How do I talk with my patient or client about … ? (Part II)

“I have been talking with Peter about diabetes, and we were working on starting an exercise regimen. He recently started to talk about his migraine medication.”  Kate eagerly articulated these words to Roger, who then responded, “We will get to talk about medications. But before we do so, let us discuss the remaining 7 of the 12 most common physical health conditions.”

In Part I, How do I talk with my patient or client about … ?, I discussed the first 5 of the 12 most common physical health conditions likely to affect your patients or clients. Below we will discuss the remaining 7 physical health conditions.

1.    Acne:

Also known as Acne vulgaris, this is a chronic disease that affects about 16% of Americans, and it is the eighth most common disease worldwide.  It tends to occur on the back, the upper parts of the chest, and on the face. Like several other conditions, it stems from a combination of genetic and environmental factors, where the environmental components include smoking and dietary contributing factors.  Stress and exposure to hormones, like testosterone, play an important role, as is the case for several hormone related conditions. Also, lithium, a commonly used medication, can sometimes worsen acne in your patient or client.  Acne often leads to anxiety and low self-efficacy in adults, as well as adolescents, and it can result in depression and thoughts of suicide.  It therefore merits more attention than you might think.  Speaking with your patients and clients about decreasing sugar consumption and seeking out their primary care physician or dermatologist for treatment options are steps you can take to help alleviate the condition and related distress.

2.    Gastro-esophageal Reflux Disease:

Commonly known as acid reflux, gastro-esophageal reflux disease (GERD) is a chronic condition that affects between 10 and 20% of the population.  It is characterized by the return of stomach (gastric) contents into the esophagus (the esophagus connects the throat with the stomach). The complications can therefore be devastating and include esophagitis (inflammation of the esophagus), esophageal strictures (constriction and scarring of the esophagus), and sometimes cancer of the esophagus. Obesity and smoking are some of the risk factors and, therefore, you can help your patients or clients by encouraging lifestyle modifications to augment the effectiveness of commonly prescribed medications for this condition.  Encouraging your patients and clients to avoid the excessive use of coffee, alcohol, and spicy, fatty or acidic foods, and to gravitate towards moderate over strenuous exercise are additional steps you can take to help assist them in avoiding the complications of this condition.

3.    Migraine:

A type of headache disorder, migraines affects 14% of Americans and are known to last between two to seventy hours, often recurring and can worsen with physical activity. Migraines are associated with depression and anxiety, and some triggers include fatigue, stress, and hunger.These are notably important to keep in mind, as you work with your patients and clients around preventing an episode. Episodes can get more debilitating with each occurrence; and encouraging stress management, good sleep hygiene, and other positive lifestyle modifications can lead to significant outcomes in relief.

4.     Chronic Kidney Disease:

Kidney function will progressively be lost in approximately 14% of Americans, which in turn can lead to damage to other parts of the body, resulting in conditions like cardiovascular disease and anemia, among others. As mentioned in Part I of this article series, diabetes is the leading cause of chronic kidney disease, with hypertension as another major cause. This emphasizes the need to continuously work with your patients and clients to encourage changes in their lifestyle towards significant health outcomes. Recommending initiating aggressive control of hypertension is one major role you can serve, as part of establishing a very effective treatment plan.

5.     Urinary Tract Infection:

Urinary tract infection (UTI) is an infection of the urinary system. It is also known as pyelonephritis (kidney infection) or cystitis (bladder infection), depending on whether the respective upper or lower parts of the urinary system are affected. Some risk factors include diabetes and obesity, and it is more commonly occurring in women when compared to men, 10% versus 1%. Occasional complications of urinary tract infections can include damage and scarring to the kidney, which, as you have learned so far, serves a vital function for the body.  Talking with your patient or client about UTI preventive measures is, therefore, the right thing to do. Urinating immediately after intercourse and paying special attention to personal hygiene after urinating or defecating are important conversations to have with those who may be experiencing repeated urinary tract infections

6.    Hypercholesterolemia:

High cholesterol in the blood is called hypercholesterolemia; the condition is commonly known simply as “high cholesterol.” This type of cholesterol would typically be referred to as “bad cholesterol” (LDL cholesterol or Low Density Lipoprotein cholesterol) and contrasts with “good cholesterol” (HDL cholesterol or High Density Lipoprotein cholesterol). Genetic factors are an important influence for hypercholesterolemia, as are environmental components. Unhealthy diets, obesity, and limited exercise are all important contributing environmental factors. Other risk factors include comorbidities (other physical health conditions), like hypothyroidism and diabetes, and the use of medications, like the newer antipsychotics. Because hypercholesterolemia is a major risk factor for cardiovascular disease, it is essential to aggressively address risk factors for high cholesterol as early as possible. This includes proper stress management, healthy dieting, and exercise.

7.    Epilepsy or Seizure Disorder:

Seizure episodes can lead to physical injuries; and for a long time epilepsy has been viewed as a stigmatizing disease. Your patients or clients will benefit from your support, and a basic understanding of what this condition entails may help you be more effective and efficient in your work with them. Some cases of epilepsy may be caused by a number of illnesses, including head injuries, brain tumors or infections, strokes or aberrations from birth. Alcohol withdrawal and any related electrolyte abnormalities could also be responsible for seizure episodes in your patient or client. Some other triggers for seizure episodes include stress, excessive alcohol use, or limited sleep. You can therefore help your patients or clients learn about these triggers and provide some education on best management practices. Learning about simple, life saving actions you can take, should your patient or client experience a seizure episode is beyond the objective and scope of this article. But it is still an essential skill for you to possess. This can also help you save more lives and enhance your career gratification.

“How do I even start the conversation with him; what do I tell him?” Kate, concerned, asked these questions during supervision with Roger, who then carved out regular time to work with her on basic Integrated Care skills. Kate has been meeting with Roger regularly, implementing the new skills learned and eager to amass additional competencies. She has been making much progress, and in today’s supervision with Roger, she readily stated,  “I have been talking with Peter about diabetes, and we are working on starting an exercise regimen. He recently started to talk about his migraine medication.”

From not knowing how to even start, Kate is now asking for specific skills, which she has been implementing. There is a lot to learn in the application of Integrated Care, but if you pay attention to the needs of your patients or clients and look for ways to learn the skills you need, you will be able to continue helping them, while feeling gratified and empowered, which in turn will help prevent burn out.

I hope this series of four articles has laid the foundation for you to continue to learn and master skills in Integrated Care. Please share with your colleagues and feel free to share your stories, experiences, successes, and challenges with me. Furthermore, what else would you like to read or learn about Integrated Care skills?

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References:

1. Alexander, F. G. (1950). Psychosomatic medicine, its principles and applications. New York: Norton.

2. Cadman, D., Boyle, M., Szatmari, P., & Offord, D. R. (1987). Chronic illness, disability and mental and social wellbeing: Finding of the child health study. Pediatrics, 79, 805–813.

3. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Aff. 2009;28(5):w822-31.

4. American Diabetes Association. The Cost of Diabetes. http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html. Accessed December 23, 2013.

5. National Cancer Institute. Cancer Prevalence and Cost of Care Projections. http://costprojections.cancer.gov/. Accessed December 23, 2013.

6. Centers for Disease Control and Prevention. Alcohol and Public Health: Alcohol Related Disease Impact (ARDI). www.cdc.gov/ardi. Accessed June 1, 2017.