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The Holistic Approach

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I can’t stop thinking about PIES at the minute. Now PIES in this case, are not the pastry based mouth-watering food substance as one might think. It stands for 4 abbreviations that define an individual’s well-being. These abbreviations are physical, intellectual, emotional and social factors.

This is a very simplistic approach towards well-being but ever since learning it for my Health and Social Care GCSEs, I’ve not been able to disregard it. There is a reason I’m stating this now though. I sometimes try to apply my PIES. When as students we look at are given are case scenarios, PIES are normally mentioned in some way. The patient’s physical health or presenting complaint is normally, this is normally related to physical symptoms (pain, fever, SOB etc.). The intellectual aspect I directly relate to compliance for some reason, this is something in counselling sessions I obtain by asking “Can you tell me about your medicines?” or “Can you just tell me what I just told you?”. If a person has an intellectual understanding behind something, it increases there cases of compliance. In a recent case study it stated that the patient was not interested in his medication or condition. Interesting there was a compliance issue in this case and sometimes it is not just due to lack of information. Emotional health factors are one of the most important aspects which are barely even mentioned at university. This is understandable as we’re training to be pharmacists and not counsellors and I suppose I’ll see what emotional factors are about next year. Lastly are social factors, normally the patients social history is stated. In a recently case study, the patient’s wife dealt with his medication. This also could have contributed to his incompliance.

So looks like learning PIES at GCSE wasn’t so irrelevant. Not only do I look at cases specifically from a pharmacy point of view, but also as a general care plan for the patient which hopefully catalysis an improvement in a patients well-being through multidisciplinary teamwork (in practice and not just theoretically).

Another thing on my mind recently was defining ‘health’. It might seem obvious but patients generally define health through the absence of symptoms. An example of this would be a patient undiagnosed with cancer with no current symptoms. “I feel fine.” This view is a probable cause of recurrent infections etc. WHO has defined health as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’.  It directly related to PIES, although the intellectual part is missing. However without some understanding, how can you have patient consent to treat?

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