Treating the complete patient
Treating the complete patient
I currently practice sleep medicine, but treating the whole person and providing the best possible care to patients is my number one goal. When it comes to the importance of reviewing medications, taking patient history and asking about overall health, one patient in particular stands out.
Two years ago, I met a 32-year-old woman with multiple health problems, who had been previously diagnosed with bipolar disorder. She had been prescribed 20 different drugs, including a long list of psychiatric medications and central nervous system depressants, some at very high doses.
On examination, the patient could not speak without slurring her words, could barely keep her eyes open and was ambulating with a walker. She was seeing multiple doctors, and I was concerned that she was severely over medicated.
I could hear our nurse rooming the next patient, but I didn't feel comfortable moving on just yet. I could have ordered a sleep study and gone on with my day, but instead I decided to put the sleep issues to the side and just talk about how the patient was feeling about her life and health. We both agreed that her current state of being did not seem healthy, and together we made a list of concerns.
The first advice I offered was that the patient check with her psychiatrist about decreasing her psychiatric medications. After further review I felt there were other medications that could be combined or stopped, so I called her primary care doctor to discuss these issues.
The patient also expressed a desire to lose weight. She was deconditioned, so we discussed small ways she could start exercising again. At the end of our discussion, she was so excited that someone was willing to stop and listen to help her reach her goals that she began crying. It made me sad that although she was seeing multiple health-care providers, not a single one had done this before now. How different her life could have been!
The last time I saw this patient, it was me who cried. I could not believe the person who sat before me. In addition to resolving her sleep issues, the patient reported that she had started exercising regularly and doing aerobics with her daughter. At the time of the visit, she had lost 80 pounds. She is now taking only six medications and just one psychiatric medication. She is seeing a new psychiatrist and there is some question as to if the patient ever really had bipolar disorder.
With our heavy schedules, it is often easier to focus on the task at hand. But is this really providing our patients with the best care? If I never see another patient or write another prescription, I will always know that there was at least one patient in whose life I made a difference. Have you had a similar experience? Please tell us about it in the comments section.
Sharon M. O'Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.