A note written by an internist for a patient with altered mental status:[1. The hospital team, which included several specialists, had done a thorough medical workup for the patient. A psychiatrist got involved after three or four days.]
One option is to have someone (from patient’s culture) perform sacrifice and prayers for him. Another option is to find a traditional (culture) doctor for him here. We’ll discuss these options. Lorazepam and Seroquel for now.
I smiled after I read this. Why?
- Was it the earnest efforts of the physician to integrate two different cultures—the culture of Western medicine and the culture the patient belonged to—in this patient’s care? That the internist was willing to consider treatments that he did not understand or use? That the physician was motivated to help the patient, regardless of method?
- Was it the haste of the last sentence—a fragment, an afterthought—that suggests resignation about the patient’s minimal improvement? and relief because the physician was familiar with those pills? That, “for now”, giving those medications meant that the physician was “doing” something?
- Was it the realization that other cultures might view our faith in medications as strange?
- Was it the uncertainty about the tone of voice the physician used when dictating this short note? Was he actually earnest? Or rolling his eyes?
The punchline: The patient’s symptoms did improve with medications. When a spiritual leader from the patient’s culture spent an hour with him a day or two later, the patient’s condition completely resolved.