As physicians, it’s our privilege — and our challenge — to translate the more complicated aspects of medicine into terms that make sense to our patients. When we’re caring for patients from different cultures, we also need to appreciate how their beliefs and values may impact their ability to understand and take part in their medical care.
Doing so requires time and reflection, as well as an openness to changing our approach to providing care. This may sound difficult, but doing so can become one of the most rewarding aspects of practicing medicine. Here are four reminders for caring for patients from different cultures.
1. Have Cultural Differences on Your Radar
While a language difference can make it easier to recognize that you’re encountering a patient from another cultural background, it’s important to remember that even patients who share the same language as you may have a different understanding of healthcare and medicine. Medical interpreters can solve the former problem; for the latter, you must be thoughtful about how a patient’s cultural value system, beliefs and norms may impact their care. Keep in mind that the words they choose to describe symptoms may differ from what you would choose. In addition, a patient’s background may affect how they describe pain or how they understand medical terms or what is relevant to their medical history.
I experienced this in my first few months as an intern covering the overnight shift on the general pediatric floor. I was called to the bedside of an Arabic-speaking family to answer questions about the management of their child’s abdominal distress, and my first task was to understand what the parents felt to be the problem. It took a few different questions with the interpreter to clarify that what we felt to be an infectious disease problem, the parents felt was solely a genitourinary problem. It emerged that they had a family member who had presented with similar symptoms, and they expected similar management.
So my second task became convincing the parents of the potential of other diagnoses. Physicians should particularly be sensitive to the possibilities of misunderstanding, as a miscommunication may lead to medical errors and even to poor patient outcomes.
2. Keep Asking Questions
Certain bare minimums should apply to our approach to all patients, from respecting and promoting patient autonomy to providing comprehensive information to support informed decision-making. A little more is required when taking care of patients from different cultural backgrounds. Proactively asking questions is key. Some of these can be about their understanding of their medical care; what factors may guide their decisions, such as faith or culture; and the role family or friends may play in medical decisions.
Once, I was caring for a child of a primarily Spanish-speaking family on our medicine floor. The plan was to discharge the child for long-term outpatient care to a facility that would be covered by insurance and provide excellent care. When we proposed the plan, however, the family expressed concerns and rejected the discharge. At first, we appeared to be at an impasse; our initial concern was that the family didn’t understand the goals that led to our plan.
However, a multidisciplinary meeting with the family revealed concerns not about the facility but about the neighborhood in Chicago where it was located. The child’s grandparents were adamant in their rejection of the location based on their own experiences. Even if it didn’t match the decision we would have made ourselves, this was a good reminder to always try to understand the rationale patients have for their choices.
3. Acknowledge Your Medical Bias
As physicians, we enter every patient room with our own biases. We place trust in certain tests or procedures, and our decisions to move forward with or hesitate over medical decisions are colored by the culture of medicine.
This is highlighted for me each clinic day when discussions turn to vaccination. For a lot of families, the conversation about vaccines involves more than medical literature. Friends and family members have usually shared anecdotes about vaccine experiences, and vaccines are often discussed on social media. Fears of the medical system have sometimes been bolstered by real instances of medical injustice.
For me, the vaccine conversation is a chance to understand a parent’s concerns and where they come from. Our patients’ backgrounds play a part in their reactions to and acceptance of different parts of medicine, and it’s important to understand and respect that their experiences in life will shape the decisions they make. These experiences are as valid to them as ours are to us.
4. Support Patient Autonomy
An often difficult part of medicine is accepting a patient’s decision when we feel that the evidence and the research does not support it. Whether you’re caring for patients from different cultural backgrounds or not, remember that medical decision-making is often a multifaceted process. While we may struggle with the medical logic, we must remember that our duty is to support our patients with the best possible information, giving them the tools to make informed choices. But at the end of the day, respecting their decisions is a core part of providing that support.