Beruflich Dokumente
Kultur Dokumente
Assignment 1:
Patient Study
A Biopsychosocial
Report
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Assignment 1: Patient Study Candidate Number: M9757
CONTENTS
Aim..............................................................................................................3
Methodology................................................................................................3
Consent.....................................................................................................3
Confidentiality and Anonymity..................................................................3
Medical Context...........................................................................................4
The Patient................................................................................................4
Mak Midahs Illness Experience................................................................4
Onset......................................................................................................4
Investigation and Diagnosis...................................................................4
Epidemiology............................................................................................5
Illness Experience and Evolution..............................................................6
Main Discussion........................................................................................7
Pathophysiology.....................................................................................7
Associated Risk Factors.............................................................................8
etiology.....................................................................................................8
Lifestyle Risk Factors..............................................................................8
Genetic Susceptibility............................................................................8
Complications...........................................................................................8
Treatment and Management..................................................................9
Shared Decision Making.........................................................................9
Self-Management.................................................................................10
Health Definition..................................................................................10
Roles of Healthcare Professionals.........................................................10
Social Context...........................................................................................11
The Patients Educational Level..............................................................11
The Patients Family................................................................................11
Family Tree..............................................................................................12
Social Class.............................................................................................13
Localities.................................................................................................13
Lifestyle..................................................................................................14
Impact of Illness......................................................................................14
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Assignment 1: Patient Study Candidate Number: M9757
Stigma..................................................................................................14
Behavioural Change.............................................................................14
Biographical Disruption........................................................................15
Family...................................................................................................15
Public Health.............................................................................................16
Epidemiology..........................................................................................16
Health Issues..........................................................................................16
Iceberg-Concept of Illness.......................................................................17
Health Promotion and disease prevention..............................................17
Community Healthcare Agency.................................................................19
Malaysia..................................................................................................19
United Kingdom......................................................................................20
Comparison.............................................................................................20
Reflection-Patient Study............................................................................21
Reflection-GP Visit.....................................................................................22
List Of Tables.............................................................................................23
List Of Figures............................................................................................23
Word Count................................................................................................23
References.................................................................................................24
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Assignment 1: Patient Study Candidate Number: M9757
AIM
To portray the impact of chronic illness, by patient-centered
approach, taking into consideration the biological,
psychological, and sociological aspect.
To emphasize the importance of reflection on the attitude and
experience throughout the study.
METHODOLOGY
CONSENT
During the first visit, we ensure that the patient understands the purpose
of the study before signing the Consent Form.
Good Medical Practice 2013 states that patients have the right to
expect that information about them will be held in confidence by their
doctors. (1) Hence patients information are only shared among the group
members. Pseudonyms are also used to maintain patient anonymity.
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Assignment 1: Patient Study Candidate Number: M9757
MEDICAL CONTEXT
THE PATIENT
Midah is currently 73 years old. She was diagnosed with Type 2 Diabetes
Mellitus (T2DM) since 1998, and has been living with it for more than 50
years. Initially, it was hard for her to accept this shocking news, as
she was not aware of any chronic illness in her family.
ONSET
She started experiencing polydipsia and lethargy in 1998, at the age of
55. She thought it was due to insufficient water intake and
subsequently drank 6-8 glasses of water as recommended by healthcare
professionals. (2) She then sought advice from her husband when no
improvement was observed. Freidsons lay referral system suggests
patient might portray help-seeking behaviour by referring to friends and
family before attending consultations. (3)
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Assignment 1: Patient Study Candidate Number: M9757
EPIDEMIOLOGY
Quoted from Ministry of Health (MOH) Malaysia, Midah is among the Malay
population which shows the highest prevalence percentage (58.9%) of
T2DM, as compared to other races. (6) For life expectancies, Midah, being
a female with diabetes, is expected to have 5-year less of life compared to
healthy female adults. (7)
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Assignment 1: Patient Study Candidate Number: M9757
Hypertension,
Prescribed
with Anti-
Hypertensive
Drugs.
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Assignment 1: Patient Study Candidate Number: M9757
MAIN DISCUSSION
PATHOPHYSIOLOGY
Insulin, an endocrine hormone produced by -cells of Islets of
Langerhans in the pancreas, maintains normal blood glucose
concentration by facilitating glucose uptake into cells and diminishing rate
of gluconeogenesis. Closely linked to normal functioning of -cells, it also
affects the feedback loop of blood glucose metabolism, as well as insulin
sensitivity of the target tissues.
In T2DM, peripheral fat, liver and muscle cells develop insulin resistance.
This results in failure of cells to utilize free glucose in bloodstream,
subsequently increases the blood glucose concentration. In return, -cells
have to compensate by upregulating insulin production. Overburdened
insulin production eventually fails to meet the demand, leads to
progressive pancreatic damage and hyperglycaemia. (9)
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Assignment 1: Patient Study Candidate Number: M9757
ETIOLOGY
T2DM can be contributed by lifestyle risk factors as well as genetic
susceptibility. (11)
GENETIC SUSCEPTIBILITY
Presence of TCF7L2 gene is most commonly associated with T2DM,
notably the obstruction in insulin secretion and glucose production, due to
functional abnormality of -cells. (14, 15)
COMPLICATIONS
In 2013, Midah complained that her eyesight deteriorated gradually,
and was worried about the effect on her daily routine. A possible
indication of her developing diabetic retinopathy. Researches also
displayed several other diseases like nephropathy (27.8%) and myocardial
infarction (10.8%) are also strongly associated with diabetes. (16) She
elaborated that she was also diagnosed with hypertension in the same
year and was prescribed with anti-hypertensive drugs. This diagnosis
further confirms the association between T2DM and heart & blood vessel
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Doctor
Patient Low High
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SELF-MANAGEMENT
Midah goes for consultation every 2 months as she thought she could
manage her T2DM better. However, she does not have any glucometer
due to financial constrain. Studies showed only 4.9% of the diabetic
patients own glucometer. (20) NICE guidelines recommend diabetic
patients to have glucometer so that early intervention could be given if
blood glucose concentration rises. (21) Stated in Banduras Self-
Efficacy Theory, Health-promoting behaviour is based on goals,
outcome expectancies and self-efficacy. (22) Patients ought to
demonstrate self-management to prolong or even better, prevent
deterioration of chronic illness. (23)
HEALTH DEFINITION
According to World Health Organization (WHO), health is a state of
complete physical, mental and social well-being and not merely the
absence of disease. (24) Midah perceived health as the ability to carry
out daily activities with the absence of symptoms that suggest
illness. She emphasizes on physical well-being, consistent with the
biomedical model of health. (25) Having thought of healthy people dont
usually take tablets, she considers herself unhealthy as she have
to rely on tablets. On a scale from 1-10 (1 being the worst), Midah
rated her condition 6. She expressed diminished self-esteem as she
have to live with the disease.
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Healthcare Roles
Professionals
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SOCIAL CONTEXT
THE PATIENTS EDUCATIONAL LEVEL
Midah received formal education up to Primary Education. The interview
was conducted in Bahasa (a.k.a. Malay Language) as she was illiterate in
English. According to Malaysian Standard Classification of Occupation
(MASCO) 2008, Midah is categorized under 1st skilled level for Education.
(26) Studies showed that educational level is highly associated with
diabetes mortality. (27) Lack of education might impact on her self-
management of diseases especially during emergency medical conditions,
where more likely she would be presented late to healthcare as she did
not know how to react.
Midah learnt that T2DM was strongly linked with family history,
and was worried that this could affect her children. Research shows
that the probability of a child to suffer from T2DM is 1 in 7 if one of the
parents is diagnosed from T2DM before age 50. (28)
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FAMILY TREE
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LOCALITIES
Midah is comfortable staying in the neighborhood, as most of her
neighbours are Malays. She feels that if something bad happens, she
could easily get help from as there is no communication barrier.
Klinik Kesihatan Gelang Patah (KKGP) and hypermarket are just 5-minute
ride away from their house. Her husband drives her to the clinic whenever
she needs to attend follow-ups.
LIFESTYLE
Midah does not smoke and drink. She believes that smoking and
drinking are sinful for Muslims and are harmful to health.
Disability as defined by WHO, is an umbrella term, covering
impairments, activity limitations, and participation restrictions. (29)
Supported by the definition, she perceives herself as being disabled as
she gets exhausted easily while doing exercises.
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IMPACT OF ILLNESS
PSYCHOLOGICAL CHANGE
BEHAVIOURAL CHANGE
Midah implemented changes to her lifestyle after having T2DM. At first, it
was harsh to adapt to dietary changes. She felt helpless as she did
not have proper knowledge on self-management of T2DM.
Transtheoretical Models Stages of Change illustrates on the stages
of behavioural change. (32) She is currently in Maintainence stage as
she is controlling her diet to prevent more health complications.
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BIOGRAPHICAL DISRUPTION
FAMILY
She felt committed to stay positive living with T2DM. With lifestyle
changes, she hopes to be the role model in guiding her family members
towards healthier lifestyle, thus reducing the risk of them getting
T2DM.
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PUBLIC HEALTH
EPIDEMIOLOGY
HEALTH ISSUES
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ICEBERG-CONCEPT OF ILLNESS
Cost-effective healthcare.
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Services provided:
Benefits included:
Midah did not receive any form of diabetic prevention support and was not
aware of Diabetes Malaysia. She hopes this information can be
spread across the society to benefit other T2DM patients.
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UNITED KINGDOM
Hotline to Diabetes UK
COMPARISON
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REFLECTION-PATIENT STUDY
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REFLECTION-GP VISIT
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LIST OF TABLES
Table 1 Midah's Risk Factors for T2DM.........................................................7
LIST OF FIGURES
WORD COUNT
Total 3158
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REFERENCES
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