[Purple Cohort] Module 4

[Adam Qazi]

Please submit your SOAP Reflections below:

[Ahmed Yeddi]

My pateint is 65 year old male with PSH of TURP who presented for erectile dysfunction for the last 18 months. He was prescribed sildenafil but was not taking it because he was not able to afford the co-payment for the medication, which is 4 dollars. This is unbelivelably sad but unfortunately true. Adherence to therapies (whether a medication or life style change) is a primary determinant of treatment success. Failure to adherence is a serious problem which not only affects the patient but also the health care system. Medication non adherence in patients (for various reasons) leads to substantial worsening of disease,death and increased health care costs. A variety of factors are likely to affect adherence. Barriers to adherence could be addressed as patient, provider and health system factors, with interactions among them. Identifying specific barriers for each patient and adopting suitable techniques to overcome them will be necessary to improve medication adherence.

[mowyad Khalid]

Medication adherence us the cornerstone of internal medicine.
My pt was a 61 yo gentleman, with PMHx of HTN,DMT2 on insulin after other medications did not control his DM.
His HBA1c was elevated, indicating uncontrolled diabetes. When I enquired more, it turns she doesnot appreciate the consequences of DM. After discusding the potential complications, and the importance of adherence, she promised that she will rake her medications on time as prescribed.
Follow up visits indicatef compliance as evident by decreading HBA1c and glucose log

Sometimes, explaining the dissease and the importance of medication to the patient works very well

[mowyad Khalid]

Medication adherence us the cornerstone of internal medicine.
My pt was a 61 yo gentleman, with PMHx of HTN,DMT2 on insulin after other medications did not control his DM.
His HBA1c was elevated, indicating uncontrolled diabetes. When I enquired more, it turns he does not appreciate the consequences of DM. After discusding the potential complications, and the importance of adherence, he promised that he will rake his medications on time as prescribed.
Follow up visits indicatef compliance as evident by decrseading HBA1c and glucose log

Sometimes, explaining the dissease and the importance of medication to the patient works very well

[Kendall Bell]

My patient is a 66 yo gentleman who came to the clinic yesterday to establish care with a pcp, I saw him while I was on harper floors in November and he has not been to a primary care physician for over 10 years, and gets most of his care from his Nephrologist who manages his HD. The patient has severe venous insufficency, with two ulcers that lead to MRSA bacterima on two different occasions. During his hospitalization we made sure to send him home with a wound care nurse who visits him 3 times a week and manages his dressing changes. Yesterday when I examined the patient and removed his dressings, I noticed one of his ulcers had expanded despite care of the wound nurse, and the patient mentioned to me although she is scheduled to visit him 3 times a week, some weeks she comes just once or twice. Also after removing his dressings I soon realized there were inadequate supplies at 50 east canfield to properly replace the dressings. I asked the MAs to grab some supplies they directed me to a storage bin that was empty. With the help a fellow resident we raided all the rooms and had to improvise and make due to rewrap his leg. This was really frustrating to me, as most of the stories we hear the patient is noncompliant/nonadherent due to some social issue that makes it difficult for them to take care of themselves. However with this patient, he quit smoking, he is taking all his medication as prescribed and it is the health system (the visiting nurse, and our clinic) that is failing him and causing him to be non-adherent.

[Carli Denholm]

I found the TED talks this week to be very thought-provoking. Particularly striking, for me, was the idea that healthcare cannot truly work as a free market system because a free market system requires that consumers be informed consumers. It is very true that most patients are not informed enough to make decisions regarding their healthcare. Free market has the benefit of creating competition which fuels innovation, but it is often unfair and favors the wealthy. So, there needs to be a balance were healthcare can be reasonably available to all fairly while still maintaining incentives for improvement and keeping costs manageable for society as a whole. There are, obviously, a lot of other factors to consider, but this was just one component of the discussion which I found particularly interesting.

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