Case Study 2

Case Study 2

Your patient 66 year old lady, who is being cared for by her 78 year husband. Both husband and wife have little formal education. Early in the medical interview the husband framed his wife’s confusion and erratic behavior as a consequence of somatic causes, such as her pain from the Western medication that was “too strong” for her. He has tried multiple avenues of treatment. As he put it, “With the Eastern medication, she at times drinks about 50 preparations of herbal formulas and it doesn’t improve the condition at all. So we turn to Western medicine and it cause heat and discomfort/hot temperament and then we turn back to traditional medication, for instance a traditional medication with herbs and acupuncture.”

She is currently seeing more than three Western doctors, including a psychiatrist, a family practitioner, and a gastroenterologist. Later in the interview, he enthusiastically related a story about how he had put his faith in a spirit medium and the Buddhist Goddess of Mercy in order to heal his wife. The day before the interview, he had taken his wife to a spirit medium for the first time. The medium practices in a local Buddhist temple, and the ceremony appears to combine elements of both Buddhism and of folk religion. The husband says that in order to cure his wife, “The first thing is that we have to pray/appeal to Buddha or the Lady Buddha Quan Am, this and that Buddha to give us faith in the unseen forces or spirits. Pray/appeal, believe in Buddha, at night when we sleep light incense. We have faith in, we believe so that, have faith so that the pain will subside. Fast/abstain from meat, follow Buddha, control one’s temperament, don’t be hot tempered or often think and wonder about something so that the mind is stressed and eventually it will subside.” His search for a cure for his wife is very pragmatic, “If we are ill/hurt, we would go wherever people can do something, go to shamans/voodoo masters/spiritual masters too.”

Topics for Discussion

Questions for Discussion or Written Assignment

1. What would a health provider’s problem list include for the cases above?

2. What are the salient cultural beliefs that are influencing this family’s health behavior? How could an understanding of the cultural health beliefs and/or cohort experiences assist the health care provider in giving effective care?

3. What are possible strategies for increasing adherence to medications in this woman?

4. If the family reveals to the doctor that they have sought help from a spirit medium and taken herbal remedies, how should the healthcare provider respond? How might use of these alternative treatments influence their ongoing healthcare?

5. What kind of treatment, management, or referrals might the health care provider consider?