Community Culture
What is an individual?
A physician in the United States typically expects that health care decisions will be made by the individual patient or the parent(s)/guardian(s) of a child. In the US, as in most Western cultures, an individual fits the definition found in the Merriam-Webster dictionary: “a single human being, as contrasted with a social group or institution.” However, in some cultures the definition is blurred, with individuals viewing themselves as linked to a family, social group or institution rather than as distinct entities. In Western medicine, personal healthcare decisions are assumed to be the right of an autonomous individual. Yet, a patient who does not view him or herself as separate from family or other social groups, will need to include the thoughts and views of the social group or institution when making “autonomous” decisions.
What is a family?
The definition of family varies among cultures. For many Americans, family consists of 2 parents, usually one male and one female, and their children, although the 2000 US census identified 28% of children as living in single-parent families. For others, family may include a much more extended list of individuals: aunts, uncles, cousins, grandparents, second cousins, step-parents, step-siblings, same-sex parents, etc. Even using a broad definition of family to include those that live in the same household together may not accurately describe an individual’s family. For some people family includes those who live next door, across the country or even across the world.
What is a community?
A person’s cultural community is that group of people with which they share a set of learned beliefs, values and systems. For some, community is a group of people living in a similar location or neighborhood. For others it encompasses groups sharing common interests or a common identity. Culture plays an integral role for all communities.
What roles do family and community play in medicine?
The family has an important role in medicine, and especially in pediatrics, because decisions about a child’s health care are almost always made by the parent(s) or guardian(s), not the child. Thus, it is important to learn about your patient’s family structure:
- Who is considered the head of the household?
- Who lives in the house?
- Who influences decision-making and the family’s concepts of health and illness?
- What are the expected dynamics between males and females and between the young and the old?
The answers to these questions will help you begin to understand the family. You may learn, in fact, that the person who will make the decisions about your patient’s evaluation and treatment is not even in the room with you.
Family and community also play key roles in the support of a patient. They may work to help a patient financially, by contributing money to pay for medical bills, emotionally, by prayer, or even physically by donating bone marrow. Thus, understanding the patient in the context of his/her community is essential to providing family-centered care.