You are seeing Erik Gbodossou, a 38-year-old West African man, who is HIV infected and has just been released from the hospital after successful treatment with pneumonia. He has improved clinically since being treated; however, he is having trouble eating because of a persistent candida infection and also has struggled with early to moderate periodontal disease, especially in the mandibular arch that has not responded to non-surgical therapy even though he has been compliant with dental visits and home care procedures. He was willing to take the antibiotics prescribed for his pneumonia, but is balking at taking antiretroviral therapy which you know may help improve his life expectancy and his oral condition. You are frustrated that this patient is not interested in treatment that can help him. You've checked and his insurance will pay for most of the cost of his medications. 

You are the patient.

You are a 38-year-old man named Erik Gbodossou. You are originally from West Africa. You have just been released from the hospital after being treated for pneumonia. You feel much better than when you first came to the hospital. You found out 2 years ago that you are infected with the AIDS virus. You have been seeing a traditional healer who is well respected in your community. He has successfully treated you with diarrhea, gum, and skin problems in the last 6 months by mixing special herbs and medicines for you. Using divining bones, the healer has helped you understand that your illness has happened in part because you have been distant from your family and community since leaving Senegal. Now, this doctor is telling you that you must take western medicines to keep you HIV infection from getting much worse. You are not convinced that this is the right thing to do. You want to talk this over with the healer.

Discussion Questions

1. What differences do you see between the patient and the clinician?

2. What are these differences based on culture, communication style, etc.?

3. How well is the clinician dealing with these differences?

4. Is he or she being sensitive to the patient's concerns, beliefs, etc.?

5. Do you have any suggestions for the clinician to help him/her work more effectively with this patient?