SDH

[Ahmed Subahi]

Pt is a 34 y/o male with a PMH of HIV who presented with increasing pain from his chronic perianal ulcer. He states that the pain has gotten worse over the past week prompting him to come to the ER. The ulcer traverses the gluteal fold per the patient posterior to the Anal orifice. He also describes progressively worsening ear pain for the past week. Pain is localized to the external right ear. No sinus drainage or congestion. He also notes R sided facial swelling extending to the postauricular region. He admits to fever, otalgia, aural fullness (R>L), odynophagia, dysphagia. Currently denies hearing loss, otorrhea, tinnitus, vertigo, disequilibrium. He was diagnosed with HIV 14 years back and has not been taking medications for over two years as he does not have prescription drug coverage. He was admitted to the hospital 3 month ago with the same complaint and discharged on HAART and Acyclovir, but he didn’t take his medications due to the lake of insurance. This is an example of failure of medical plan in spite of the great efforts by medical team to make diagnosis and to provide evidence-based treatment
The outcome was poor due to the difficult social circumstances which definitely has affected the patient perception of his diagnosis and also resulted in the failure of access to outpatient health facilities and ability to get prescription filled. The key lesson is some of the hospital provided services should be allocated to anticipate and improve social obstacles otherwise the health system will end up spending extra cost with no outcome

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