Global Health Systems 1st Edition by Margie Lovett Scott ,Faith Prather

Exercise 8

In the following scenario, a healthcare practitioner talks about her experience with Mika Takashi, a Japanese patient. Here, she presents a time line of events and healthcare provider actions that led to a number of unintended consequences for Mika. As you move through her account, what sounds familiar and what would have happened differently if you were the healthcare provider?
Mika Takashi
A few years ago, I conducted a history and physical examination for a 42-year-old Japanese patient who was new to my practice. After her husband was killed in an automobile accident, Mika Takashi came to the United States with her two small children (ages 2 and 5) to live with her sister and her family. She was 32 years old. Upon her arrival she spoke very little English. However, in our encounter, she spoke and understood English very well. Mika was switching primary care physicians after three years in another practice where she was dissatisfied with her care. A review of her record from the previous office revealed that soon after entering the practice, Mika complained of her heart "hurting," resulting in a full cardiac workup; the findings were normal. She was prescribed antacids and advised to exercise more.
After taking a brief history, and questioning her about her current health status, I asked if she continued to have either pain or sadness in her heart. She slowly nodded and replied, "Sad, very sad!" Her facial expression immediately changed from engaging with full eye contact, to dejection, and avoidance of my eyes. In follow up I asked, "How long have you felt sad, Mika?" She replied, "A long time," which I later learned was for nine years. She had taken the death of her husband very hard which made her depression worse. To further complicate the situation, when her then 7-year- old son was sent to the school nurse after vomiting in class one day, the nurse, finding welts completely covering the child's body, asked the child, "Who did this to you?" The child responded, "Mommy." Consequently, Mika was accused of child abuse. Despite clarification by the family of the harmless Coining practice, in which warm coins are rubbed across the body for medicinal purposes, Mika was being accused of deliberately harming her child. A lengthy investigation resulted, and Mika became even more severely depressed. The Office of Child Protective Services became involved, and their lives were disrupted for three years before she was finally exonerated.
I prescribed an antidepressant with the fewest side effects, and referred Mika to a clinical psychologist. She is currently doing very well.
Did the school nurse respond appropriately to the situation presented by Mika's 7-year-old? Did she rush to judgment?