June 2011 Case A Review: Checkpoint A Contents Patient Name: Jonathan Sandman Case Investigation #: 587291 Dear Investigators, Thank you for agreeing to take a look at this patient s file. After the initial visit with the patient Dr. Williams wasn t able to make a complete diagnosis. With your help, hopefully we can narrow down the cause of the patient s troubles staying awake. Initial assessments lead us to believe that the patient s problems are circadian in nature, but only you can determine that for sure. We have divided the patient s case file into several smaller checkpoints to make the information easier for your diagnostic team to manage. Each checkpoint will contain a set of resources we were able to assemble to help you with your diagnosis. Below is the list of materials we were able to gather for checkpoint A: Patient records o Central Midwest Hospital Email Records o Doctor-Patient Interview Transcript o Epworth sleepiness survey After looking through these materials, complete the checkpoint sheet for our records and to gain access to the next level of materials. Good Luck Page 1 of 1
Central Midwest Hospital Email Records ----------------------------------------------------------------------------- The following communications have Physician Signature: been approved for release from the hospital s secure email system for medical case review. ---------------------------------------------------------------------------- --Message 1-- Date: Wed, 16 Jun 2010 12:03:16 PM Delivered-To: awiliams@centralmidwest.com Subject: Would like to schedule an appointment for my son From: Samantha Sandman <ssandman@binkmail.com> To: Dr. Alex Williams <awilliams@centralmidwest.com> Hello Dr. Williams, I am interested in setting up an appointment for my son, Jonathan. He seems to have some trouble staying awake after he gets home from school and I am not sure what s causing it. Since he joined the basketball team this year he has already missed 3 practices because he was already asleep before practice started after school. He s also in the next school play, and he seems to really struggle to make it through the evening rehearsals. I m worried about him, and I don t want to see him quit his extracurricular activities just because he is sleepy. Let me know what would be a good time to set-up and appointment. Sincerely, Samantha Sandman --End of message 1-- Page 1 of 3
Central Midwest Hospital Email Records --Message 2-- Date: Wed, 16 Jun 2010 3:45:23 PM Delivered-To: ssandman@binkmail.com Subject: Your son s appointment From: Dr. Alex Williams <awilliams@centralmidwest.com> To: Samantha Sandman <ssandman@binkmail.com> Dear Mrs. Sandman, Thanks you for writing to me about your son. While there could be many reasons why Jon has been having trouble staying awake in the evenings, please don t worry. Has your son changed his behavior in any way since joining the basketball team? I will put Jon into my schedule and we ll see if we can narrow down what is causing this. Dr. Williams General Practice Physician Central Midwest Hospital Room 332 --End of message 2-- Page 2 of 3
Central Midwest Hospital Email Records --Message 3-- Date: Thur, 17 Jun 2010 10:25:43 AM Delivered-To: awilliams@centralmidwest.com Subject: Would like to schedule an appointment for my son From: Samantha Sandman <ssandman@binkmail.com> To: Dr. Alex Williams <awilliams@centralmidwest.com> Hello again Dr. Williams, Thank you for setting up the appointment. I haven t noticed any obvious changes in Jon s behavior, but I am not sure what exactly I should be looking for, do you have any suggestions? I m worried he might be getting up early to play video games since he has been so busy in the evenings before he falls asleep. Thanks again for your help, Samantha Sandman --End of message 3-- ----------------------------------------------------------------------- End of Hospital Email Records Request #467237 ----------------------------------------------------------------------- Page 3 of 3
Doctor- Patient Interview Transcript ----------------------------------------------------------------------------- The following transcript has Physician Signature: been approved for release from the hospital s secure records for medical case review. ---------------------------------------------------------------------------- Patient: Jonathan Sandman Primary Care Physician: Alex Williams Date Recorded: Jun 20, 2010 ------------Begin Transcript------------ Doctor: Hello Jon, good to see you again, how have you been doing? Jon: Okay. Doctor: How is school going for you? Jon: Alright, I guess, I can t wait to graduate. I am waiting to hear back from colleges that I applied to. Doctor: That s great, and classes going okay? Jon: Well, actually, I haven t been doing very well lately on my tests. I find it hard to concentrate during exams, sometimes I fall asleep during class. My teachers get pretty annoyed. Doctor: Are you unusually stressed or tired? Jon: Well, it is basketball season, and homework usually takes me 3 hours a night. Doctor: Are you getting enough sleep? Jon: Sometimes I go to sleep really early on weekends. Doctor: Do you feel more rested on weekends? Jon: Yeah, usually I feel more awake. Doctor: What time do you usually go to sleep? Page 1 of 3
Doctor- Patient Interview Transcript Jon: On weeknights I go to sleep at 11 or 12. Sometimes I fall asleep while I am working on my homework. Doctor: Do you have trouble falling asleep? Jon: No. I fall asleep right away. Doctor: What time do you wake up? Jon: Sometimes I wake up at 4:30, and I can t fall back asleep. Sometimes I finish up homework but usually I play video games before I go to school. Doctor: How long has this been going on? Jon: I guess it is pretty recent; I never used to wake up so early. Maybe I didn t notice it before; this is my first year on the basketball team. Doctor: Did you used to go to sleep earlier? Jon: Yeah, I would usually go to sleep right after I finished my homework at 7 or 8. Doctor: You are having some trouble at school do you do anything to try to stay awake? Jon: Yeah, I drink coffee. Doctor: Do you take any other drugs: alcohol? Jon: No. Coach says that if he hears we drink we are off the team. Doctor: Any other recreational drugs? Jon: No. Doctor: Do you spend a lot of time with your friends? Jon: Mostly on the basketball team. We used to go out on weekend nights, but usually I just stay home now. Page 2 of 3
Doctor- Patient Interview Transcript Doctor: Do you drive to school? Jon: Well, I used to, but now my friend drives me. Once while I was driving at night, I got really tired, and fell asleep at a red light. Someone honked and I woke up right away though. Still, it was scary. Doctor: That does sound scary. It sounds like avoiding driving is a good idea until we get this sorted out. ------------End Transcript------------ Page 3 of 3
August, 3 2011 Draft Materials Initial Patient Epworth Sleepiness Scale Patient Name: Jonathan Sandman Primary Care Physician: Alex Williams You have been requested by your physician to complete an initial sleepiness inventory. Please complete the following survey and bring to your next doctors visit. Physicians use the Epworth Sleepiness Scale to determine the level of daytime sleepiness in their patients. Patients are asked to think about how they have responded to these situations recently, or imagine how they would have felt in the situation. Patients score themselves from 0 to 3 as follows: 0= no chance of dozing 1= slight chance of dozing 2= moderate chance of dozing 3= high chance of dozing Situation: Sitting and reading Score: Watching TV Sitting in a public place (e.g. theater or meeting) As a passenger in a car for an hour without a break Lying down to rest in the afternoon when circumstances permit Sitting and talking to someone Sitting quietly after a lunch without alcohol In a car, while driving, stopped for a few minutes in traffic A score of 10 or more is considered sleepy. A score of 18 or more is very sleepy. Patient Signature: Page 1 of 1