John Green, 33 year-old Caucasian male, presents to the office to establish as a new patient. John’s natal sex is female but he identifies as a male. He transitioned from female to male 2 years ago. He has made a full transition with family and socially last year. He just moved back home and is unemployed at this time.
Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
John Green, 33 year-old Caucasian male, presents to the office to establish as a new patient. John’s natal sex is female but he identifies as a male. He transitioned from female to male 2 years ago. He has made a full transition with family and socially last year. He just moved back home and is unemployed at this time. He has been obtaining testosterone from the internet to give to himself. He has not had any health care since he decided to change other than getting his suppression medications through Telehealth 3 months ago. His past medical history includes smoking 2 packages of cigarettes per day for the last 10 years, smokes 3-6 marijuana joints every weekend (has an active green card), and does suffer from depression episodes. He is HIV positive for the last 3 years but remains virally suppressed at his last blood draw 6 months ago. He has been feeling very weak over the last few weeks which prompted him to move back home with his parents. He takes Biktarvy once daily that comes in the mail for free, tolerates it well, and 100 mg Testosterone IM every 7 days. His PMH is non-contributory. No past medical history. He has never been married. No significant family history. He is worried since moving back home and unemployed he will be a burden on his family, and he thinks his health may be declining.
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The diversity of culture and lifestyle around the world creates challenges for health care providers and systems to provide culturally competent medical care. Cultural competence is the ability of health providers and organizations to deliver health care services that meet the cultural, social, and religious needs of patients and their families. Culturally competent care can improve patient quality and care outcomes. Strategies to move health professionals and systems towards these goals include providing cultural competence training and developing policies and procedures that decrease barriers to providing culturally competent patient care.
Patient’s beliefs, behaviors, and values are shaped by factors such as ethnicity, gender, language, mental ability, nationality, occupation, race, religion, sexual orientation, and socioeconomic status. Cultural competence is the provider and systems able to understand and integrate cultural intelligence into the delivery of healthcare. The goal of providing culturally competent health care services is to provide consistent quality of care to every patient, regardless of their cultural, ethnic, racial, or religious background.
Strategies for improving cultural competence in individuals and systems include:
- Encouraging family to participate in healthcare decision making.
- Incorporating culture-specific values into health promotion
- Providing cultural awareness training
- Providing an environment that allows traditional healers
- Providing interpreter services
- Recruiting minority staff
When individuals and systems are able to provide a positive environment of cultural competence that meets the religious and spiritual needs of those who are cared for, the outcome for patients improves, and the healthcare system as a whole becomes a more positive environment.
The specific socioeconomic factors that may be contributing to the patient’s abdominal pain include her limited English proficiency and financial situation. She may not be able to afford adequate medical care or treatment for her condition, which could be causing her pain to worsen. Additionally, her limited English proficiency may make it difficult for her to communicate effectively with clinic staff, which could lead to delays in diagnosis and treatment.
The patient may be experiencing spiritual pain that is manifesting as physical pain. The staff should ask the patient if she is in any pain and if so, what kind of pain it is. They should also ask if she is feeling any other symptoms, such as fatigue, anxiety, or Depression. They should then try to determine what might be causing the pain. This could include stress from a recent event or from ongoing life challenges, as well as spiritual issues such as feeling lost, hopeless, or unsupported. If the staff feels that the patient could benefit from spiritual care, they should refer her to a chaplain or other member of the spiritual care team.
Based on the information provided, it is likely that the patient is experiencing a stomach ulcer. This can be caused by lifestyle factors such as smoking or drinking alcohol, as well as by stress. The patient may need to make changes to her lifestyle in order to help improve the symptoms of the ulcer. These changes could include quitting smoking and drinking, and reducing stress levels. She may also need to take medication to help treat the ulcer.
One possible cultural factor that may be impacting the patient’s care is her language barrier. The first visit, the staff relied on her younger bilingual daughter to translate, which may have impacted the accuracy of the information relayed to the staff. Today, the patient presents with the same problem, but worse. It is possible that the patient is not able to communicate her symptoms accurately to the staff due to the language barrier. Additionally, it is possible that the patient’s cultural beliefs or values are impacting her care. For example, the patient may believe that medicine should be taken only when symptoms are severe, which could lead to her not taking the medication prescribed to her.
There are a few specific issues that we would need to be sensitive to when interacting with this patient. First, the patient may not have regular access to medical care or may be unable to afford necessary treatment. Additionally, the patient may not have regular access to food or may be living in poverty, which can lead to malnutrition and other health problems. The patient’s culture may also play a role in their health. For example, some cultures believe in traditional remedies instead of seeking medical care. Additionally, the patient’s faith or religious beliefs may influence their treatment decisions. We would need to be sensitive to these cultural and socioeconomic factors when interacting with this patient.
The five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
1. What is the nature of your abdominal pain?
2. When did the pain start?
3. Does the pain come and go, or is it constant?
4. Was the pain worse yesterday or today?
5. Have you experienced similar pain before? If so, what was the cause?
Based on the patient’s symptoms, it is likely that she is experiencing a gastrointestinal issue, such as gastritis or pancreatitis. Omeprazole may have helped to relieve her symptoms initially, but they have worsened in more recent days. The staff should continue to provide her with medication and pain relief as needed, and should also work to determine the underlying cause of her pain. If her daughter is available, she can be helpful in translating the medical advice.