Clinical Scenario

M. G. is a 40 year old Hispanic male with PMHx diabetes mellitus type 2, HTN presenting to establish care at a family medicine practice. M.G. recently immigrated to New York from Mexico and has been in the US for approximately 7 months. Since his move, he has sought therapy for symptoms of depression that developed during his transition to life in the US and has recently began intensifying. He is now seeking additional treatment for his worsening symptoms that have been interfering with his daily life. Due to his immigration status, M.G. does not currently have health insurance. Although he speaks some English, it is limited, and his preferred language is Spanish.

 

Cultural Factors

• Language differences – M.G.’s preferred language is Spanish. It may be difficult to receive medical care from providers who do not speak Spanish.
• Geographic – M.G recently immigrated to the US and may not be familiar with resources available in this location.

 

Unique beliefs/considerations

• Mental health stigma – In the Latin American culture, mental health discussions are often considered taboo. Reassurance that it’s normal to discuss mental health issues should be provided.
• Financial situation – M.G. recently immigrated to the U.S and does not have health insurance. Getting appropriate follow up and having money to stay compliant with medications needs to be considered.

 

Areas of potential Conflict

• Cost – M.G. does not have health insurance so there may be some push back on certain medical treatments. Social work may be able to aid in finding low costs options.
• Diet habits – Many latin cultures include traditional meals that are high in salt and fats. Due to his limited funds, he may opt for lower cost meals which many times aren’t healthy. He can be referred to a nutritionist or low cost healthy options can be recommended.

 

Expected Skills

• Language access – M.G.’s language preference should be confirmed at the beginning of the visit. His preferred language should be accommodated to ensure that full communication is available between the patient and provider.
• Confidentiality – Confidentiality should be available and emphasized in every visit. Since this visit involves mental health discussions, it should be important to remind M.G. that everything discussed in this visit will be kept confidential so he feels comfortable expressing himself fully.
• Collaboration – The provider should feel comfortable involving other health professionals to provide the best care for M.G. Social work can be considered in this situation due to his immigration status and lack of insurance. In addition, mental health professionals who are more specialized in the Latin community and able to speak M.G.’s preferred language can be found to make him feel more comfortable.
• Empathy – M.G.’s feelings should be listened to and validated. He has faced many new changes and challengers including adapting to a new environment. He should be reminded that adjustment can be difficult and there are resources available to provide him with support.

 

Patient Education

• Depression – Depression is a type of mental health disorder characterized by persistently depressed moods or loss of interest in activities. Major depressive disorder diagnosis requires a significant impairment in daily life, including social and occupational settings.
  • Treatment typically includes a form of psychotherapy. In addition to psychotherapy, medical management can be used. Selective serotonin reuptake inhibitors (SSRIs) are first line in medical management.
• Diabetes – Type 2 diabetes mellitus is an endocrine disorder characterized by insulin resistance. Insulin is a hormone produces in the pancreas and helps to regulate the amount of glucose in the blood.
  • Treatment includes diet, exercise and lifestyle changes. If lifestyle changes are unsuccessful in controlling glucose, oral antihyperglycemic medications can be used. Metformin is initial therapy and can help to lower glucose levels.
• Hypertension – Hypertension is persistently elevated blood pressure with at least 2 different readings on at least 2 different visits. BP target is less than 140/90.
  • Lifestyle management is initial management. This includes salt restriction, smoking cessation, exercise, diet and weight reduction.
  • Medical management is used if lifestyle modifications are not successful.