Table 2.
Other case examples of health-related themes brought up at several routine office visits
| Health issue | Patient 1-Provider 1 | Patient 2-Provider 2 | Patient 3-Provider 3 |
|---|---|---|---|
| Chronic illness | Diabetes management | Hypertension management | Diabetes management |
| Provider: So what’s happening with your sugars? Patient: My sugar? Is it bad? Provider: No, I’m asking. Are you checking it regularly? Patient: every morning. Provider: Okay, and what kind of numbers are you getting? Patient: 75, 93, 102. It has not been over that | Patient: Yeah. I started taking the vinegar again and like the blood pressures been going between like, what? The other day it was like 131 over 76. Then, the next morning I was up and about and it was like 130-something over 96 | Provider: How about your sugar? How is that doing, because you’re not on any medication for that, are you? Patient: No. In fact that’s the first thing they checked. It was 119 when they checked it that morning | |
| Prevention | Cancer screening | Immunizations | Cancer screening |
| Provider: Is your colonoscopy every five years or ten years? Patient: I think you said ten. Provider: That’s what I think too. I’m just going to double check | Provider: Yeah. And in terms of shots, you should get the flu shot this year. We don’t have it yet anyway, so I can’t even <laughter>, and I can see you shaking your head | Provider: I’m going to go ahead and give you the [stool] cards for now … And then the other screening test is the prostate. Now that’s really controversial right now, ‘cause we usually do a PSA test every year. Patient: I know | |
| Behavior | Checking feet | Medication adherence | Diet |
| Provider: These (feet) are beautiful. You look at them every night? Patient: My feet? Provider: Um hmm. Patient: Sometimes. <laughter> Provider: Get in the habit | Patient: So I stopped taking that one. A week after I started taking it, I almost had an accident. I was coming home, I got a cramp in my neck that went into my head, down my shoulder and stopped right at the elbow … I thought I had a stroke. Provider: Okay. So if you didn’t like the Norvasc and you didn’t like the Hydrochlorothiazide and you’re feeling like the Toprol is causing you problems, we need to find something else | Provider: So you’re just controlling that with your diet? Patient: Yes. Yes. Provider: Are you still trying to follow a, like a diabetic, I mean a really low-fat no meat diet like your wife? Patient: Yes. Yeah | |
| Medication issues | Provider: The second thing I’m wondering about is that Wellbutrin you’ve been on for four years now. Provider: And what happened with the Zoloft before (‘cause we switched you)? Patient: I was on that for years and years and I don’t know why you took me off and gave me Wellbutrin. Provider: Oh we switched you ‘cause it was non-formulary | Provider: ‘Cause I could give you the non-generic Toprol, but it probably will be more expensive for you. Patient: Okay, I could try it | Provider: Now the thing’s rubbed off, I can’t read it, but it looks like it says you should be taking it three times a day and you’re only taking it twice a day. Do you think they want you to take it three times? Patient: When I first went he told me ‘You’ve got to take it three times a day,’ but after, I don’t know if my pressure went down. He only told me to take it twice I believe |
| Social environment | Social support | Economic/financial | Social support |
| Provider: you look in that Shaker Magazine, there’s a whole section for seniors as far as activities. Patient: Patient: Shaker Magazine? I didn’t know because I went to the library in Cleveland Heights, and I asked them. I said you know ‘I live in Shaker. Do they have any activities for senior citizens?’ … But hearing it from you, I will do that | Patient: About two years or so, that you put me on that after I had the reaction from the Norvasc. No problems. They stopped making the generic and they said that the insurance was covering the name brand. I was taking the name brand. Remember I told you I started having a problem? Then they started making the generic again … | Provider: Do you have to go over there every ten days to see a nurse? Patient: No, I … Provider: So you do it yourself? Patient: My daughter shoots it [the medication] | |
| Care co-ordination | Provider: And Dr R just did labs on you and everything that he did was okay Patient: I have to go and pick up the little black one [pill] from Dr R | Provider: Okay, and so did you get my letter with your test results from August? | Provider: And your heart doctor, he probably doesn’t know what happened to you, or did you tell him? Patient: No, I haven’t. Provider: Cause you might want to give them a call … |
| Acute illness | Patient: I feel tired. No energy, even though I exercise. [Long Discussion] Provider: So, do you think you’re depressed? Patient: Yep | NA | Patient: I just got out of the hospital a couple of … Provider: Oh no, ‘cause I’ve been getting letters from the heart doctor. Patient: Yeah. I had a slight stroke I think … |
| Intra-personal | Emotional | Sexuality/intimacy | NA |
| Patient: I was very distraught when [my grandson] moved. My youngest son visits and I have two grandchildren here, you know that they visit | Provider: Have you been with anybody new lately? Patient: No |
NA=not applicable.
Sub-themes are highlighted in bold and included where a sub-theme is helpful to orient the reader.