsening their case. Health professionals are human beings that can make mistakes too, and they don’t know it all. So you owe it to yourself to do your research on whatever condition you’re treating and the medication you’re using. Ask the right questions and save yourself from fatality!

If you don’t know where to start, refer to What Do You Know About Your Medication? to know the questions you should be asking. 

 

 

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