CASE STUDY EXAMPLES
CASE G: DIABETES
G is in his 20s and was recently diagnosed with diabetes after mentioning to one of his relatives, a nurse, that he has been very thirsty and has had blurry vision. His relative advises him to look at the CDC’s webpage “Living with Diabetes” and refers him to an experienced endocrinologist. At first, G is overwhelmed with the implications of his diagnosis: he needs to manage his diabetes, eat healthy food, and be physically active. His physician supports him in helping him understand that one of the most important things he can do to manage his diabetes is regular blood sugar monitoring, for example using a blood sugar meter or continuous glucose monitor. G’s physician also introduces him to community-based organizations (CBOs) that provide support for people living with diabetes. As a low-income adult, G is concerned about filling his diabetes prescription living in a non-Medicaid expansion state.
CASE H: CHRONIC KIDNEY DISEASE
H is a teenager. He has been feeling tired, had a decreased appetite, and experienced weight loss. One day he experiences nausea and vomiting and his mother takes him to their family doctor, who suspects a stomach bug. As H’s symptoms continue, his mother asks family and close friends for advice. Upon learning that H experiences itchy skin, swelling in his feet, feeling tired, increased urination and pink-colored urine, a family friend, a nephrologist, suspects kidney disease and recommends H’s mother takes him to a pediatric nephrologist. H is diagnosed with chronic kidney disease and receives treatment. He struggles with learning, focusing and participating in school and extracurricular activities. H’s parents are supportive, for example, they help him in eating healthy food, making sure he has breakfast before school, and walking regularly, and H remains optimistic about his health prospects.
CASE N: SUBSTANCE USE DISORDER
N is an educated, upper income woman in her 30s. She has economic stability, health insurance and optimal access to health care services. She grew up with optimal material circumstances but experienced isolation as an adolescent. From early adulthood, she has been engaging in alcohol and illicit drug use. Her social environment includes a drug-using peer group, which has been a barrier to substance use disorder (SUD) treatment and recovery.
CASE p: Intimate partner violence
P’s husband of several years is manipulative, tense, dominant and controlling in their relationship. He regularly manipulates, humiliates and degrades her. He repeatedly harasses her with unwanted phone calls, texts, e-mails, and cards, and has threatened to harm himself. P’s husband also gaslights her, making false statements to and about her, withholding and omitting information so that she doubts her own perceptions. He blames her for his abuse and accuses her of making things up. When P tries to leave the relationship, her husband threatens suicide saying, “I’ll kill myself if you leave me”. P considers reporting the incidents but fears reprisal and a biased police that would protect the offender. She goes to see her physician who identifies her as experiencing abuse, validates her experience of intimate partner violence (IPV), works with her to develop a safety and exit plan, and refers her to counseling addressing trauma from IPV. P starts domestic violence counseling and gets housing protection through the Violence Against Women Act (VAWA).
CASE V: adverse childhood experiences
V was raised in an economically stable household living in a safe neighborhood. V’s mother takes care of him and supports him. They regularly engage in positive activities together. However, from a very young age, V has been exposed to his father’s psychological abuse through pervasive blaming, belittling, terrorizing, and intimidations. In addition, V is a victim of his father’s alcohol use disorder and has been exposed to his father’s domestic abuse, including of his mother and siblings. As a result, V develops toxic stress, and experiences fatigue, dissociation, and fear. Despite his mother’s support, V has problems sleeping and upsetting dreams, angry outbursts and extreme emotional reactions. He has problems concentrating and loses interest in activities – symptoms of post-traumatic stress disorder.
CASE X: MULTIPLE SCLEROSIS IN FRANCE
X is a woman in her 30s, living in France, who has multiple sclerosis. She regularly exercises and maintains a healthy sleep pattern but has difficulty walking and feels very tired. She requires specialized housing and adapted transportation. She fears that relapses and/or disease progression will increase her social isolation. She benefits from the French Social Security “long-term illness” (Affection de Longue Durée, ALD) status that covers her medical fees and provides transportation to her appointments. She joined the French Association for People with Sclerosis (Association Française des Sclérosés en plaque, AFSEP), through which she receives emotional and psychological support that has helped her find motivation to see recommended health care providers. With the AFSEP, she has learned a lot about multiple sclerosis, which helps her navigate her treatment plan, although this knowledge includes the fact that there is no cure for MS, which generates a pessimistic outlook for her condition.
