Reference no: EM133323503

Dr. Johnson, the chief resident, looked at Gebru Gidada's chart, puzzled. He glanced up to see Mrs. Baker, the office nurse. "I think there's a mistake," Dr. Johnson said. "This is Dr. Rivera's patient, and he's been seeing the cardiologist in Blueville for months. How did he get on my schedule?" "I don't know what's going on," said Mrs. Baker, "but he specifically asked to see you."

Dr. Johnson shrugged and went back to studying the chart. From the notes, it appeared that Mr. Gidada was age 57 and had moved to the area about 15 years earlier from Ethiopia. He had worked in the local factory from the time he arrived and was now retired. About six months earlier, he had come to see Dr. Rivera, asking for "that strong medicine on TV, the purple one" for his heartburn. Dr. Rivera had talked further with the patient and noted that he mentioned "burning in the chest, heaviness and pressure, usually when lying down, some pain in the arm and shortness of breath." It seemed obvious to Dr. Johnson that Mr. Gidada needed a cardiologist to see him, but according to the notes, Mr. Gidada believed that he was healthy from all his work in Ethiopia and could not possibly have heart disease. Dr. Rivera did not give him the heartburn medication, and apparently she could not convince Mr. Gidada to see the cardiologist. He had a heart attack about six weeks later. Now, he had asked to see Dr. Johnson. "What is going on here?" thought Dr. Johnson, as Mr. Gidada entered his office.

"Hello, sir! What can I do for you today?" asked Dr. Johnson. Mr. Gidada got right to the point. He made it clear that the cardiology team in Blueville was providing his medical care but that he wanted to "have a talk" with Dr. Johnson, "man to man," said Mr. Gidada. "Okay," said Dr. Johnson, chuckling to himself that although they both considered themselves black men, he and Mr. Gidada had very different histories and cultural backgrounds. Mr. Gidada was a poor farmer who emigrated from Ethiopia many years ago. Dr. Johnson was a young man, recently graduated from a prestigious osteopathic medical school on the East Coast, and his wealthy family had been here for generations.

The Case:

Gebru Gidada: Not Welcome?

"Here's the thing," said Mr. Gidada. He continued with a story that while he was in the hospital and in the exercise room for many hours over the past few months, he had had time to think. He said he realized that Dr. Rivera was right about everything she had said in their visit months ago. And he wished he had listened. He said he was also concerned about others close to him who lived the same way he did. He said that he had cousins in the area, and a whole community from his country, and that they were all just like he was before the heart attack. "They are always smoking and eating bad food and not exercising," he said. "I wish I could tell them all the things Dr. Rivera told me before I went into the hospital. They just do not know, but I'm not sure how to tell them. Could you help me?"

Dr. Johnson asked Mr. Gidada what he thought people in his community knew about heart disease. Mr. Gidada said, "No one in my community thinks this will happen to them. They think they have no control over it, and they keep acting just like I used to act. I wish I could get them to change."

"Well," said Dr. Johnson, "we'd be happy to see anyone here in the office." "That's part of the problem," said Mr. Gidada quietly. "My people don't feel welcome here. That's why I came to you. They need to see you." Dr. Johnson understood that Mr. Gidada meant that they needed to see "another African-American."

"How are people treated when they come here?" asked Dr. Johnson. "Not good," said Mr. Gidada. "They don't feel welcome, and the place has nothing for them. They think people here ignore them and treat them badly. Many in my community don't speak English well yet. There is nothing here to help them understand what to do or what people are saying to them. People don't respect our beliefs. Would you come to a meeting with my community and teach them about heart disease? I could translate what you say. People very badly need to hear about preventing what happened to me."

Dr. Johnson didn't know how to respond. He felt honored to be asked to help the Ethiopian community, angry that the community was made to feel so unwelcome in the office, and apprehensive that the Ethiopian community would expect more cultural awareness than he could deliver, even if he did share their race. "Why don't you give me some dates and I'll see what I can do," said Dr. Johnson finally. Mr. Gidada smiled as he said, "We'll work around your schedule. You tell me when you're free."

Question 1: Why is Mr. Gidada interested in Dr. Johnson's help? What assumption is Mr. Gidada making about Dr. Johnson based on race?

Question 2: How do you feel about the situation? What struck you most about Mr. Gidada's discussion with Dr. Johnson?

Question 3: What troubles you the most? What difficulty does Mr. Gidada's conversation present for Dr. Johnson? What problems does the office present for the Ethiopian community?

Question 4: How would you handle this? If you were Dr. Johnson, how would you respond to Mr. Gidada?

Question 5: What is the patient's perspective? What motivation does Mr. Gidada have to engage Dr. Johnson? What might be the result if Dr. Johnson refused to address the Ethiopian community?