Scenario #14: Chinese, Zhang Li
Learner Group: PT
Environment: Outpatient Orthopedic Clinic
Authors: Karen Panzarella, PT, Ph.D., Shannon Kelly
- On-site to preplan joint assessment
- Identify and understand cultural barriers that could influence patient adherence to attend therapy sessions
- Educate and broker with patient and family regarding therapy benefits
- PT takes thorough history with patient and wife
|1||B||PT to preplan strategy to perform initial assessment|
|2||B||PT to communicate and educate patient and family regarding benefits of rehab|
|3||B||PT to begin medical history and tests and measures|
|4||B||PT to engage patient during conversation/history taking|
Synopsis of Scenario
Patient is a 35 year old male of Chinese decent referred to physical therapy for evaluation and treatment for low back pain. Due to his cultural beliefs he has avoided western medicine thus far, except for appointments with his primary care physician who is also of Chinese decent and maintains a practice in China Town where Zhang lives. He has previously attempted acupuncture to alleviate his symptoms, and although it has provided temporary relief the pain keeps coming back. When the remedies were not helping, his wife and MD convinced him it may be helpful to see a PT. Mr. Li is very quiet and does not offer details when asked questions. The only time he speaks more than a few words is to express his interest in homeopathic remedies such as Tai Chi and acupuncture.
- Situational Awareness/Cultural considerations/Patient Education
- Family Involvement
- Communication with Patient and wife
- Decision Making
- PT to plan initial assessment
- PT to determine cultural barriers to accessing treatment. Patient is resistant to treatment and is only attending PT at the suggestion of his MD.
- Education and brokering with patient and wife to agree upon rehab goals and recommendations for proceeding with initial assessments and treatment
- PT to determine patient goals, past medical history, and social history
- Deciding course of action to proceed with care respecting patient cultural considerations remove cultural barriers
|Role||Tone||Timing of Participation||Lines/Comments|
|Wife: Mei Lei||Quiet||Throughout scenario, sitting next to patient||
Mei is also quiet, but offers more information than Zhang if prompted:
"Zhang would like to get back to work at his restaurant."
"Do you offer a Tai Chi program?"
Name: Zhang Li
Age: 35 y.o.
Past Medical History:
Fx (R) Radius, 16 y.o., Mild IBS, Was involved in a major MVA 2 years ago, suffered minor bruising on the abdomen and face.
History of Present Illness:
Patient complains of intermittent low back pain that begin approximately 2 months ago. Believes the mechanism of injury was picking up a heavy box while working in his restaurant. Pain is increased when patient is sitting or lying on his side. Pain decreases when walking or lying on his back or stomach.
Patient lives with his wife and 3-year old son in a 2-story duplex downtown. He owns a restaurant next to where he lives and works there 7 days a week. Patient has been unable to work his usual long hours due to the pain and has to hire extra help in order to keep the place running. He does not own a car and relies on public transportation if he needs to go elsewhere besides his restaurant.
Report to Participant:
Your patient, Zhang Li, emigrated from China to the US approximately 10 years ago. He lives in what can be considered "China Town" and still heavily embraces the Chinese culture. Zhang has been experiencing low back pain for the past 2 months however he has refused any therapy services except for acupuncture until today. His wife and MD have convinced him to seek out Physical Therapy for additional relief and treatment of his symptoms. You will have 20 minutes to take a history and perform a systems review.
|Staged for Learners||Available For Learners to Use|
Position: sitting on edge of plinth
|Environment||Outpatient PT clinic|
Plinth, rolling stool, chair
|Goniometer, reflex hammer, tape measure BP cuff and stethoscope|
Progression of Events
|Time||Actor Actions||Performance Measures||Wife Script|
Smiles slightly, appearing a bit confused
Nods head yes to almost everything
Avoids direct eye contact
Answers in as few words as possible (1-3 word responses)
Actor Vocals:Mental status: alert, orientated x3
Tone: Calm, quiet
"Yes" (agrees often, even if truly doesn't)
"My Back Hurts"
Sitting in chair next to plinth
"My husband is a hard worker, wants to get back to work"
"He is in a lot of pain"
"He has only received acupuncture"
"Acupuncture works temporarily"
Same as above
Tone: Quiet, reserved
Answers questions with as few words as possible
"Can't you just get to the treatment, make him better?"
"Yes, that's fine"
"How about Tai Chi, our neighbors say it works"
Integrated Debriefing Guide
|Threads||Performance Measures||Debriefing Prompt|
Give us a quick summary of what happened
What went well?
What didn't go so well?
Recognize a concern during patient interaction
What was concerning about this case? Please explain.
|Understand cultural implications|
What cultural influences may have been present in this case?
How were they addressed? How should they be addressed? What are some solutions?
|Team Communication||Preplan strategy to perform initial assessments|
Were you functioning as a team?
How were the roles delegated?
How could the workload be divided up differently?
|Understand clinical presentation|
What signs and symptoms would you expect with a patient with low back pain?
What other presentations can produce similar symptoms?
|Identify contributing factors|
What risk factors were present?
What is important about this patient's history?
|Assessment||to perform initial assessments|
Are there any specific assessments that are important to consider with this type of patient?
Whom is to provide them?
What is important to document?
Whom documents what?
|Decision Making Prioritization||communicate and educate patient and family regarding benefits of rehab|
What cultural considerations need to be explored?
How were decisions made? Was the patient and family involved in the decision making process?
What resources could be accessed?
How was the family involved in the decision making process?
|Communication||PT determines plan of care with patient and wife.|
Would any other healthcare professionals be helful in this case?
When is it helful to contact another provider?
What additional information would you like to have proceeded with this case?
What are some ways we could improve on sharing information?
|Situational Aawreness||Cultural Considerations|
What are strategies for keeping the big picture in view?
What are strategies to be a cultural broker in this scenario?
|Professional Behavior||To patient, and wife|
How were we coming across?
Was the patient included in conversation?
What are some strategies for managing difficult interactions?
What would we do differently next time?
Any other questions or comments?