CASE SCENARIO

A 66-year-old patient, S.A., presents to my family medicine clinic with memory and concentration concerns. He is a refugee originally from the Democratic Republic of the Congo; his primary languange is Swahili. S.A. was tortured in the Democratic Republic of the Congo and then fled to Tanzania. He spent 17 years in a refugee camp in Tanzania and has now resided in the United States for 7 years. His history includes uncontrolled diabetes and no other medical conditions; however, on previous visits, he has mentioned having trouble sleeping.

S.A. tells me that he has attended English language classes regularly for 2 years but has made no improvement. He attributes this lack of progress to his inability to think and remember; he states that not being able to learn English is causing him a significant amount of stress. He recently heard from a friend about a form that doctors can complete for people who are unable to learn enough English to pass their citizenship examination. He asks whether I will complete this form for him. How can I determine whether this patient is a candidate for the medical exception for the US citizenship examination?

COMMENTARY