Assume you are an Anglo-American health care professional working in a community clinic, because of your fluency in Spanish you have been asked to consult on the following case:

Nester Gonzalez is a 52 year old Latino male patient referred to the community clinic after being seen in the Emergency Medicine clinic for evaluation of chest pain and urination difficulties. As it happens, his examination in the Emergency Department was negative for cardiac problems and his chest pains and shortness of breath were diagnosed as an anxiety attack. However, his physical examination was positive for an enlarged prostate gland, which was the basis of the community clinic referral. Upon further examination and tests, Mr. Gonzalez is now diagnosed with prostate cancer. His PSA is 12 with a Gleason score of 7. At this point the two doctors in the clinic are involved in his case are in disagreement about the course of treatment; one recommends removal of the prostate while another suggests that it is pointless because in all likelihood the lymph nodes are involved. The clinic doctor primarily managing Mr. Gonzalez case has stated that he isn’t sure what Mr. Gonzalez understands about his illness and doesn’t get much help from him in terms of evaluating treatment options.

The patient has been married to Bonita, aged 28, for 5 years. This is the second marriage for Mr. Gonzalez and the first for Bonita. Mr. Gonzalez lost his first wife died of breast cancer 7 years ago. There is one daughter aged 3 from the current marriage, and 3 children from the previous marriage: a 14 year old female, a 17 year old male, and a 23 year old male. The oldest son is in the Navy, all other children live at home. Financial resources are quite limited and the entire family is dependent upon Mr. Gonzalez’ employment as a salesman for a local appliance company. Mrs. Gonzalez speaks only very limited English, and is terrified of this illness both because she deeply loves Mr. Gonzalez and because she fears losing him would end her right to live in this country. Although Mr. Gonzalez is a US citizen and married to Bonita, the marriage took place in Mexico and Bonita is not a U.S. citizen. Finally, the health insurance benefits only cover 80 percent of major medical for Mr. Gonzalez, and are tied directly to his employment.

 What are your immediate thoughts about the case? Where would you begin?