Instructional Strategies

In addition to lecture and reading assignments, the following case can be used for discussion or written assignments.

Case of Mrs. P

Case Study of Mrs. P

It’s 4:45 PM on a Friday afternoon in August, and the air conditioning is unsuccessfully fighting a valiant battle against the angry San Jose, California sun and clearly failing. The waiting room has been full all day with hot, irritable patients. Sitting in your office, you haven’t had time to think about how irritable and hot you are. You look at your watch for the third time in as many minutes. You have committed yourself to leave for vacation with your wife and kids as early as possible this afternoon, and you have one more patient to see before your vacation begins.

You read through the chart of Mrs. P. a 65-year-old Pakistani lady. Mrs. P. moved to California from Islamabad three years ago. You note her medical history is significant for hypertension and occasional insomnia. She has never had a mammogram done. Her hypertension has been moderately well controlled for many years on hydrochlorothiaziade 25 mg QD. Recently she was started on doxepin 10 mg qhs for insomnia.

You remember Mrs. Parvez as a shy retiring lady who is usually brought in by her son. Mrs. Parvez is moderately proficient in English and speaks with a thick accent. She also usually lets her son do most of the talking and you remember that you have to persist tenaciously to get her to talk. Just as you are almost sure that Mrs. Parvez is a ‘no-show’ today and you switch into your ‘vacation mode’, your nurse Alicia pops her head in and cheerily announces that “Mrs. P___ has been roomed” and that she is due for her breast exam and Pap smear.

You pick up the chart and walk into the patient’s room. Mrs. P is sitting on the exam table and her son Mohammed gets up to greet you. After the initial pleasantries, you say that you want to do a routine exam and a pap smear. You give Mrs. P an exam gown and tell her to undress and change into the gown, and you leave the room saying that you will be back in a few minutes.

Ten minutes later you walk into Mrs. P’s room only to find that it is empty. Astonished, you walk into the waiting area just in time to see Mohammed’s car pulling out of the parking lot! Perplexed, you have the clerk reschedule Mrs. P. to be seen in 2 weeks time and request Alicia to call Mrs. P. the next day to follow up. You then hastily leave as your wife is paging you for the third time in 10 minutes. As you pickup your car phone to call your wife you cannot help wonder about Mrs. P. and Mohammed and their sudden departure…

Topics for Discussion

Discussion Topics:
Cultural issues that may be involved in this case—

1.What could account for the sudden departure of Mrs. P. and her son?

2. In a culturally competent practice, what would have been done differently?

3. What might be done by Alicia and the physician to try to repair the relationship?

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