Read the "Patient-Centered Care" case study at the end of Chapter 3 in
the textbook and respond to the following questions:
1. How could the team have better included Mr. Ramos's wife
and family in his rehabilitation?
2. How might the involvement of Mr. Ramos's family have changed
the outcome of his rehabilitation?
3. What could have been accomplished if the team would have
engaged in patient- centered care from the outset?
Mr. Ramos is a 66-year-old Honduran American man who immigrated to the United
States in his 20s. He is married and has three grown children who live nearby. He
has a relatively traditional relationship with his wife. His wife works part-time as a
childcare worker in daycare, mainly serving the Latin community. He also works as
a butcher in a Hispanic grocery store in the neighborhood. While Mr. Ramos is
financially stable and probably does not need to work, he takes pride on in
providing for his family and has not considered retirement yet. Mr. Ramos is
recovering from a hip fracture due to a fall at work. He was hosing down the floor of
the butcher shop at the end of the evening when he slipped and fell. After the
surgery, he was transferred to a nursing home to recover and initiate rehabilitation.
His team included an orthopedic surgeon, a geriatrician, a dietician, a
physiotherapist, a social worker, and the attending nurse. Mr. Ramos’s wife and
children visited frequently and usually brought him home-cooked food. Mr. Ramos
worked closely with his physical therapist, Dr. Albert Miller. The doctor developed a
state-of-the- art treatment plan for Mr. Ramos. Every time he would introduce a
new exercise or modify an existing exercise in the treatment plan, the doctor
demonstrated to Mr. Ramos and Tina, the physical therapy aide, how to perform the
exercise. Mr. Ramos was always very compliant with Dr. Miller. However, when
working with the PT aide, he seemed more hesitant to perform the exercises. Tina
suspected Mr. Ramos was experiencing more pain than he had expressed, so she
asked him. He shrugged his shoulders, which she took as a “no.” Once Mr. Ramos
was ready to be discharged, Dr. Miller put together a comprehensive treatment
plan for his outpatient treatment. It included weekly outpatient therapy at the
rehab center and a series of exercises to perform at home meant to strengthen the
operated leg, increase flexibility, and regain balance. After a couple of weeks, Dr.
Miller felt Mr. Ramos’s progress had slowed down, so he asked Mr. Ramos if he had
been doing his exercises at home. Mr. Ramos answered, “I am trying.” The doctor
decided to sit down with Mr. Ramos and go over the treatment plan with him.
One by one, the doctor asked Mr. Ramos, if he found the exercise difficult to
perform. If so, what made them difficult? In general, the doctor learned that Mr.
Ramos was not following the plan because he was still experiencing some pain
performing some of the exercises. In other instances, he felt “silly” doing the
exercises, especially when his wife was around. The doctor modified the treatment
plan by agreeing with Mr. Ramos to a couple of the most important exercises. Dr.
Miller also told him not to perform the movements to the point it hurt and
suggested Mr. Ramos could take Tylenol a half hour before exercising to control the
the textbook and respond to the following questions:
1. How could the team have better included Mr. Ramos's wife
and family in his rehabilitation?
2. How might the involvement of Mr. Ramos's family have changed
the outcome of his rehabilitation?
3. What could have been accomplished if the team would have
engaged in patient- centered care from the outset?
Mr. Ramos is a 66-year-old Honduran American man who immigrated to the United
States in his 20s. He is married and has three grown children who live nearby. He
has a relatively traditional relationship with his wife. His wife works part-time as a
childcare worker in daycare, mainly serving the Latin community. He also works as
a butcher in a Hispanic grocery store in the neighborhood. While Mr. Ramos is
financially stable and probably does not need to work, he takes pride on in
providing for his family and has not considered retirement yet. Mr. Ramos is
recovering from a hip fracture due to a fall at work. He was hosing down the floor of
the butcher shop at the end of the evening when he slipped and fell. After the
surgery, he was transferred to a nursing home to recover and initiate rehabilitation.
His team included an orthopedic surgeon, a geriatrician, a dietician, a
physiotherapist, a social worker, and the attending nurse. Mr. Ramos’s wife and
children visited frequently and usually brought him home-cooked food. Mr. Ramos
worked closely with his physical therapist, Dr. Albert Miller. The doctor developed a
state-of-the- art treatment plan for Mr. Ramos. Every time he would introduce a
new exercise or modify an existing exercise in the treatment plan, the doctor
demonstrated to Mr. Ramos and Tina, the physical therapy aide, how to perform the
exercise. Mr. Ramos was always very compliant with Dr. Miller. However, when
working with the PT aide, he seemed more hesitant to perform the exercises. Tina
suspected Mr. Ramos was experiencing more pain than he had expressed, so she
asked him. He shrugged his shoulders, which she took as a “no.” Once Mr. Ramos
was ready to be discharged, Dr. Miller put together a comprehensive treatment
plan for his outpatient treatment. It included weekly outpatient therapy at the
rehab center and a series of exercises to perform at home meant to strengthen the
operated leg, increase flexibility, and regain balance. After a couple of weeks, Dr.
Miller felt Mr. Ramos’s progress had slowed down, so he asked Mr. Ramos if he had
been doing his exercises at home. Mr. Ramos answered, “I am trying.” The doctor
decided to sit down with Mr. Ramos and go over the treatment plan with him.
One by one, the doctor asked Mr. Ramos, if he found the exercise difficult to
perform. If so, what made them difficult? In general, the doctor learned that Mr.
Ramos was not following the plan because he was still experiencing some pain
performing some of the exercises. In other instances, he felt “silly” doing the
exercises, especially when his wife was around. The doctor modified the treatment
plan by agreeing with Mr. Ramos to a couple of the most important exercises. Dr.
Miller also told him not to perform the movements to the point it hurt and
suggested Mr. Ramos could take Tylenol a half hour before exercising to control the
