A 22-year-old man comes to the office due to fatigue, poor appetite, and weakness. The patient recently emigrated from India and has few social supports. He feels tired throughout the day despite sleeping 8-9 hours every night. He is worried about his new job and thinks that his coworkers don't like him. The patient reports no significant medical history but is very worried that he is losing semen when he urinates. Temperature is 36.7 C (98 F), blood pressure is 110/78 mm Hg, pulse is 62/min, and respirations are 14/min. BMI is 24 kg/m². Physical examination is unremarkable. The patient is alert and oriented. His thought process is organized, linear, and coherent. He does not appear to be responding to internal stimuli. Which of the following would be the most appropriate initial response to the patient's concerns?

Question

Quizplus · Accepted Answer

This patient's somatic symptoms (eg, fatigue, weight loss), anxiety, cultural background (ie, South Asia), and belief that he is losing semen during urination are consistent with Dhat syndrome. Dhat syndrome is a culture-bound syndrome found in South Asian cultures in which sufferers attribute a range of psychological and somatic complaints to the loss of semen via various methods (eg, loss in urine, excess masturbation). Culture-bound syndromes are illnesses or explanations of illnesses that are unique to specific cultures. Due to the challenge of becoming familiar with all the various cultural manifestations of illness, physicians must approach the treatment of unfamiliar culture-bound syndromes from a patient-centered approach. Patient-centered cross-cultural care empowers patients to educate the physician on beliefs about their illness. Physicians facilitate this education by adopting an open and inquisitive communication style that explores the cultural explanations, manifestations, and consequences of the illness. This patient has provided a description of his illness but has not been given an opportunity to share his beliefs about its causes. Therefore, the most appropriate next step would be to ask an open-ended question to explore these beliefs. (Choices A, B, and C) Although further assessment of specific depressive and psychotic symptoms is necessary, the most appropriate initial step is to engage the patient by conveying the physician's willingness to understand the patient's cultural perspective. Subsequently, open-ended questions that ask the patient to describe his experience would be preferable to close-ended questions that can be answered yes or no. (Choices D and F) At this point in the physician-patient relationship, reassurance is unlikely to be an effective intervention, and it may even be perceived as invalidating the patient's concerns. Once a complete patient-centered evaluation has been completed, it would be appropriate to provide reassurance and discuss treatment options, including referral to a counselor. Educational objective: Dhat syndrome is a culture-bound syndrome of South Asia that manifests with psychological and somatic symptoms that are attributed to loss of semen. When evaluating culture-bound syndromes, it is important to take a patient-centered approach and allow the patient to explain the cultural explanations, manifestations, and consequences of a given syndrome. References: Relevance of culture-bound syndromes in the 21st century. (http://www.ncbi.nlm.nih.gov/pubmed/26332813) Phenomenology and beliefs of patients with Dhat syndrome: a nationwide multicentric study. (http://www.ncbi.nlm.nih.gov/pubmed/26142412)

A 22-Year-Old Man Comes to the Office Due to Fatigue