General Case

Patient Case

Mrs. B and Doctor T will be used as an example to model decisional guidance

Mrs. B is a 75 year-old woman with multiple chronic conditions. She often presents to her primary care physician, endocrinologist, pulmonologist, or cardiologist with symptoms such as fatigue which has multiple possible causes but no one clear etiology. She has not been adherent to CPAP. She has had two admissions for heart failure in the past year. Mrs. B will be used an example throughout this guidance tool. You can Click Here to see her Health Priorities Template.

Bothersome Symptoms:
Fatigue, hand pain, urinary frequency, dyspnea (when diuretic is reduced/stopped)

Medications:
Alendronate
Amlodipine
Atorvastatin
Hydralazine
Insulin
Lisinopril
Metformin
Metoprolol
Omeprazole
Rivaroxaban
Spironolactone
Torsemide
Tylenol

Chronic Conditions:
Atrial Fibrillation (Afib)
Coronary Artery Disease (CAD)
Depression
Diabetes Mellitus Type 2 (DM2)
Gastroesophageal Reflux Disease (GERD)
Gastrointestinal Bleeding (GIB)
Heart Failure with Low Ejection Fraction (HFrEF)
Hyperlipidemia
Hypertension
Obstructive Sleep Apnea (OSA) on CPAP
Osteoporosis
Osteoarthritis

Hospitalizations over past year
Upper Gastrointestinal Bleeding
Heart failure (twice)

Tasks:
Daily weights
CPAP nightly
Low salt, low refined carbohydrate diet
Fingersticks for glucose monitoring
Insulin injection
Medications

Mrs. B enjoys volunteering and spending time with her family. She is unsure if her medications may be causing symptoms that prevents her from doing these activities.

Dr. T is not sure if some of the therapies are helping Mrs. B, and wonders if some may be causing more burden and harm than benefit.