A 65-Year-Old Man Who Recently Emigrated from the Dominican Republic

question 126

Multiple Choice

A 65-year-old man who recently emigrated from the Dominican Republic is admitted to the hospital for surgery.  He has multiple myeloma and a pathologic fracture of the right humerus.  The surgery is completed without complications.  Afterward, the patient is alert and oriented but grimaces frequently and appears uncomfortable.  He is offered pain medication, but he politely declines.  When asked through an interpreter whether he is in pain, the patient replies, "It hurts a lot, but I can bear it and don't wish to be a burden."  Which of the following is the most appropriate response by the physician?

• A)"If you are sure you don't want pain medication, we will honor your request."
• B)"I'm concerned that you feel like a burden.  Have you had feelings of low self-esteem lately?"
• C)"It's not necessary to bear the pain.  Medication will help you feel better."
• D)"Pain following surgery can be very severe.  My goal is to help you be more comfortable."
• E)"Speaking to our pain medicine care team can help you feel more comfortable about pain treatment."

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Definitions:

Jungian Theory

A psychological framework developed by Carl Jung, focusing on concepts such as the collective unconscious and archetypes.

Object-relations Theorists

Psychologists who focus on how relationships and interactions with others during infancy and childhood shape the development of the self.

Independence

The state or quality of being self-reliant and free from outside control, making decisions and bearing the consequences for oneself.

Id

A component of Sigmund Freud's psychoanalytic theory, representing the instinctual drives and desires of the unconscious mind.