The US is a “melting pot.” But that does not mean we are a homogeneous amalgam of cultural identity. What is distinctly American is that almost all of us (perhaps 99% of the US population) are not truly Americans in the purest sense of ethnic origin. This means that in one working day, a physician might be faced with 5 or more different cultural perspectives on medicine and personal health. Being aware of our own biases about healthcare based on Western medical education and practicing with a sensitivity to other cultures are key to a mutually fulfilling relationship between doctor and patient.
So what’s a doctor to do? Most of the time, we improvise and observe patterns. But now, I think I have found a better answer.
I just obtained a copy of Culture and Clinical Care, edited by Juliene G. Lipson and Suzanne L. Dibble. This book was recommended –oddly enough- by a representative from the Department of Labor and Industries. So far, I have limited my reading to the ethnic groups I tend to see in my office, but it does appear to be a great reference to have in the office. The 35 chapters are alphabetically organized by ethnicity, from Afghans to (Former) Yugoslavians, including Native Americans and Hawaiians.
Here are some tidbits from the book:
– You should use “Mr.” or “Mrs.” When addressing older patients. Use of the first name may be disrespectful.
– Chinese language is expressive and often sounds loud to non-Chinese people. Chinese may sound unintentionally abrupt when speaking English.
– Chinese patients may not ask questions due to respect for the doctor, but may nod at everything.
– Food is important for health, balancing “cold and hot” or “yin and yang.” For example, nausea/vomiting is thought to be from too much yin, so they treat with hot soup/broth. Diarrhea is caused by too much yang, treated with yin foods (fruits, vegetables)
– During the first 30 days postpartum, Chinese mothers may be told by family members to not go outdoors, shower, or bathe, because her pores are believed to be “open” and illness can enter the body.
– The eldest male in the household is often the spokesperson.
– Menopause is viewed as normal and they tend to have fewer symptoms than European Americans.
South Asian/East Indian
– They may find a loud voice to be disrespectful.
– Traditionally, it is disrespectful for a woman to sit with legs crossed or apart
– When sick, they may be passive and expect to rest while the family takes up responsibilities.
– Unlike many other cultures, depression is not stigmatized, and, in fact, it triggers family members to interact more to show that they love and value the depressed person
– Tend to be stoic about pain
– Tend to view larger body size as a sign of good health.
– They often do not associate diet and exercise with health.