What are some of the important factors that you will consider in designing?

What are some of the important factors that you will consider in designing a scientific care plan for your patient in the outpatient clinic that has direct applicability to a practicing clinical gastroenterologist?
HPI

A 60-year-old Italian male presents with acute abdominal pain. He is a retired schoolteacher and still does some teaching on the side. He is complaining of acute onset of umbilical pain that started last evening after eating. He is experiencing a gnawing hunger pain in the umbilical area. The pain is more diffuse now and he feels nauseous, but there is no vomiting. He believes he had fever last night because he felt very warm and sweaty. His symptoms subsided after he sat up for a few hours on a chair, but he is not sure how it went away.
The patient has been having these symptoms for the past 24 hours. He has had similar symptoms in the past, but it was not as bad as this. The pace of illness was worse last night and is much better now. In the past, the symptoms would last only an hour or two and resolve spontaneously.
In terms of severity, the pain experienced last night, during the “attack,” was a ten. Today, it is a seven. He was awake last night and the pain has been bothering him for the past 24 hours. Last night, the pain was more localized in the periumbilical region. It is more diffuse now. The pain does not radiate to the back; it is mainly generalized in the abdomen now and less intense from what it was last night.
He has also been having some heartburn-like symptoms for the past two weeks. The symptoms increased after eating. The heartburn would resolve spontaneously within a few hours and sometimes it was relieved after he took some OTC antacids. The patient thinks he is having a heart attack. The worsening of his symptoms has made him seek medical care today.
PMH
The patient is being treated for hypercholesterolemia, hypertension, and gout. He goes to his primary care provider every three to four months for a routine checkup. The patient had “stomach” problems as a young man but he is not sure of the diagnosis that was made eventually. He says the healthcare providers did an Upper Gastrointestinal (GI) back then, but nothing else. He had an appendectomy 20 years ago, without any complications. He has been using a lot of non steroidal anti-inflammatory drugs (NSAIDs) to control his gout symptoms. Besides these, the patient has had no significant illnesses.
The patient states that he has always had a “queasy stomach” and has had no other workups to date for the problem. He knows that he has some type of heartburn problem, but is treating it with only over-the-counter medications and has had no further investigations.
ROS
Intermittent heartburn symptoms for a few weeks, nausea. No vomiting. No blood in the stool.
MEDICATIONS
Indocin 50 mg Q 6 hours PRN gout symptoms

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