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Investigation: General History

Identifying Data

  • Mirna Jones is a 45 year old African Canadian divorced with 3 children: 15, 10 and 7 years old.

  • She is a teacher.

Chief Complaint

Ms Jones presents at a hospital emergency department with a variety of symptoms, including fatigue, feeling dizzy and faint, chronic back pain and nausea.

History of the Present Illness

Ms Jones had previously been seen at a walk-in clinic where she told the physician that she had been feeling nauseated for a day and a half. She was told it was heartburn and was given a prescription medication. This did nothing to alleviate her symptoms, and she went back to the same clinic later when she developed back pain and fatigue. At this second visit she saw a different physician, who did not have access to the note from her previous visit or other old records, Ms Jones was told it was "stress" and was given a muscle relaxant.

Past Medical History: Substance Use

  • Ms Jones has in the past referred to herself as a "social smoker" and had previously smoked approximately 2-5 cigarettes a day.

  • As her stress level has increased over the past several years, her level of smoking has increased now to almost a pack a day. She feels guilty about smoking, not only in terms of the money spent on cigarettes but also concerning the example it sets for her children. She has discovered cigarettes in her daughter’s room and confronted her about it. While the daughter promised to stop smoking, she also responded that the patient was "hardly one to talk" given the fact that she smoked herself. The patient has tried to quit "cold turkey" but has been unsuccessful. She wants a prescription for anti-smoking medication but, as a supply teacher, does not have the same health benefits as under her previous full-time job.

Past Medical History: Diet and Exercise

Her irregular work hours and heavy family responsibilities mean that she has little time or energy for physical activity. The patient’s lack of energy by the end of the day coupled with the decline in her income often means that she serves convenient but high-fat "fast food" such as store-bought pizza for dinner. She realizes that this is not nutritionally sound for her children or herself, but often does not have the energy to prepare anything else.

Past Medical History: Interaction with Health Care System

The patient’s interaction with the health care system has been irregular and influenced by instances of either overt racism or ignorance concerning the health of African-Canadians on the part of health care providers. As a single mother, during a visit to a hospital emergency ward with her daughter, who had a fever, she overheard a staff member make a remark about "welfare mothers." In fact, at the time, she was working a clerical job and going to school at the time and not on social assistance (her mother provided childcare ). As a consequence, while the patient ensures that her children visit their family doctor for regular check-ups, she herself only visits a walk-in clinic when something specific is wrong.


She takes no prescription medication and only uses over the counter acetaminophen occasionally.


She has no known drug allergies.

Family History

Her mother died of adenocarinoma of the pancreas, a disease more common in black women than white women. It remained undiagnosed until later in the advance stage of the disease partly because her mother’s doctor did not recognize the signs of jaundice in someone with dark skin.