Introduction: this irregular blood glucose level and to change

Introduction:

 

 

As a medical student, communications skills and dealing
appropriately with others are

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considered one of the most important things you have to learn and
practice, because they will

 

facilitate your task in dealing with your patients and taking the
perfect medical history in the

 

future. The medical history is a routine process happens every day
at every medical clinic.

 

It helps the physicians to take the correct information from their
patients, which consider

 

an important key in identifying the right diagnosis and the optimal
treatments for the patients.

 

So, as students the practice on taking a medical history was the most
important thing we have

 

focused on in the first visiting for us to the educational
hospital. In this case commentary will

 

discuss the details of the visit and the medical history.

 

 

 

 

Background and history:

 

X patient (X the nick name for the patient) is a Saudi female
patient with 62 years old from

 

 Ras Tnora. A widow retired
teacher. She is a diabetic patient; X is a patient suffers from

 

 diabetes type2. Presented to
the diabetes clinic in king fahad university hospital

 

with irregular blood glucose level and problem in her eyes for five
days ago. she said that

 

there was an abnormal increase in her blood glucose level though
she doesn’t eat large

 

amount of sugar. The main X’s aim from the visit was to identify
the main cause of this

 

irregular blood glucose level and to change her medications.

 

Diabetes type 2 started with X since she was 37 years old. X
doesn’t suffer from any chronic

 

disease except diabetes. X did three surgeries in the past, the
first one was thyroid gland

 

removal (thyroidectomy), the second was in her heel because of
diabetic ulcers, and the last

 

one was in her eye because of Diabetic
retinopathy. Patient hasn’t done a blood transfusion.

 

 X is taking
some medications that are insulin glargine ( Lantus), and aspirin for

 

the stomach.  X has suffered from a little increase blood pressure
and balance problem in the

 

last days, and increase in cholesterol level.

 

X a widow has 3 daughters and 6 sons, the husband and
the eldest son suffered from diabetes

 

type 1, while her parents and other kids were healthy
didn’t suffered from any chronic

 

disease. X lives with her sons in the same house all
of them are employees and spend most of

 

their time in their workplaces, but she said that
they give her all kinds of support regarding

 

her situation. X is a retired kindergarten teacher,
now she spends most of her time at home

 

without any physical activities, and her diet wasn’t
regular in which she eats her meals at a

 

random time.  And
on the hand of religious and believes, X believes that this is the life and

 

should accept what the god has written for us.

 

X doesn’t smoke and live at home free from smoking,
and doesn’t drink alcohol. She doesn’t

 

use any over the counter drugs and hasn’t allergic to
any drugs or substances.

 

After taking the medical history the doctor suggests
the main causes of that irregular blood

 

glucose level is the unhealthy diet and the amount of
the medication dose. So he advised her

 

to increase the dose of her medication, and alter her lifestyle by changing her diet.

 

 

Biological
aspects:

 

Diabetes is a disease related with
increasing in blood glucose level. The sugar (glucose) in

 

 your blood which comes from your diet you need
to transport it from your blood stream to

 

your cells which they use it as a
source of energy. So the glucose need a hormonal assistance

 

which provided by an essential
hormone called insulin that play a role in entering the glucose

 

into the cells, especially
skeletal muscles cells. In diabetic patients they have problem with

 

their insulin, but it is different
depending on the type of the diabetes. There are two types of

 

diabetes, in diabetes type 1 the
body can’t make an insulin, while in diabetes type 2 which is

 

more common the body doesn’t
produce enough insulin or your cell becomes resistance to

 

 the insulin, so you will have increase in your
blood glucose level. Diabetes is a common

 

disease especially here in Saudi
Arabia although it is a dangerous disease can damage your

 

kidneys, eyes, and nerves. And can
causes heart disease. There are a lot of symptoms show in

 

the diabetic patients some of
these, weight loss, increased thirst, increasing the ketones

 

bodies in urine, fatigue, and
other symptoms. Therefore, when you notice these signs you

 

have to visit the hospital to
check up and ensure that you don’t have any problems. The

 

factors that have a role in
diabetes are unclear enough until now, but in diabetes type 1 your

 

immune system has an effects on
your pancreas cells which lead to reduces or inhibit the

 

production of the insulin and
usually caused by genetic and environmental factors, where

 

obesity and prediabetes are
considered factors that may cause diabetes type 2, also genetic

 

and environmental factors have a
role in development of type 2.

 

There are some pathophysiological
changes related with diabetes disease, one of these is the

 

retinopathy which is a
complication happened in diabetic patients affects eyes by damaging

 

the blood vessels of the eye
retina that lead to vision problems and sometimes can cause

 

blindness, it is developed in the
two types of diabetes. Also alteration T cells mediated

 

particularly in helper T cell
(CD4+) is a pathophysiological change, Beta cells failure is

 

one of these changes when B pancreatic cell fails to produce the adequate insulin to
skip the

 

cellular resistance, and there
many other changes related with diabetes disease.

 

Diabetes treatment is divided into
non-pharmacological and pharmacological treatments each

 

type has an important role in the
treatment process.  Non-pharmacological
treatment which is

 

mean that the patient doesn’t
depend on the drugs, it depends on the patient life style, in

 

which the patients have to take in
their consideration the importance of their life style on their

 

situation. So patients should aim
on their diet, in which most of researches say that eating

 

three main meals with the five main
food groups every day essential component of diabetes

 

management, also snacks have a role
to prevent hypoglycemia after multiple insulin

 

 injections. Physical activities also are a
non-pharmacological treatment, adults advised to do

 

an aerobic exercises a minimum 150
min/week. Exercises work on reducing the insulin

 

resistance and lower the blood
glucose level, also helping in maintaining body weight,

 

because overweighting affect
negatively in diabetic patients. 

 

Pharmacological treatments vary
depending on the type of diabetes. In which diabetes type1

 

medications are insulin either
short acting insulin e.g. regular insulin (Humulin) or long

 

acting insulin e.g. insulin glargine
(Lantus). Amylinomimetic drug is a medication for

 

diabetes type 1
e.g.(pramlintide), it is a drug used before meals acts on the stomach by

 

delaying the time to empty
itself, and reduces glucagon secretion that lead to decrease

 

glucose level in the blood. There different types of
diabetes type 2 medications, some of them

 

 are
Alpha-glucosidase inhibitors these type of drugs work in helping your body to
break

 

down starchy foods and table sugar this decrease
blood glucose levels for examples: Miglitol

 

and Acarbose.

 

Biguanides is a type of medication for diabetes type
2 works by decreasing production of

 

glucose in the liver and sugar absorption in
intestines, increase the body sensitivity to insulin,

 

and help muscles in the absorption of glucose. e.g. Metformin.

 

Sulfonylureas those type of medications work by
enhancing the pancreas’s cells to make

 

more insulin e.g. Tolazamide (Tolinase).

 

Outcome: diabetes is a manageable
chronic disease in which until now there are no fully cure

 

for it. But there many treatments
are used to control diabetes and decrease or inhibit its

 

Symptoms. So diabetic patients
must care about their lifestyle all the time. because the

 

lifestyle of the patient helps in
management of the disease.

 

 

 

 

 

Ethical issues:

 

The relationship between the
doctor and the patients has a big role in diagnostic and

 

treatment processes. So the
doctors have to try to build good relations with their patients.

 

Generally, the keys in making a
good relationship with another person you need to show the

 

respect and interest to this
person and these come in several things.

 

And that’s what I have noticed in
our case (the relationship between the doctor and X

 

patient). Which there was a good
relationship between them, and this good relation showed

 

up in many things, firstly when X
entered the clinic the doctor stood up and welcomed her in

 

respectful way and she responded
in the same way. Also thing that showed the good relation

 

the eyes contact between them,
though the patient (X) is a female but the male doctor use the

 

proper way to keep eye contact. In
addition to that the doctor was giving X the enough time

 

to say her concerns and opinions
which helps to build a nice relation.

 

The consent from the ethical
aspect is an important thing that the doctors have to take it from

 

the patients, because through it
the doctors show the respect and freedom to the patients. This

 

what exactly happened between X
and the doctor in which he took a consent from X before

 

start taking her medical history.

 

Patient’s confidentiality, is a
thing doctors have to take in their considerations. Because, from

 

the ethical perspective the patients
have the right to keep their information secrecy, so

 

ethically as a doctor you need to
respect the patients demands. In our case the confidentiality

 

 appeared in several things one of them when
the doctor took the consent from X for us as

 

medical students to be present
during the interview, also the doctor respected X

 

confidentiality through inhibiting
any person out of the medical staff to enters the clinic

 

during the interview.

 

 

 

 

 

Legal issues:

 

 A legal consent which means a consent is taken
by doctors in aspect of protecting

 

themselves legally in case of any
complications after any decision or operation they do.

 

Almost it is taken in before
surgeries or chemotherapies.

 

usually be a written consent in
order to be shown in the in the future if it is needed. Doctors

 

usually are careful about taking an
accurate consent because any misunderstanding in the

 

consent can enter them in law
problems. The doctor in our case took a legal consent when he

 

took consent from X to change her medication
dosage. This can protect him in case of any

 

complications related with that
change.

 

Confidentiality in the legal
aspect. The persons have the legally rights to save their

 

information in security. So as
doctors you must protect your patient’s privacy and don’t tell

 

 any other persons about their results or
information. Because if you break the patient

 

 confidentiality, you expose yourself to legal
accountability, so you should to respect the

 

patient’s decisions and privacies

 

 

 

 

sociological
aspects:

 

1-Political aspects: Kingdome of
Saudi Arabia is living a state of development and changing

 

in all fields and one of these
fields the health sector. In which the Saudi government is doing

 

the best it could through provide
all kinds of support to the health system to improve the

 

 quality of the health field and provide
services to all citizens and residents in a fair way

 

trying to make the health system
here in Saudi Arabia in the best situation.

                                                                                                                                      

2-Economic aspect: The Saudi
government paid huge budgets to provide health accessibility

 

in all regions to all papulation
fairly. In which the citizens here have the right in the free

 

health services in government hospitals.
This facilitate accessibility to all papulation sects

 

either who owns the cost to pay
for the health services or who can’t.

 

3-Cultural aspect: the difference
in cultures is natures of the humans. So you need to respect

 

this differences in the believes
and concerns to build good relations with other. Doctors

 

encounter all sects from different
countries with different religions and believes which they

 

 have to respect them. Because, not respecting
and accepting these differences can be a

 

difficult factor in building
relations with the patients.

 

4-Social aspect:  social aspects have effects on the patient
state either the diagnosis or

 

treatment processes. In our case
patient X is a Saudi widow 62 female lives in Ras Tnora she

 

is a retired kindergarten
teacher since 15-year, the level of her education a
bachelor’s degree.

 

As I mentioned before X has 3 daughters and 6 sons.
And lives with her sons in the same

 

home.

 

 

Self-care and
lifestyle (ESSENCE model):

 

 1- Education: Patient X has a large background
about her condition which is diabetes type 1

 

disease. Her background
information about her condition based the experience and as an

 

academic person she read a lot
about her disease from different reliable resources.

 

2- Stress management: Stress has
impact on patient’s treatment progression. In which in case

 

of high stress the affect your
state negatively. Patient X live in lovely and supported

 

environment from her family, which
help her to skip psychological effects related with her

 

condition.

 

3- Spirituality: X believe that her
disease is inherited and that what the god written for her. So

 

she accepted it and try to live together
with it.

 

4- Exercises: Physical activities
and exercises affect the patient health positively in different

 

 factors like lose weight, maintenance normal
blood glucose level. X unfortunately is not

 

capable to do any physical
activities resulted from various factors some of them are the old

 

age and overweight also the
surgery in her heel affects her.

 

5- Nutrition: The healthy food and
drinks have a big role in making a healthy body, also in

 

the treatment of some disease. In
X condition which is diabetes. the healthy diet is essential

 

factor in controlling the blood
glucose level. X eats a healthy type of food but unfortunately

 

she is not committed to eat the
three main meals in the proper time, that can affects her

 

healthy diet.

 

6- Connectedness: The family and
society support and the good relationships help the patient

 

situation psychologically, by
providing all kinds of support.

 

7- Environment: X’s around environment
is considered a healthy environment in all

 

environmental aspects. Also their
good financial state helps in making the healthy

 

environment.

 

 

 

 

Patient
perspective:

 

X accepts her disease and try to
live together with it, but she still has a little worried about

 

 her eyes condition in which X thinks that if
she can loss her vision. From different aspect X

 

finds the enough support from her
family and society that helps her in skipping any

 

complications. Actually X’s
condition especially in overweight and not capable of doing

 

physical activities affect her
life from different perspectives either her social life or personal

 

life. After exiting from the
hospital X was happy about the services and good dealing from

 

the hospital staff. X expects
after the interview with the doctor her condition will better if she

 

follows the doctor advises.

 

 

 

 

My own
perspective:

 

The interview was in a
professional way started from the doctor who welcomed us in

 

respectfully way and allow us to
enter the clinic and interview the patients, then when the

 

doctor take the consent for us
from the patients. In addition, the cooperation from the patients

 

with us. So I think it was a
wonderful interview from all aspects.

 

Interviewing the patients had an
effect on me in breaking the barriers to deal with patients.

 

Also apply what we have studied
about dealing and communicating with patients. So it was

 

having a big role in entering the
atmosphere of hospitals.

 

Although there are some factors
which can relatively affect the patient-doctor relationship,

 

 such the crowded and a low light, the
interaction between the doctor and X was almost in

 

perfect way, in which the doctor
was dealing with X in professional and respectful way, also

 

X was cooperative either with the
doctor or with us (medical students). 

 

I think as medical students we
should focus on studying and practicing in dealing with

 

patients as same as focusing in
the study of medical and scientific stuff.

 

 

 

Conclusion:

 

In our interview we have met a diabetic patient (X) suffers from
diabetes type for 25 years,

 

 she came to the clinic to
know the cause of her irregular blood glucose level. The doctor

 

advised her to change her diet and he increased her medication
dose. Then we

 

 (medical students) took the
medical history from X and discussed here in our case

 

commentary project.