Looking at the Whole Patient
Look at the whole patient, not just the disease. How many times was this drummed into your head in school? By now, you should have a good understanding of this concept. In order to individualize the care plan and maximize the outcomes for each patient, you have to look at the whole patient.
For instance, the patient in 204B has had a transient ischemic attack (TIA), which is how the hypertension was discovered. The hypertension is severe, and there is tremendous risk for cerebral vascular accident (CVA). Medication, a low-sodium diet, and stress management are the physician's directions. Typical drill, no problem, you can deal with this one in your sleep.
You need to help your patients, their families, and caregivers to understand that all the patient's personal habits and lifestyle choices will need to be incorporated into long-term plans for coping with his health status. The patient's family, job, hobbies, culture, diet, and habits all contribute to his illness and risk factors.
Okay, so you enter the room of Mr. Hashimoto. He's fifty years old, alert, oriented, and sitting up in bed. He's on his cell phone, has his PDA in one hand, and is eating sushi, which he has just drenched in soy sauce, with the other hand. Mr. Hashimoto is yelling into the phone, and another phone is ringing somewhere in the room. He's wildly directing you to find that phone for him.
Mr. Hashimoto is the owner of a very popular sushi restaurant and has just opened a new one across town that is struggling. He's yelling at the manager of that new restaurant and is threatening to fire him. As he's yelling, he's pouring more soy sauce on his sushi and frantically looking for his cigarettes. Your work is cut out for you!
Enlist the patient and his family and caregivers to see beyond the diagnosis as well. Convincing Mr. Hashimoto to look at the big picture is going to be a challenge. He thinks a pill will make him better and fix it all. If his behavior had been calm and demure, and you had not witnessed his job-related stress, smoking habit, and dietary issues with the soy sauce, you might have missed out on all the clues that increase his risks.
You may not always have an opportunity to have an open window that provides you as many clues as Mr. Hashimoto did. Some patients won't share these with you, and you will need to help them understand that they need to examine them for themselves in order to promote wellness and improve their outcomes.
