Reflections

[Irfan Shafi]

My pt. 56 Y O F presented for refill of her medications, upon examination and further evaluation she admitted to non adherence to her CHF medication stating ” its one of those bad days when I don’t feel like doing anything including taking medication” , I further asked if she had any one at home taking care of her, she replied she lives by herself and her niece sometimes comes and helps with her groceries. She had good insight of her health condition and also mentioned that whenever she misses her lasix doses for a couple of days her legs start to swell. She admitted to daily Marijuana use since age 20, and she also started to smoke 1-2 cigars daily for last 2 months , when I asked the reason she said this helps her go through life. Upon further evaluation she showed symptoms of Major Depressive disorder , she said she was told in past that she has depression and followed up with psychiatrist but she didn’t like the medication because of the side effects, so she stopped taking them 2 years ago.
I explained to her that MDD is like any other medical illness and needs to be treated as it has great impact on her health overall. I also explained to her that even though she may have had side effects to some medications but there are other medications which she may tolerate better. I gave her referral to Psychiatrist.
As mentioned in this weeks CWC case, it is important to consider socioeconomic status, environment, behavioral factors, and access to the health system in all patients particularly those at high risk. Patients present to us as medical illness but there is always more than just the illness and sometimes the factors like poor access to health care or underlying mental health issue or homelessness plays a major contributor towards worsening of the illness, so I believe we as clinicians should always keep it in the back of minds that these factors exist and may be the reason for patients poor health.
After doing this week case I understood the importance of the 5 domains- support, Resource, Behavior, Psychiatric, Biochemical and also that we should access these domains in our patient population,as that could significantly improve the well being of our patients.

[Peter]

Reflections offer study a chance to learn from the past and grow toward a brighter future.
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