not work, an MAO inhibitor was prescribed. The MAO inhibitor was effective in treating his depression, but brought on a host of side effects and involved dietary restrictions such as no dairy products.
Nancy Mullen, George's wife, had suffered for some time from hypertension and mild diabetes; recently she developed macular degeneration. With this condition, her eyesight deteriorated steadily. She was beginning to have trouble reading books, newspapers, and prescription labels, as well as paying bills and shopping. Nancy takes two hypertension medications and three medications for her diabetes daily, in addition to an assortment of vitamin and mineral supplements. Nancy and George frequently take over-the-counter (OTC) preparations for their health based on information from friends, television shows, newspapers, and magazines. Unfortunately, some of the OTC products have worked against their regular medical care by interacting with prescription drugs to create their own side effects, as well as to compromise the effectiveness of the prescription medications.
One of the Mullen's children, Pamela Barber, lives about 30 miles away and tries to help her parents with their medical needs. She already is busy at a demanding professional position as a human resource manager for a large company, as well as being a single mother of two teenagers. She barely manages to meet the demands of her job and the needs of her children; she feels guilty that she does not always have time to attend to the steadily increasing health care needs of her parents. In her efforts to provide what care she can, Pamela frequently is puzzled by her parents' explanations about their health status and doctors' visits. She is concerned that her parents do not take their medications correctly or follow the instructions of the health care providers. Pamela has come to believe that inadvertent errors in self-care by her parents create additional medical problems. She also is concerned that in addition to making errors in taking medications because they fail to understand or follow physician instructions, her parents may come to harm because of the OTC herbs and minerals they are taking. She believes her parents remember only fragments of what they read or hear in the media about these products, which leads to confusion about what is effective.
Pamela began to talk directly with her parents' physicians to better understand their diagnoses and prognoses. She was not surprised to learn that sometimes the physicians need to spend extra time with her parents to explain treatments and conditions. Given the garbled information her parents tell her they received from their physicians, Pamela was astonished that the physicians believed her parents understood quite well what they were told. For example, the physician had spent considerable time explaining to Nancy Mullen that an herbal treatment she was taking for her diabetes is ineffective and could even be dangerous. The physician told Pamela that he felt her mother understood that she should not take the herb. Later, Nancy told Pamela that she believed this herbal remedy would have a beneficial effect on her diabetes. Pamela was frustrated that her parents seem to consistently misunderstand information and translate the misunderstanding into dangerous medical behaviors.
In addition to her parents' health problems, Pamela was recently diagnosed with rheumatoid arthritis, a systemic, progressive condition that results in considerable fatigue and requires her to take seven different medications to treat inflammation, pain, and autoimmune activity. Her prognosis is good if she carefully adheres to her medication schedule and does not become overly fatigued; however, this regimen is proving more difficult than she anticipated. Pamela recognizes that because of her extremely busy schedule, she has difficulty taking her medications at the right times of day, so although she understands what she needs to do with the medications, Pamela misses many doses. Pamela's medical errors are playing a role in her own debilitated health.
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