Concluding Remarks

Mrs. Nguyen thanks you for your openness in discussing her herbal medicines. She is fine with stopping the Diabetee-Care tea and will reduce her garlic consumption to one clove a day. It is possible that Ms. Nguyen's low blood sugar and bruising was caused by her herbal products. You ask her to return in one week to monitor her INR, glucose level and LFTs.

It is very important to advise patients about the safety and effectiveness of the products they are using or are considering using. Most patients do not realize the great variability in quality and safety of dietary supplements. As we have discussed, several entities have set up standards for the production, bioavailability, and purity of dietary supplements, including the United States Pharmacopeia Convention, Consumer Labs, and the National Science Foundation.

Remember, two out of three patients taking prescription medications and supplements do not tell their physician about their HDS use. Rather than asking closed-ended, yes or no questions, ask instead open-ended questions, like "What vitamins, herbs, and other supplements do you use? What about teas, tinctures, or natural products?" Supplements should be treated as equally and importantly as other drugs, and need to be documented on the medication list and recorded in the patient medical record just the same.

You are now finished with Case 2: Mrs. Nguyen. Please proceed to Case 3: Mr. Gomez.