CASE STUDY #1
RESPONSE: assess the risks involved in the situation and discuss the implications (ethical, legal implications) and provide a rationale for the steps you chose for your resolution.
Identify the major issue(s) in the scenario (e.g., ethical, legal); Identify all those invested in outcome (e.g. family members, patient, doctors, hospital administration, policy makers, etc); Identify one action plan to resolve issue(s) – with proper literature support; discuss personal reaction to the scenario.
White Coats, Windsor Ties, and Western Medicine
At the midpoint of my third-year rotation in the Glaucoma Service, three of my colleagues and I were gathered in a small office, ready to discuss the morning’s cases. As the Chief of Clinic described each case, it sounded as if we’d be having a routine day. Then, the case of a patient I’ll call “Mr. Z” snatched my attention. The Chief explained that he had previously suspected that Mr. Z was suffering a brain aneurysm and referred him out to undergo brain scans. On this day, Mr. Z was back at our clinic for his 3-month glaucoma follow-up. The Chief told us that during the exam we may see an afferent pupillary defect, a depressed and abducted eye (i.e., “down and out” eye), and an aberrant regeneration of the third nerve. He also mentioned that the patient was very ill. As an inquisitive optometry student who had never seen this type of case, I went out of my way to ensure that Mr. Z would be my patient.
Putting an Apprehensive Patient at Ease
Mr. Z was hunched over and barely able to walk even with the help of his son and wife. I doubted whether he would be able to finish the exam. He occasionally flashed a smile; nonetheless, I was immensely concerned about his health. I was obligated to acquire answers to case history questions and to find out why he was so ill, but it wasn’t as simple as that. He and his wife spoke limited English, and based on quick judgment of my patient’s complexion and appearance, I knew I needed to make some cultural considerations.
As mentioned previously, Mr. Z had been to our clinic before. As a matter of fact, he had been coming for 6 years. Despite this, I sensed apprehensiveness from both him and his wife. They were quiet and especially respectful when they asked questions pertaining to his health and what procedures were being done. While being in an exam room with a doctor wearing an immaculate white coat can make patients anxious, Mr. Z and his wife also were not natives of Western culture, and English wasn’t their first language. I had seen the same uneasiness in other patients in similar circumstances. In these situations, a separation can manifest between patient and doctor.
My job as the student optometrist was to reassure the patient, so I did what I was trained to do. I lowered my seat below his wife’s level and used a welcoming tone. Although I knew his wife would be the one answering my questions, I made an effort to keep eye contact and turn towards Mr. Z. I made sure to nod and smile as they shared information about his health condition with me, and I listened intently when they expressed their concerns. Then, I stopped the examination for 2 minutes. I asked about their son in the waiting area and about how they found our clinic. I wanted to briefly distract their minds from the examination, hoping it would help me to gain their trust. I understood from past experience that once our patients trust us, they are noticeably more open with us.
During these 2 minutes, we laughed and shared stories. Mr. Z’s wife asked me where I was from, so I asked their ethnicity as well. I felt the barriers between us dissolve. For them, it seemed as if my white coat and tie suddenly blended in with my character. Mr. Z smiled every few seconds and was eager to set his head onto the chinrest as I prepared to applanate his right eye.
What I was able to witness in this case was that although Mr. Z barely spoke, and his wife knew little English, she was still able to effectively convey to me why her husband was feeling ill and what they expected that day. In turn, I was able to obtain essential details, including how Mr. Z had been using his glaucoma medication.