Transcript RTHC – Case Discussion

Religious Traditions in Health Care
Case Discussion
RTHC – Case Discussion
33 y/o female comes to establish care.
She’s recently moved to Chicago with husband who was transferred here by work.
Past Medical Hx:
Diabetes, Type I with CRI
Rheumatoid Arthritis
Fibroids, heavy menstrual periods
Anemia, iron deficiency
Surgical Hx:
Appendectomy
Ob/Gyn
G0 P0
M- 13 I- 28 days D- 7 (heavy)
Medications:
Insulin
Methotrexate
Iron tablets
Allergies:
None
Social Hx:
Occupation: Office Receptionist
Married, Lives with Husband
Tobacco: None
Alcohol: None
Religion: (Hindu, Buddhist, Catholic, Jewish, Muslim, Protestant Christian)
Has not yet joined a faith community in Chicago.
ROS:
Wrist pain, swelling
Heavy, painful menses
RTHC – Case Discussion
The physician takes a spiritual history and finds that
faith and religious practice are important to her.
The physician inquires as to how best to address the
patient’s needs per her faith and spirituality.
To help the physician understand the religious
dimension of her life she explains the following:
Briefly describe your religion’s view of the doctorpatient relationship and list some significant beliefs,
expectations and practices from your respective
religions…
RTHC – Case Discussion
The patient’s rheumatoid arthritis has been well
controlled on Methotrexate.
The physician inquires into the patient’s wishes for
having children, explaining that should she get
pregnant her current medication could not be
continued and substituting Prednisone would likely
complicate her diabetes.
They discuss the alternatives, including switching
medications, as well as the pts views on pregnancy
prevention, including contraception, tubal ligation,
abortion.
Discuss your religion’s perspectives on contraception,
sterilization and abortion…
RTHC – Case Discussion
Completing the discussion on child-bearing, the
physician inquires into the patient’s views on assisted
reproductive technologies.
(In vitro fertilization, GIFT –gamete inter-fallopian transfer, surrogacy, etc.)
Discuss your religion’s views on Assisted
Reproductive Technologies…
RTHC – Case Discussion
15 years later that patient has develops ESRD- End
Stage Renal Disease from her diabetes.
The physician discusses the management options
including dialysis, and renal transplantation.
Discuss your religion’s perspectives on
transplantation and organ donation…
RTHC – Case Discussion
The patient’s menstrual blood loss and painful
periods become significant enough that an elective
hysterectomy is scheduled.
The physician inquires into the patients views on perioperative blood transfusion
Discuss the religious perspective on blood
transfusion…
RTHC – Case Discussion
Upon admission to the hospital the Pastoral Care
team visits the patient inquiring into her spiritual
needs and wishes while hospitalized.
Discuss the spiritual needs of a patient from your
religious perspective…
RTHC – Case Discussion
The post operative period is significant for multiple
complications that lead to multi-system failure.
The patient is in the ICU, nonresponsive, on a ventilator,
requiring dialysis.
The staff discuss the poor prognosis with the patient’s
family, and discuss End of Life management…
Discuss your religions views on End of Care for the
patient…
RTHC – Case Discussion
The patient is taken off the ventilator and comfort
control measures are carried out per the families
wishes.
The following day the patient dies…
The hospital staff approach the family asking
permission to perform an autopsy to understand
better what led to the patient’s demise…
Discuss your religion’s perspective on autopsy, and
the care for the body after death…