“I don’t know if you understand, Doc, what kind of man this is.”
The man who spoke appeared to be a few years my junior. He was speaking of his father, who is one of my patients at the local Veteran’s Home, where I am a relative newcomer.
“This man fought in two wars and earned two Medals of Honor. He is not going to tell you how much pain he is in, even when you ask him, because he isn’t even going to admit to himself how much he hurts.”
He made a point I actually hadn’t considered before during my tenure at the Veteran’s Home. My patient has metastatic cancer, and the nursing staff asks him every day to rate his pain. His answer is always 2 on a scale from 0 to 10.
As doctors and nurses we estimate our patients’ discomfort through their words and also through their vital signs, facial expressions, posture and other nonverbal clues. But when it comes to treating war heroes, do our usual instruments fall short?
I remember thinking when I admitted the ailing veteran that he seemed so humble and plain spoken. The words “true hero” came across my mind then. I didn’t consider that I might not be able to accurately assess his cancer pain or his level of distress over his terminal diagnosis.
There is a lot of talk about cultural competency in this country. Today I even read in one of the publications of the American Medical Association that several states are mandating that physicians take courses to improve their skills in dealing with patients from cultural and ethnic minorities.
Somehow I think we oversimplify the issue of cultural competency if we focus on only those we think of as minority groups. Our challenge in caring for all our patients is to meet them where they are, to step out of our own world long enough to at least get a glimpse of theirs. We must first meet as human beings before we can begin our medical assessment.
War heroes are a minority, too.
A Country Doctor Writes: 
Interesting. My mom was just relating the pain my grandpa was going through (WWII vet) and how nothing seems to touch it. Pain management is woefully addressed in our society.
I agree with you that war heroes are a minority. But I am uncomfortable with your seeming dismissiveness of cultural competency training for doctors. Healthcare is where the rubber hits the road when it comes to the “global marketplace.” Hospitals, even in rural areas, regularly face patients from more than 50 ethnicities, 15 religious groups, and other populations including LGBT, disabled, deaf/hard of hearing, and blind/low vision. Veterans deserve our respect. But we must also take time to understand that not all people from all background have been welcome in the military. The military has historically been hostile toward LGBT, minority, and atheist soldiers. So not everyone has had the chance to be a “hero.” Too many people that would have gladly given their lives for the United States, were victims of discrimination that prevented them from having the opportunity to serve. Let’s honor our veterans. But let’s not minimize the importance of training doctors to understand that one size does not fit all when it comes to treatment.