Shawn Billings, a 28 year-old African American patient

Shawn Billings, a 28 year-old African American patient


Shawn Billings, a 28 year-old African American patient comes in to the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication.

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Module 2 Week 2 Discussion: Main Post

Mr. Billings has presented to the clinic today for another migraine. The clinic staff has deemed him a frequent flyer. However, Mr. Billings is suffering from chronic migraines. He worries about receiving medication and has brought his father to the visit today. According to Henderson et al. (2020), as a healthcare provider, one must look at the whole patient when providing care, which includes embracing their beliefs, values, and expectations to provide high-quality care. Based on the information provided, which is limited, the patient has received medication to treat his migraines. However, little has been done to investigate the cause or help manage a chronic condition. African Americans suffering from chronic pain are undertreated more severely when compared to non-Hispanic Whites (Maly & Vallerand, 2018). Unfortunately, African Americans suffer more from health disparities or social determinants of health than other ethnic groups. According to Singu et al. (2020), African Americans are more likely to live in poverty, have limited access to healthy foods, live in areas with higher levels of pollution, and experience stress at a higher level due to socioeconomic status. These health disparities and SDOH could present potential causes for the development of migraines.

Regarding the patient’s father attending the appointment with him, the healthcare provider should include the father in the patient’s care. Family members of African American patients are more likely to participate in patient support methods using personal or spiritual care (Núñez et al., 2021). Excluding the father would prevent supportive methods and further increase the patient’s agitation. This action would negatively impact the patient’s care and experience.

Health History Assessment

To collect an accurate health history on Mr. Billings, I would inquire about health disparities or SDOH that may cause chronic migraines. Before asking the questions, I would explain to Mr. Billings that an accurate assessment of health disparities may reveal the source or sources of his physical concern. Without explanation, Mr. Billings agitation may become worse. For example, the patient may take offense to questions about poverty or income, especially when he is being seen for a migraine. Without explanation, the patient may feel as if the provider is placing judgment.

Questions to ask:

What do you do for work?

Do you make enough money to pay your bills?

Do you have access to healthy food?

What is the highest level of education that you completed?

Do you experience stress?


       By asking these questions, it would help the healthcare provider determine areas of need or potential causes for the physical symptoms the patient is experiencing. Furthermore, it could help the provider rule out health disparities or SDOH as a cause. Indicating the need for further testing, change in treatment, or referral to a specialist that can provide appropriate long-term management for migraines. 



Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: A concept analysis. Health & Social Care in the Community26(4), 590–603. to an external site.

Maly, A., & Vallerand, A. H. (2018). Neighborhood, Socioeconomic, and Racial Influence on Chronic Pain. Pain Management Nursing19(1), 14–22. to an external site.

Núñez, E., Villa, G., McFadden, R., Palmisciano, A., Lanini, I., O’Mahony, S. M., Curtis, J. R., Levy, M. M., & Amass, T. (2021). Differences in Family Involvement in the Bedside Care of Patients in the ICU Based on Self-Identified Race. Critical Care Explorations3(3), e0365. to an external site.

Singu, S., Acharya, A., Challagundla, K. B., & Byrareddy, S. N. (2020). Impact of Social Determinants of Health on the Emerging COVID-19 Pandemic in the United States. Frontiers in Public Health8 to an external site.

Shawn Billings, a 28 year-old African American patient

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