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Culturally tailored healthcare in orthopedics

Carlos, a middle aged Latino construction worker, has increased pain in his knee post-op compared to most men his age. Dr. Walker disregards Carlos's complaints and considers him to be drug seeking. Dr. Elizabeth Smyth informs Dr. Walker of a study that shows Latino men actually show an increase in pain post-op compared to men of other ethnicities.

0:00 Dr. Walker and Carlos are sitting in Dr. Walker's office

0:01 [Dr. Walker] Nice to see you again, Carlos. What brings you back in to see me?

0:03 [Carlos] The prescription you gave me after the surgery ran out and my knee is still killing me. Every time I put pressure on it or go to physical therapy the pain is terrible. I could really use another prescription of those pills. I got to get back to work full time, you know, and start paying off this surgery bills.

0:19 [Dr. Walker] (examining the knee and having Carlos flex it for him) Carlos I'm not going to write you a prescription for a stronger pain medication. Prescription pain medication can be addictive and should only be taken when necessary, and over the counter drugs should be sufficient to take the edge off the pain you're having now.

0:34 [Carlos] (shaking his head) Ok, but I've been taking those already - I just don't think it's going to be enough.

0:38 [Dr. Walker] The discomfort you are experiencing is not out of the ordinary, and as we discussed before surgery, I anticipate you should continue to get better over the next several weeks. Now, is this the only issue we need to discuss today or is there something else you want to talk about?

0:54 [Carlos] I guess that's all (shaking his head and rubbing his knee, wincing)

0:56 [Dr. Walker] Alright. You're going to come back in and I'm going to a look at the knee in another month or two, right?

0:58 [Carlos] Right.

1:03 Dr. Walker leads Carlos out of the office. Dr. Walker walks down a hallway and runs into Dr. Smyth

1:06 [Dr. Walker] Hi Elizabeth, how are you?

1:07 [Dr. Smyth] Cliff, hi, I'm good. How are things?

1:10 [Dr. Walker] Things are good, that hip replacement yesterday went quite well. But. I can't seem to get this patient I saw this afternoon off my mind. A month or two ago I performed knee surgery on this Rodriguez patient. The thing is he just doesn't seem like the type that would be looking for a quick fix. I thought maybe it was just because he was so desperate to get back to work.

1:33 [Dr. Smyth] (thinking) You said his surname was Rodriquez - I'm guessing he's Latino?

1:37 [Dr. Walker] Yes, he is.

1:38 [Dr. Smyth] You know, I read a study recently that you should take a look at. The results were quite interesting - the And even though this study refers to radius surgery, these data may be indicative of a more generic finding related to your patient's ethnicity Since your patient is Latino, he may legitimately feel more pain in recovery than the patients you usually see.

2:07 [Dr. Walker] I would like to read this study you are referring to and get more information on this topic.

2:12 [Dr. Smyth] I'll look it up and e-mail you about it later today. In regards to your patient, you should take care to listen to him and consider his pain assessment in detail before dismissing his complaints as drug seeking.

2:26 [Dr. Walker] You may have a point - I'm going to have Sara call and make another appointment, you know, get some more details. Thanks Liz.