Here are 2 cases to frame this assignment: you will choose one of these as the basis of your discussion.
Case 1. Gao-Jer is a 27 year old woman with severe Graves disease; because of an autoimmune issue, her thyroid is making too much thyroid hormone. She is having a rapid heartbeat, diarrhea, sweats, and weight loss, but her biggest concern is proptosis – that is, the high thyroid levels are making her eyes protrude. She has already been seen by her primary care provider, who referred her to ophthalmology, where it was recommended she have urgent surgery to correct the issue, before she develops permanent eye damage. They scheduled the surgery for next week. She also spoke with a thyroid specialist, who prescribed a medication (methimazole) and asked that she see a surgeon right away to discuss removal of her thyroid. Gao-Jer comes to your facility to see a primary care provider, because she feels overwhelmed by all of this and would like guidance. She wants help navigating all the referrals. Does she need to do all these things right now? She is Hmong, and she is waiting for the Txiv Neeb (a type of shaman) in her community to return from Laos in a month so she can ask for his guidance. Others in her community have suggested other remedies. If you were the primary care provider, how would you handle this?
Case 2. Mick is a 64 year old engineer who has a long history of severe diarrhea. The PA he saw ordered a colonoscopy, the first he has ever had, because he was starting to have more pain. Ultimately, he was diagnosed at the GI clinic with ulcerative colitis. He has been having increased bleeding and pain, to the point where he has begun to lose weight. He has not responded to several medications, and he recently saw a general surgeon, who would like to remove a part of his large intestine. Mick is wanting to avoid the surgery if at all possible. His wife, who is “into natural stuff” has encouraged him to try diet changes or acupuncture first. She wants him to see a vaidya, a practitioner of Ayurveda. Mick returns to the PA to ask his opinion. What should he do next?
Conventional medicine often invokes a “find it, fix it” approach to care. A person comes in with a symptom or problem, and various protocols are followed. Often, the protocols are tailored to test findings, not to specifics related to the patient. Shared decision making may or not occur. Often, there is a tendency to focus on a chemical pathway or an organ system and this can lead to relying heavily upon pharmaceuticals and invasive procedures. Self-care strategies and lifestyle modifications may be relegated, especially if the problem is more acute. Conventional providers may have limited knowledge of how complementary approaches could fit into the picture. In a striking example of this, a large national survey of oncologists found that 93% of them were concerned about herb-drug interactions, but only 64% felt they could answer patients’ questions about them and only 14% could correctly answer quiz questions about which supplements people should avoid during cancer treatment.1
Question:
Choose one of the two cases mentioned above, and using it as a guide, answer the following questions:
- How do you think the clinician seeing the patient should proceed? Explain your reasoning.
- Does medical treatment need to address all aspects of someone’s health to be effective? Does a whole-person approach? Are there times when focusing on just one facet of a person’s health is appropriate?
- If a different system of healing, like traditional Hmong medicine, acupuncture, or Ayurveda offers a diagnosis that is not recognized by conventional medicine, how can this be addressed? What should a patient do, and how can the health care system support them? As a leader, how can you influence this?
- What are the roles of a patient and a clinician regarding treatment? Consider:
- When a practitioner recommends a treatment to a patient, should that be considered an order to be followed? Is it an offering? A service?
- Is it acceptable for a patient to question/refuse treatment? If they do, is it acceptable for that practitioner to discharge the patient from their practice? (This frequently comes up around children’s whose families refuse vaccinations, for example.)
Submission
- Your initial post should be at least 200 words and is due by Day 4 (Thursday, June 5, Week 5).
- Everything must be written in your own words. Do not copy content directly from your source materials, other students, or other sources. You may not use quotes.
- Initial posts must contain at least two references, even if it is the course materials, but you may also include use outside sources. Make sure to cite your references according to AMA formatting style.
- Respond to 2 classmates by Day 7 (Sunday, June 8, Week 5). Your response to classmates should rely on your understanding of the topic(s) under discussion and be constructive. Statements such as “that’s interesting” or “I agree” are acceptable but sufficient to earn credit. Explain what you agree or disagree with in their posts, respectfully defend your position(s), and share what you have learned.
Grading Rubric
Click on this link to download a copy of the discussion rubric.
Due date: Initial post Day 4 (Thursday, June 5); Peer responses by Day 7 (Sunday, June 8).
Module Learning Outcomes for this Assignment
- Explore medical treatment from patient, practitioner, and system perspectives, focusing on defined purposes.
- Examine the impact of different physical settings on medical care, health promotion, and self-care.
Citation: 1. Lee RT, Barbo A, Lopez G, et al.. National survey of US oncologists’ knowledge, attitudes, and practice patterns regarding herb and supplement use by patients with cancer. J Clin Oncol 2014;32(36):4095–4101.