A Whole Other Story: Interpreting Narrative Medicine

The practice of conventional medicine is rooted in the ability of a patient to effectively communicate with their physician, and for the physician to comprehend the patient’s story and perceive it through the lens of evidence-based practice. In reality, the differences in environmental backgrounds hinders this exchange of information and prevents a shared understanding and strategy. Narrative medicine provides a framework in which this divide can be bridged by encouraging the clinician to develop an appreciation of cultural nuances that drive a patient’s decision making. The importance of this practice is highlighted with four stories in which the only path to competent patient management was through the utilization of narrative medicine.

The Power of Prejudice: Cross-cultural Competency and Muslim Populations

Oh people! We created you from a male and a female and made you into nations and tribes so that you may know one another. Verily the noblest of you in the sight of Allah is the Most God-fearing of you. Surely, Allah is All-Knowing, All-Aware. (49:13) This oft-cited Quranic verse encapsulates the Islamic worldview on the raison d’être of different groups of people and ethnicities, thereby highlighting the importance of cross-cultural communication and Islam’s role in transcending these differences. The same worldview can be adopted in psychiatric practice to provide culturally competent patient-centered care. This paper introduces a clinical vignette of a Muslim patient with poor mental health and her experiences living in the US as a religious minority. The vignette frames the following discussion in the context of rising hate in the country and brings to light the consequences of Islamophobia on the mental health of American Muslim populations. The psychology of outgroup hate is explained by analyzing the literature produced on the interrelated topics of stereotypes, discrimination, prejudice, and xenophobia, and concludes with tools available for cross-cultural competency in a clinical setting.

Co-constructing the Video Consultation-competent patient

Through detailed multimodal EMCA analysis, this paper explores consultations between a geriatric patient in a residential rehabilitation facility, his local caregivers, his relative, and his GP, who is present via telepresence robot. The analysis focuses on a) the patient’s interaction with the telepresence robot and the other participants in the opening sequences, including the establishment of joint attention, as a mutual accomplishment; b) how the role of “the competent Video Consultation (VC)-patient” is negotiated and co-constructed (Goodwin, 2013; Jacoby & Ochs, 1995) over time; and c) how the patient displays increasing VC-competences and develops practices associated with a situational identity as “tech-savvy patient” (Suchman, 2009; Zimmerman, 2008).

Rampant spread of infection in an afebrile immune-competent patient presenting with young-onset ischaemic stroke

A 27-year-old healthy woman developed spontaneous right-sided orbital cellulitis, followed by left hemiparesis and cranial nerve palsies. MRI revealed underlying basal exudates and vasculitic infarction involving the pons and cerebellar peduncles, following which a cerebrospinal fluid examination confirmed acute bacterial meningitis. Although the patient remained afebrile, imaging revealed asymptomatic septic foci in bilateral lungs, empyema and pyelonephritis. Blood culture grew drug-resistant Klebsiella pneumoniae. The case highlights the absence of fever in an immune-competent patient presenting with young-onset stroke secondary to meningitis.

An unusual case of chest pain

Osteomyelitis is an infection of the bones caused by pyogenic organisms. The ribs are an extremely uncommon site for osteomyelitis, occurring in less than 1% cases. The main causative organisms are Gram-positive bacteria, such as Staphylococcus aureus and Hemophilus influenzae. Gram-negative bacteria like E. coli have been rarely reported. Authors hereby present a case of an immune-competent patient who presented with an osteomyelitis of the ribs caused by the latter. In developing countries, tuberculosis is considered as the primary cause of osteomyelitis and pleural effusions. However, other organisms should also be considered in patients who present with fulminant infections.

Persistent Cutaneous Metastatic Tubercular Abscesses Revealing Multifocal Tuberculosis in an Immunocompetent Patient

Tuberculosis remains one of the infections with high mortality rate. Multifocal tuberculosis usually affects immune compromised patients such as Human Immunodeficiency virus carriers. However, patients with no underlying immunodeficiency may still present an extensive and atypical form of tuberculosis. We hereby report the case of a 16-year-old female patient presenting persistent and multiple cutaneous lesions associated with fatigue and loss of appetite which led to the diagnosis of disseminated, multifocal tuberculosis with neurological, musculoskeletal, genital, pulmonary, peritoneal and lymph nodes involvement. Screening for potential underlying immunodeficiency yielded no results. Clinical and radiological outcome was favorable on anti-tuberculosis drugs with complete regression of identified lesions. This case serves as a reminder that tuberculosis remains a challenging diagnosis that encompasses a variety of clinical presentation ranging from cutaneous abscesses to life-threatening conditions such as cerebral tuberculomas even in immune competent patient.