Case study- discussion

Bao, Chi, and Duong Phan are sitting quietly in the examining room when Dr. Williams rushes in.“Oh geez”, he thinks to himself, “I have to get to a Seminar by 5:30 PM and I’m already running an hour behind. I’d better make this quick.”He turns to Chi Phan and says hurriedly, “So, Mom, we have the results of the sleep study.As we thought, it is OSA.His AHI was 120 increased in REM to 250.He had long periods of hypoxemia and hypercarbia.He is at risk for pulmonary hypertension with these results. I doubt that an adenotonsillectomy will adequately treat his problem.The most rapid and effective treatment at this time is CPAP with a Cflex of 3.He may need to tolerate a nasal interface, but if he develops a significant leak we will change him to a Quattro full face mask.)Chi looks at Bao, who says tentatively, “face?A mask?”.“Oh shoot”, Dr. Williams thinks, “here we go again, this is going to take forever.”He figures the mother must be a little slow – she isn’t saying anything. Or maybe she doesn’t care about her son.Dr. Williams responds loudly, “It – will – help – your – child – keep – breathing”.Frustrated, he decides to proceed with some more questions before trying to explain anymore.When he asks about any medication that six-year-old Doung is taking, Bao replies that he is not on anything right now.Bao says that their pediatrician had prescribed Ritalin but his wife tried it before giving it to Duong.It made her feel funny, so she decided not to give it to him.

Dr. Williams resumes trying to explain OSA and CPAP to the Phan family.He explains it as clearly as he can but cannot understand why they are not saying anything.“It must be that they do not want to do this,” he thinks.Agitated, he puts his hands in his pockets and starts pacing.Finally, he sits down again and says in exasperation, “Well, if you don’t use CPAP, you’ll have to get a trach”.As he says this, he points to neck and demonstrates a hole.He asks, “Do you understand?”Bao and Chi nod politely. “OK, so we’ll order the CPAP and you can do that,” Dr. Williams finishes. He tells the family that the you will arrange to have to equipment delivered.As he leaves, Dr. Williams, one hand still in his pocket, hands the checkout sheet to the family.He finds you and says, “I want you to call the social worker and see about a referral to child protective services. This Mom is clearly not involved and her tasting the medication is truly bizarre.

On their way out of the clinic, Bao tells Chi that he will consult with his mother and father over Duong’s medical problems and will talk to the Buddhist Temple performing a ceremony before considering any medical procedures.“I think we should ask our friends for the name of another doctor, I do not want to come back to this rude place.”

You are the CHW working with Dr. Williams. You realize there’s so much that he doesn’t know about different cultures let alone dealing with children. He makes such assumptions.Explain in detail the mistakes that Dr. Williams makes in his actions and his thinking.At least 3 of the mistakes you discuss should be discussed in relationship to the Hmong culture.As a culturally competent doctor what could he have done to either correct or avoid each of the mistakes you identified?


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