Hs200 Mental Health

Question 1. Describe the strengths and limitations of the biomedical approach to Mr. Alex’s health problem. Pick two other disciplines and describe what they can add to a biomedical understanding of the situation.

Essay-

Mr. Alex is 87 years old and lives in his own home. He is in reasonably good health, but when he visited his family doctor for a check-up the doctor noticed that his mobility was less this year than it was at his last check-up. Mr. Alex admitted that he was having some pain and stiffness in his knees, and the doctor examined him and diagnosed moderate osteoarthritis. She referred Mr. Alex to an orthopedic surgeon to see if joint replacement was an option. She told Mr. Alex that keeping normal physical function would ensure that he can continue to live in his own home.

Mr. Alex attended his consultation with the surgeon, who assured him that due to improved surgical and anesthetic techniques and better medication, rates of complications after joint replacement were no worse for older seniors than for younger ones. The surgeon did a questionnaire to rule out dementia and lab tests for other health conditions, and told Mr. Alex that his office would contact him with a surgery date.

Several months later Mr. Alex had a date for surgery, and he reported to a pre-operative clinic where he had more tests and spoke to an anesthetist. He was given lots of information about exercises to strengthen his knees pre and post surgery, and how to care for his knee. After his surgery he spent about a week in the hospital and received excellent, best practice care and then was discharged home.

The clinic’s outpatient services contacted Mr. Alex and gave him a date to go to physiotherapy. However, he missed his appointment. When the clinic phoned to follow up, Mr. Alex said that he didn’t think the surgery worked, because his knee was just as bad as before. He was a bit upset that the surgery didn’t fix his knee like the doctor said it would. The surgeon arranged for a home care nurse to check on Mr. Alex and found that he wasn’t doing the recommended exercises or going to physiotherapy, and had lost a lot of range of motion in his knee. The nurse was sorry that Mr. Alex seemed a bit too old to understand the instructions about caring for his knee, and now the surgery was wasted. The nurse sternly told Mr. Alex he needed to follow the instructions from the doctor.

Mr. Alex said told her that he was planning to go to physiotherapy but at that time there were shots fired on his street and he heard police cars, so he decided to stay inside. He said that is often the case in his neighbourhood, which is part of the reason he didn’t go for walks, talk to his neighbours or spend time in his garden any more. He spends a lot of time sitting looking out his window and often calls the police when he sees suspicious activity or someone having trouble. He used to feel that people in the community looked after each other, but now things have changed. Now he is afraid that he may even be in danger. He rarely sleeps well.

Mr. Alex knows that living in his own house just isn’t the same as it used to be, but he is reluctant to ask about other alternatives. He associates care homes with people who are physically or mentally ill

Question 2. Describe the causes of Ms. Gunn’s diabetes from a biomedical and lifestyle perspective, and compare and contrast with social epidemiology perspectives. How does a lens of individual responsibility affect health services and health policy, compared to a lens of social responsibility?

                        (2 pts biomedical and lifestyle, 3 pts social epidemiology, 2 pt policy)

Essay-

Ms Gunn was diagnosed with diabetes when she was 32. She knew her grandfather and her mother both had diabetes, but she thought that she was still too young. Her grandfather raised her and her sister, because her mother often struggled to look after them. After her grandfather died, their family drifted apart and Ms. Gunn moved to the city on her own.

 At the time she was diagnosed with diabetes, she was working nights in security at a casino. That was a pretty good job for someone with only a high school GED, but sometimes she had to deal with people who were drunk or desperate. She got lots of racist and sexist insults but she tried not to take it personally.

She took pride in her job and wanted to be alert at all times, so she would drink Mountain Dew and Red Bull. Then when she got off work at 3:00 am she was still wide awake. She and some of her co-workers would drink a few beers to help them relax. Then they would get hungry and go for junk food. One night at work, her vision got blurry and she could barely see across the casino floor. She went to the doctor the next day and he sent her straight to the hospital. She stayed there and they brought her blood sugar level back down with an insulin injection. That was the beginning of her battle with diabetes.

The doctor told Ms. Gunn that working nights was bad for diabetes, because it disrupts social and biological rhythms that affect people’s metabolism. He said that for her to stay healthy she would have to work hard on losing weight, being active and eating proper foods all the time – even while she was at work. She would have to start planning meals, packing lunches, and taking time for exercise.

Ms. Gunn was pretty scared, but she didn’t change. She kept on staying up late, but now she had to wake herself up at 7:00 in the morning to take insulin shots. Sometimes she missed a dose because she was too tired or sick. Sometimes she just felt like staying in bed until it was time to go to work again. The doctor was really worried that her diabetes was not controlled, and he feared that she would have some complications. He sent her to diabetes educators who taught her about eating fruits and vegetables and staying away from fried foods – but Ms. Gunn continued to spend her money on fast food. Finally the doctor advised Ms. Gunn to get a different job or at least stop working the night shift – but she was friends with others on the night shift and she would have no one to hang out with if she worked days. So she refused.

The health care providers were sad and frustrated, but they felt there was nothing more they could do for her. They decided not to spend more medical time and energy on Ms. Gunn unless she was ready to take control of her life.