CASE #2 A resident presents a 35-year-old man with a 5-year history of intermitt
ID: 3516910 • Letter: C
Question
CASE #2 A resident presents a 35-year-old man with a 5-year history of intermittent abdominal pain consistent with irritable bowel syndrome. In the course of a full examination, small testes are noted. On questioning, the patient notes low sex-drive. Initial work-up reveals a low testosterone level; further work-up includes a chromosomal study that indicates the patient has a 47,XXY karyotype (Klinefelter’s). He has an appointment to discuss his results. He teaches mathematics in middle school. He lives with his wife and son. Questions for Discussion: 1. What advice would you give the resident to help in the discussion of the diagnosis with the patient? 2. What are the benefits and burdens of labeling to consider?.
Explanation / Answer
1. The resident must access and convey the medical information to the patient so that he can get new information and can know about his psychological implications. The resident can help the patient gain perspective on his disease as patients go through different phases of reaction and incorporation of new diagnosis. At this stage , the positive thing may be found as a negative thing to them sometimes. A patient with diagnosis of Klinefelters might wonder if he is not truly a man. In this type of diagnosis, they indicate the need for specific treatment or make a patient eligible for support groups and certain services .
2. In this case, due to diagnosis, the patient has got relief. Due to diminished sex drive , he had tensions in his marriage. The diagnosis has provided testosterone in treatment which improved sex drive and sense of well being.
The benefits of labelling include understanding, specific management or prevention options and access to services. The burdens of labelling include stigmatization, discrimination and helplessness.
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