Sunday, February 26, 2006

Coming to American Medicine

…Cultural nuances are why a Hmong man would be insulted if a doctor looked directly at him during a lengthy conversation and why a Salvadoran woman who feared mal de ojo , or the evil eye, would seek a folk medicine healer, a curandero.

At Bailey's, where 10 percent of patients speak Arabic, Farsi or Urdu as their primary language, cultural norms were the reason a breast self-exam program for Muslim women several years ago took place before regular business hours and involved only female staff. The center agreed that no male employees would be on the premises.

"It all gets down to basic respect," said Christina Stevens, program director of the Fairfax County Community Health Care Network. "And it's better medicine."

Even for those on the receiving end of routine encounters, the experiences can be unsettling. Lubaba Mohammed, a young Ethiopian woman who lives in Prince George's County, was taken aback by the information she was asked during medical appointments. The doctors' manner seemed so forward, she said…

…An article last year in the Journal of the American Medical Association cited "the need for significant improvement" in physician training. It detailed a survey in which a quarter of more than 2,000 final-year medical residents said they were insufficiently prepared to deliver care to new immigrants or those with beliefs not in line with Western medicine.

"You make assumptions about patients based on how they look, how they speak, the clothes they have on, and, truth to tell, patients make assumptions, too," said Yolanda Haywood, an assistant dean at George Washington University medical school. In keeping with national accreditation standards passed in 2001, the school incorporates cultural questions into a required four-year course, the Practice of Medicine.

Dealing with varied backgrounds and beliefs takes time, which the pressures of managed care do not easily accommodate.

From the MSNBC article.
Newsweek article: "When Cultures Clash"
Stanford University film, "Hold Your Breath"


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