From the Guidelines
You should see this patient despite her previous AMA departure, as her new complaints of ear pain, facial pain, and reported history of brain cancer require immediate assessment and evaluation. When a patient returns after leaving AMA, they should be treated as a new presentation, and their previous departure does not negate the duty to provide care 1. The patient's new complaints, particularly the reported history of brain cancer, necessitate a thorough evaluation, including a review of her previous medical records to verify the cancer history.
Initial Assessment
A focused evaluation of her ear and facial pain should be performed, and the attending physician should be consulted about her status and care plan. The rehabilitation team should meet to establish clear boundaries and expectations for continued care. It is essential to document the patient's return and new complaints in the medical record, as this will help ensure continuity of care and facilitate communication among the healthcare team.
Considerations for Brain Cancer
Given the patient's reported history of brain cancer, it is crucial to consider the potential for brain metastases, which can cause a range of symptoms, including neurological deficits, seizures, and cognitive impairment 1. The diagnostic work-up for suspected brain metastases should include cranial MRI with pre- and post-contrast T1-weighted, T2-weighted, and/or T2-fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI) sequences.
Interdisciplinary Approach
Involvement of an interdisciplinary team, including neurosurgeons, is essential in the management of brain tumors, as these patients often require a range of services, including surgical intervention, radiation therapy, and supportive care 1. The team should work together to develop a comprehensive care plan that addresses the patient's physical, emotional, and psychological needs.
Prioritizing Patient Care
While the patient's previous AMA departure and new complaints require careful documentation and possibly a psychiatric evaluation, patient abandonment could create legal and ethical issues. The primary concern should be the patient's well-being and safety, and all efforts should be made to provide her with the necessary care and support.
From the Research
Patient Assessment and Management
- The patient's history of brain cancer, ear pain, and facial pain should be thoroughly evaluated, considering the potential for brain metastases or other complications 2, 3, 4.
- A comprehensive physical examination and review of the patient's medical history are essential to determine the underlying cause of their symptoms.
- The patient's previous decision to leave the facility Against Medical Advice (AMA) should be taken into account, but not necessarily influence the current assessment and management plan.
Brain Cancer and Its Complications
- Brain tumors, including metastases, can cause a range of symptoms, including pain, seizures, and cognitive decline 2, 3, 4.
- The management of brain tumor patients requires a multidisciplinary approach, involving neurosurgery, radiation oncology, and medical oncology 2, 3.
- Imaging studies, such as MRI, are crucial in evaluating patients with brain masses and detecting potential complications 5.
Current Symptoms and Potential Causes
- The patient's complaints of ear pain, facial pain, and history of brain cancer may be related to their underlying condition or a new complication 2, 3, 4.
- A thorough evaluation, including diagnostic testing and imaging, may be necessary to determine the cause of the patient's symptoms and guide management decisions.