Evan Sherman, Children’s National Medical Center
with Shilpa Patel, Children’s National Medical Center

The Case
5yo otherwise healthy, unvaccinated female presents with progressive photophobia, ptosis, and redness of the right eye for 4 weeks.  The challenge of the case is how to best navigate care for the patient when it goes against the parents’ wishes.

Here’s How You Answered Our Questions

Denouement:
Due to the sensitive nature of this case, a denouement will not be posted.

Teaching Points:
Pavan, Dave, and Shilpa left great comments.

From Conference:
Meet the parents were they are.  Try to understand where they are coming from, and try to determine and understand their fears.
One strategy is to have the parents repeat important points back to you in their own words.
Make sure to loop in the PMD.
Continue to advocate for the patient if the “stakes are high.”

Shilpa reminded us of these questions for understanding cultural differences:
From The Spirit Catches You and You Fall Down, by Anne Fadiman
1) What do you call the problem?
2) What do you think has caused the problem?
3) Why do you think it started when it did?
4) What do you think the sickness does? How does it work?
5) How severe is the sickness? Will it have a long or short course?
6) What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment?
7) What are the chief problems the sickness has caused?
8) What do you fear most about the sickness?