Case Study 1

Do you need to take a break before begining this case study? Want to go somewhere exciting? How about the Orient? If that sounds good to you then find your passports and travel to China. If you want to know more about Asia then see FACTS AND FIGURES. If you want to see pictures try travelling to Beijing. Have fun but please return to meet your first client who has been waiting patiently for 15 minutes.

Mrs. Yasuko Kozuka, a 78 year old first generation (Issei) Japanese woman, presents to your clinic for an initial exam. She has lived in the United States for two years having moved here to live with her only son. She has been referred to your office by her gynecologist. Her primary complaint is sudden onset of lower back pain. She denies strenuous activity, difficulty with bowels, and burning or frequency of urinary elimination. She has a history of mild hypertension, first noted five years ago, but no treatment was prescribed by her physician in Nagoya, Japan. Mrs. Kozuka is unable to tell you about her blood pressure readings. She walks with a noticeable limp, a result of a fractured right ankle two years ago. Additional observations which you make, among others, include a stooped carriage, small body frame, slight jaundice, and white sclera. Her weight is appropriate for her height. Her dietary preference is typical of the Issei including primarily sashimi (raw fish), rice, pickled vegetables, tofu (soybean curd), and tea. She states she is allergic to milk products. Throughout your interview, Mrs. Kozuka nods politely.

1. Review the case study and Section 1. Which of the above pieces of data may be considered typical (more common) in the Japanese culture?
2. Which of the pieces of data are particularly significant in terms Mrs. Kozuka's chief complaint of sudden onset of lower back pain? Provide the rationale for your response.
3. Identify at least three other questions you will ask Mrs. Kozuka to help you determine a differential diagnosis. Provide your rationale for each question.
4. Provide one example (each) of a specific question you will ask in assessing Mrs. Kozuka's:
1. Health beliefs/practices,
2. Dietary considerations,
3. Family aspects/roles,
4. Language/communication, and
5. Religion/rituals.
5. From the limited data given in this case study what are some possible diagnoses you are considering for Mrs. Kozuka? Provide your rationale.

Enter your responses to this case study in the Cultural Considerations Forum of the Discussion Groups in the Communications section.