Soap reflexion Nov 4 , 2017

[Alpana Garg]

My patient was a 54 year old African american homeless M who presented to the clinic with uncontrolled blood sugar with (Last HbA1c – 13.5% ) . This was the follow up visit in the DCC clinic . Due to transportation issues he was not able to regularly keep his appointments .
During history taking and physical exam I focussed on the Diabates with all the relevant questions related to blood sugar control and complication of Diabates. Significant finding was – poor hygiene with fungal infection of foot and toe nails.
I realized the deeper issue of the problem was his homeless situation as he is not following any diet ( eats whatever fast food or anything that is available, his last meal was 2 days ago ) , not taking any medications , sold the glucometer given to him.
Social worker / case manager was informed – they provided him with the resources and also gave him a bag of hygiene products , some food and drink .
I felt that this was difficult patient to manage as he cannot be compliant unless his social problems are solved. Even if I counsel him on diet / glucose checks / arrange a glucometer he will not follow any of this .
As a clinician in busy clinic its difficult to manage social issues but its worth to ask basic questions as it was discussed during reflections meeting .
Take home points would be to ask these questions –
1. Tell me about your home situation ?
2. R you eating ?
3. How many doses of medication you missed since last month ?
Also teach back , simplifying medication regimen , Clinic appointment just for Med Rec in patient with complicated regimens can be helpful.

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