Chapter 1 - Knowing Your Patient

Summary

Narrative examples are extraordinarily powerful tools for bringing home a complex issue or difficult concepts. In this chapter, through a case of a patient with PWS, a biopsychosocial formulation is developed. The importance of obtaining a thorough history that attempts to establish a “timeline”– a lifelong trajectory with a sense of the major events – is discussed. The importance of open-ended questions is discussed. The case report in this chapter reviews the history and psychosocial trajectory of an adult male with PWS who presents with worsening sleep disturbance and irritability. The case formulation at the end discusses an integrated holistic understanding of the patient’s presentation and the possible predisposing, perpetuating, precipitating, and protective factors involved. Systemic social factors including caregiver burden and health system structures presenting barriers to improvement are also discussed. The chapter exemplifies the need to recognize the unique clinical presentations of individual patients within their cultural and psychosocial contexts.