A 45-year-old, male, Spanish-speaking day laborer with a 27-year history of epilepsy sees a new neurologist for advice regarding his medication and midback pain. Six months ago, he visited the emergency department regarding the pain because his primary care physician did not have late afternoon or evening office hours and he feared that if he missed work he would lose his job. Plain-film radiographs suggested osteoporosis, and he was advised to see a neurologist to change his medications. He has been receiving phenytoin for at least 20 years with good control but was never advised to take vitamin D or calcium. He reports that his previous neurologist performed an examination and checked laboratory values, but as there was no translator, the patient had difficulty understanding everything he was told. It took 6 months to arrange for the new appointment as few offices have translator services.
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