SDH

[Tushar Mishra]

59 yo F with PMH of Bipolar disorder, DM, HTn, chronic pain syndromes used to come to each of my clinic weeks with wide array of complaints like losing vision after being shot in the head, having stroke in the past, being assaulted, urinary incontinence presented this time for regular follow up and was asking for referral to dentistry and prescription for nicotine gums.
Patient has recently moved in with her son and daughter in law, and she reports that they took good care of her. There was a stark contrast in patient’s appearance this visit like hair well kept, clean clothes. She used to come in wheelchair, and on this visit, she told me that she could walk without a cane. She was eating salads now and going to gym with her daughter in law. Earlier, she used to ask me for physical therapy referral on each visit for disability evaluation, but never follow up with those. This visit she said, that everything has been taken care of. To summarise, the patient was doing well.
What changed was none of the medical components of her management, but the social setting she was a part of. She was living with a loving family who took care of her. She had friends, she used to hang out with frequently. This motivated her to eat healthy and exercise. She even quit smoking and requested nicotine gums. Now we could be skeptical and say that this might be temporary and be another phase of BPD, but there sure was a significant change, more than that could be explained by mania. Seeing this patient this clinic week made my day, and I motivated her to keep up the good work. I emphasized following up with the rest of the referrals (including a psychiatrist, very important!), and to call the clinic if she is running out of any medications or in any way we could be of help to make sure the progress keeps on moving in the right direction.
The thing I learned is that I would try to ask my patients that what social group at they a part of, and if there is anything they could do, or we could do, to improve it so that they can lead a more healthy life (which is not just freedom from illness or frailty)

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