Patient Case Commentary: A Holistic analysis of patient care

Essay by erptyCollege, UndergraduateA+, May 2007

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Introduction: Criticisms of modern medicine have led to the systematic implementation of medical ethics, holistic approaches, the biopsychosocial model and other similar concepts. There has been a shift in recent times from a paternalistic doctor-patient relationship which predominantly focused on the biological facets of disease, to one which explores the numerous perspectives of the personal experience of illness. This case commentary employs the latter methods to investigate the impact that pregnancy has made to a 44-year-old woman, who was presenting for a consultation with her physician to discuss the results of an amniocentesis.

The case:At the time of interview, Eva*, a 44-year-old female, together with her husband Chris*, 36-years-old, presented to their local General Practitioner to discuss the results of an amniocentesis performed nine days earlier. Eva was particularly worried that her fetus had the chromosomal abnormality trisomy 21, more commonly known as Down Syndrome. However, the test results confirmed that the karyotype of the 17-week-old fetus was normal.

*All identifying information has been altered to protect confidentiality.

Previously, Eva has had two pregnancies resulting in two children, currently aged fifteen and six. She recounted that she was exceedingly apprehensive in regards to continuing this pregnancy when first confirmed, particularly due to the risks involved with giving birth at her age. Upon inquiry, Eva revealed that she had decided that she would abort her fetus if it were shown to suffer from a chromosomal trisomy or neural defect. However, Eva now reports that she has to some extent adjusted to this life change with more enthusiasm, particularly in light of the absence of severe disability.

Eva had undergone first trimester screening using nuchal translucency at the 12th week of gestation. This involved measuring the depth of the fluid in the space at the back of the fetus' neck which...