Unit 5 Written Assignment #4: IDST 4300Workforce Diversity This assignment will examine a case study on Cultural Competence. This casewill provide a good example of the issue briefly described in the text regarding medical interpretationsand also cultural competence. After reviewing the case, pleasecomplete questionslisted below.Case Scenario/HistoryA 65 year-old Cambodian gentleman presents to the Emergency Department following anepisode of coughing up blood. The resident approaches the bedside where he finds a thin elderly Cambodian male sitting alone. The patient is Cambodian-speaking only. There are no Cambodian-speaking health care providers or interpreters immediately available and the family has not accompanied the patient into thetreatment area. The son speaks some English, while the daughter-in-law speaks only at a very basic level. Once at the bedside, the resident begins to obtain a history. He learns from the son that the patient lives with him and his wife, and that since he is at work most of the week, his wife takescare of his father. The son goes on to explain that he firstnoticed his father coughing up blood two weeks ago but that today it was much worse. Otherwise, he states that his father had appeared unchangedto him. In an attempt to gain additional history, the resident begins to pose questions for the son to translate to his father.Patient lives with his son and daughter-in-law. He is a refugee from Cambodia. Living in the US for approximately 20 years. Hedenies tobacco use. Throughout thisconversation, the patient does not make eye contact with the physician, but instead focuses down at the blanket covering him. The resident, having recognized the areas of ecchymosis on the back as being consistent witha folk medicine practice called ‘coining’, asks the son about it. The son states his wife had been doing this over the past couple of weeks ever since they noticed the blood. The son speaks briefly with his wife in Cambodian, then goes on to add that theytook his father to a healer who recommended to continue the coining and gave them some herbs to make tea for his father with. The resident leaves the room to order lab work and chest x-ray. When the nurse enters the room to draw blood, thepatient refusesthe procedure. The resident returns to the bedside and the son relates to the resident that his father does not want any blood work done. The resident informs the son that blood work is a crucial part of the medical work-up and that a CXR alone will onlyprovide limited information.The patient continues to refuse. The resident leaves the bedside frustrated. Several minutes later, the son finds the resident and asks him if having the blood drawn won’t further weaken his father since he is already losing blood. The resident reassures him that they will draw only a small amount which will not impact his father’s strength. The son returns to discuss this with his father who then consents to the blood draw.
Case OutcomeDiagnosis: Mycotic thoracic aneurysmDisposition: Admitted and underwent endovascular repairThe patient’s son was informed of the diagnosis, severity and need for surgical repair. This was initially met with denial and refusal on the part of the patient. Recognizing both the urgency of the medical problem and the difficulty he faced in reconciling the two different understandings of the problem, the resident located a Cambodian medical interpreter. After much discussion and negotiation based on the principles discussed above, the patient agreed to surgery. The local kruu Khmer (folk healer) visited him in the hospital both before and after the procedure.Questions Part I:(ALL SECTIONS)1.Describe the primary issue(s) presented in the case study. What factors contributed to the difficult examination?2.What might be the reasonsfor refusing blood draws or other forms of treatment? Describethe role of negotiating medical care.3.How can health care providers, individually and as an institution, provide access to services to patients who donot speak English? 4.What are your legal responsibilities to provide these services?
