How to Propose a Treatment Plan

Dr. Schaffer is going to explain Mr. McGrath’s diagnosis and treatment options to the McGraths. She would like you to prepare a document that they can refer back to. Specifically, she would like the document to include:

• An explanation of Mr. McGrath’s diagnosis and prognosis
  
  
• An explanation of why Mr. McGrath must undergo each of the 4 tests for surgical fitness.

Dr. Schaffer has also asked you to calculate Mr. McGrath’s MELD score, so he can be placed on the UNOS transplant list.

The steps below will help guide your work.

1. Review the email from Dr. Schaffer. It may be helpful to print the email and highlight the important points.
   
   
2. Make sure your understand your job in this task before you get started. If you are unclear about what to do, first try re-reading the email. If you are still unclear, speak to your mentor.
   
   
3. Download the email attachment. You will need these test results to calculate a MELD score for the patient, and the template will help you track you work.
   
   
4. Calculate Mr. McGrath’s MELD score.
   1. Go to the UNOS site. Enter the relevant test data from the email attachment. Note: Your patient has not been on dialysis.
      
      
   2. The site will calculate Mr. McGrath’s MELD score. Note it for your report.
      
      
   3. To learn more about UNOS and the MELD score, click here.
      
      
5. Review the work you completed in Task 1: Develop Differential Diagnosis and Task 2: Confirm Diagnosis. Do you have any questions about Mr. McGrath’s diagnosis or the science to explain it? If necessary, review the resource materials in DATA. Make sure you can answer the following questions:
   
   
   1. What is liver cirrhosis?
      
      
   2. How does Hepatitis C cause liver cirrhosis?
      
      
   3. How does the diagnosis, liver cirrhosis caused by Hepatitis C, explain Mr. McGrath’s symptoms? What test results support the diagnosis?
      
      
   4. Why can’t Mr. McGrath take interferon?
      
      
   5. What are the implications of having Hepatitis C post transplant? Is he cured? If not, what will he need to do after the transplant to treat his Hepatitis C?

   Can you explain Mr. McGrath's prognosis? A prognosis is an educated prediction about what will happen to a patient. You will need to explain to Mr. McGrath what will liekly happen if he has the surgery and what will likely happen if he does not.
   
   

6. Get Mr. McGrath’s consent for the surgical fitness tests.

1. For help in understanding how surgery stresses the body, read the Surgical Fitness FAQ.
   
   
2. Convince the patient to consent to each of the following tests:
• EKG
• Cardiac stress test
• Chest X-ray
• HIV test
  
  
3. For each test, explain:
   • What the test is, how it is performed, how Mr. McGrath will prepare for it.
   
   
   • The rationale for ordering the test. What questions you trying to answer with this test and how will it help determine if Mr. McGrath is fit for surgery.
   
   
   • Any potential risks or side effects.
     
     

4. Use the Diagnosis and Treatment Archive (DATA) to research each test.
   
   
5. Use the template you downloaded from Dr. Schaffer’s email to take notes.
   
   
7. Review Tips and Traps by clicking the link above.
   
   
8. Write your report for Dr. Schaffer using the Consent Template provided.
   1. Explain Mr. McGrath’s diagnosis and status to date. What have you done for Mr. McGrath so far? What do you know about his diagnosis?

   Remember this is the first time anyone has explained Mr. McGrath's diagnosis to him. In your description be sure to explain all the details of Mr. McGrath's diagnosis and how you arrived at the diagnosis. Specifically, Mr. McGrath needs to understand:

   1. He has liver cirrhosis caused by Hepatitis C and how those two problems are related to one another.
   2. Why he is experiencing each of the three symptoms (jaundice, ascites and mental status changes).
   3. Why we must consider a liver transplant, instead of treating him with interferon.
   4. He will still have Hepatitis C after the surgery. As part of this explanation be sure to give Mr. McGrath his prognosis. Tell him what is likely to happen if he has the surgery and what will likely happen if he does not.
   5. You have already added his name to the UNOS list and what his MELD score is.
      
      
   2. Convince the Mr. McGrath to consent to the surgical fitness tests. When you explain the tests, be sure to cover each of the points above (Step 6, i – iv) that Dr. Schaffer has asked you to review.
      
      
9. Submit your work. Review the instructions under the Submit Your Work tab above, and then submit the assignment to your mentor.

• Do not move on from a step until you fully understand that part of the task.

Understanding the Science

• Read the science links. As you research each finding in DATA, make sure to read the science links. If you don’t understand the underlying science, you will not succeed in this task.

Writing Your Report

• Dr. Schaffer has asked you to consider the patient’s feelings in creating your report. Be sensitive to the fact that news of a liver transplant may be overwhelming for the patient. Be clear and thorough about what the patient should expect, but be convincing about the importance of undergoing the tests for surgical fitness.

Diagnosis and Treatment Archive (DATA) - Internal Medicine

Diagnosis and Treatment Process
This document describes the process that health care professionals typically use to diagnose and treat their patients.

Surgical Fitness FAQ
This FAQ gives information on why a patient must be fit for surgery. It also reviews many of the the possible complications and how surgical fitness can help a patient handle those complications.

UNOS and Transplant Issues FAQ
This FAQ discusses organ transplant and the role of UNOS in that process. It also looks at the MELD score, how it is calculated and why it is used.

Ask the Expert

What is Hepatitis C?

How is Hepatitis C contracted?

What is the difference between Hepatitis A, B and C?

How does Hepatitis C cause cirrhosis of the liver?

What is interferon?

What is ribavirin?

Why wouldn't a patient be a good candidate for interferon?

What are the main reasons a patient would be ineligible for surgery?