Patientcentred problems

A more detailed history about the effect of the back disorder on the patient revealed the following:

• humiliation about being on workers' compensation

• boredom and frustration leading to irritable behaviour ('not like me')

• anxious about his future, particularly occupation

• fears of being a cripple 'in a wheelchair'

• conflicts with family members

• concern about reduction of sexual performance

• anger with lack of response from medical management

• anger with lack of interest in his problem

• concerns about something more serious (he admitted to a fear of cancer)

• feelings of depression: unable to cope, sleep disturbance

• concern about taking drugs, especially NSAIDs

Patient-centred physical examination (additional)

General: Tense and anxious man looking older than his years, senile arcus.

Cardiovascular examination: Blood pressure 165/100.

Weight: 85 kg.

Height: 1.67 metres.

Body mass index: 30.5

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