Revel in, and don’t ignore, the richness of diversity

Summer is here!
For many of us, it’s a time of year when we travel and experience places and cultures that are different and exciting. As we see other parts of the country and the world, we are reminded that many people have a very different experience of life than we do. They see the world in a different way; they have cultures and religions that have given them different values, approaches, and customs; and they speak in ways that are not understandable to us. As travelers, we find these differences novel and interesting.

For people from other countries who now live in the United States, our culture and norms may seem bewildering and sometimes even frightening. This is especially true when they become ill and have to negotiate the medical establishment so they can obtain the care they need. Can you imagine the frustration and anxiety of not being able to communicate what’s wrong with you when you’re already worried about what might be causing your symptoms? Fortunately, there are several concepts and practices that serve us well when dealing with people of different cultures and/or who speak a different language.
–Spending some time getting to know our patients’ culture and showing interest in their country and customs will help to establish rapport and build relationship.
–Speaking slowly, as well as paraphrasing and checking for understanding frequently during the visit is essential to ensure accurate transmission of information.
–Beware of gestures, as they often do not translate well into other cultures. For instance, our “thumbs up” gesture is considered lewd in many cultures, and patting someone on the head, as we often do with children, can be threatening for some people.

An even more profound realization is what our patients believe about their illness. This was illustrated in Anne Fadiman’s fascinating book, The Spirit Catches You and You Fall Down, the story of the disastrous confrontation between the beliefs of the Hmong family of a child with epilepsy and her American doctors. Patients can have strong ideas about the significance of their illness, its cause, and its potential cure that will affect their acceptance of treatment recommendations and response to treatment. For this reason, medical anthropologist Arthur Kleinman developed eight questions to help uncover a person’s ideas about how their illness functions and relates to their life:
1. What do you call the problem?
2. What do you think has caused the problem?
3. Why do you think it started when it did?
4. What do you think the sickness does? How does it work?
5. How severe is the illness? Will it have a short or long course?
6. What kind of treatment do you think the patient should receive? What are the most important results you hope to receive from this treatment?
7. What are the chief problems the sickness has caused?
8. What do you fear most about the sickness?

All population estimates reflect the increasing diversity of the American population. As physicians, we are entrusted with the health of all those who come to us for help – those who share our backgrounds and those who don’t. Limiting ourselves to only what we know about the medical aspects of a patient’s condition does just that – it limits us. But with these insights and practices, we can better help each of our patients, no matter what their background and culture is. The gift to us of broadening our perspective is that we can truly enjoy the richness and diversity of human experience that we are privileged to encounter as physicians.

About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
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