Summary of Clinical Case
Minh Wheeler, a 58-year-old woman, has been diagnosed with moderate chronic obstructive
pulmonary disease (COPD). She also has insulin-dependent diabetes but struggles with
adherence to her treatment regimen due to her demanding work and home life. As a restaurant
and catering manager, her job is physically demanding, and she experiences significant shortness
of breath, making it difficult to consider exercise as part of her diabetes management.
Beyond her physical health concerns, Mrs. Wheeler faces emotional and social challenges. She is
the sole financial provider for her two college-aged children and is concerned about the financial
implications of her illness, especially regarding medical leave and health insurance. Additionally,
she struggles with guilt related to the death of her first husband and finds solace in her church
community. However, her recent diagnosis has caused her to question aspects of her faith,
especially since her pastor emphasizes that healing is possible through belief. Her husband, a
devoted member of her church, expects a miracle and opposes advance care planning, believing
that resuscitation and ventilator support should be pursued to allow divine intervention.
Main Issues in the Physical, Emotional, Social, and Spiritual Domains
1. Physical: Mrs. Wheeler's COPD is progressive and incurable, making symptom
management essential. She also has diabetes, which she struggles to manage due to her
lifestyle constraints. Exercise, a crucial aspect of her diabetes care, is challenging due to
her respiratory limitations. The prospect of managing multiple inhalers further
overwhelms her.
2. Emotional: She experiences guilt over past events, particularly the death of her first
husband. Her diagnosis has led to fear and uncertainty about her future health and ability
to support her family. She also grapples with feelings of inadequacy in managing her
multiple health conditions.
3. Social: As the primary financial provider, she faces stress regarding work stability and
health insurance. Her demanding job exacerbates her health challenges. She has a
supportive husband and church community, but their expectations regarding faith and
healing create tension regarding medical decision-making.
4. Spiritual: Mrs. Wheeler's faith is both a source of comfort and internal conflict. While
she values her church community, she struggles with the message that strong faith alone
can lead to healing. Her reluctance to complete an advance directive stems from fears that
doing so would signify a lack of faith and contradict her husband’s belief in divine
healing.
Discipline-Specific Approaches to Care
1. Primary Care & Pulmonary Specialist: Focus on optimizing COPD management with
inhalers, pulmonary rehabilitation, and oxygen therapy as needed. Patient education on
symptom management and strategies to improve quality of life is crucial.
2. Endocrinology & Nutrition Support: Assistance with structuring a diabetes
management plan that aligns with her work schedule. Encouragement of small,
manageable lifestyle changes, such as brief walks or diet modifications, to enhance
adherence.
3. Mental Health & Counseling: Given her guilt, stress, and emotional turmoil, therapy or
support groups could help her process grief and adjust to her diagnosis. Cognitive-
behavioral therapy (CBT) may be beneficial in addressing guilt and health-related
anxiety.
4. Social Work & Financial Counseling: Guidance on financial planning, insurance
options, and potential workplace accommodations. A social worker can also assist with
advance care planning discussions to ensure her wishes are respected while considering
family dynamics.
5. Chaplaincy & Spiritual Support: A chaplain could provide guidance on reconciling
faith with medical realities. Encouraging open discussions between her, her husband, and
her pastor may help ease her spiritual distress and decision-making conflicts.
Main Takeaways
COPD is progressive and requires proactive management to maintain quality of life.
Managing multiple chronic conditions can be overwhelming, necessitating a tailored
approach that accounts for personal, professional, and emotional challenges.
Financial insecurity and health-related work disruptions can be significant stressors,
requiring early intervention and planning.
Faith and spirituality play a critical role in coping with illness, but conflicting beliefs
about medical interventions may lead to emotional distress and difficult decision-making.
Advance care planning should be approached with sensitivity, ensuring that the patient’s
values and wishes are respected while considering family expectations.
Questions That Arose from This Case
1. How can healthcare providers better support patients struggling with multiple chronic
conditions while balancing demanding work and family responsibilities?
2. What strategies can be used to help patients reconcile faith-based healing beliefs with
evidence-based medical care?
3. How can providers facilitate discussions about advance directives in a way that respects
religious beliefs while ensuring patient autonomy?
4. What community or workplace resources might help Mrs. Wheeler maintain financial
stability while managing her health conditions?
5. How can interdisciplinary teams collaborate to provide holistic care that addresses
physical, emotional, social, and spiritual needs?
This case highlights the importance of a multidimensional approach to care, considering not only
the medical aspects of disease but also the personal, social, and spiritual factors that influence
health outcomes.
