Medical Culture Resource
Physicians typically view medicine as above culture because the “truth” of medical decisions is based on science. As Taylor observed, “…it is confidence in the truth of medical knowledge that underwrites physicians’ special power to alleviate suffering. Medical knowledge is understood to be not merely ‘‘cultural’’ knowledge but real knowledge. In this perspective, it may be reasonable to describe medicine…as perceiving itself to be a ‘‘culture of no culture.’’1 Yet, medicine has all of the traits that make up more traditionally defined cultures. Boutin-Foster et al observed: “The professional culture of medicine can be viewed as the language, thought processes, styles of communication, customs, and beliefs that often characterize the profession of medicine. [This culture may best be viewed initially from the dress code (“the white coat”), the shared language (“doctor talk”), and the “explanatory model” used to define health and illness].”2 To understand patients, physicians must recognize how culture affects health, health beliefs, and health disparities. In this regard, physicians must be aware of the cultures of their patients and of the culture of medicine. Berger3 quotes Napoles-Springer et al: “Education and training should emphasize improving physicians’ awareness of their own preconceptions and cultural values, as this in turn will allow for greater openness towards and appreciation of corresponding beliefs of their patients.”
Distrust of Western Medicine
Distrust of Western Medicine is generally rooted in a previous, poor experience with either Western Medicine or Western culture. This may be personal, or a learned experience passed on from family, friends, or community. For some, the offending event occurred years ago, before they were even born, and has been passed down as part of their cultural knowledge.
The distrust that many minorities feel is not entirely unfounded. History shows that the majority often exploits and mistreats the minority for their own benefit. Just in the short history of the United States alone, the majority has given Native Americans blankets riddled with smallpox to hasten their extermination, tested the effects of syphilis on African-Americans even after penicillin was discovered, and interned thousands of Japanese-Americans in camps during World War II.
For many individuals and families, mistrust is personal, not historical. Individuals may not see the value of medical care because their parents never saw a physician and lived into their 90’s. Others have developed distrust of the health care system because of repeated language and cultural miscommunications, as well as by having their own cultural health practices and values dismissed as inferior by Western physicians.
Distrust of Western medicine has an important impact on the health care disparities experienced by minority populations (see Health Status resource card). A physician must recognize that distrust of Western medicine can be a significant “third party” in the exam room. Distrust can impede communication, misdirect diagnostic decision- making, and adversely influence the outcome of the physician-patient interaction unless it is addressed. If a patient says that he “doesn’t like doctors,” take the time to ask why. Whatever the answer, try to avoid becoming defensive. If you are part of the cultural majority, you may be blamed for things that your ancestors did or that other doctors have done; becoming defensive does not help you with your ultimate goal to provide the best care possible. A more constructive approach is to regain the patient’s trust through patience, listening, and respect for your patient’s beliefs. Demonstration of respect does not mean that you must accept the validity of the beliefs; it simply means that you are willing to acknowledge them without judging the person.
For a list of readings on the impact of distrust in western medicine on various minorities health, visit:
http://www.mckinley.uiuc.edu/multiculturalhealth/reading1.html
References:
Berger JT. The Influence of Physicians’ Demographic Characteristics and Their Patients’ Demographic Characteristics on Physician Practice: Implications for Education and Research. Acad Med, 2008, 83: 100-105.
http://journals.lww.com/academicmedicine/Fulltext/2008/01000/The_Influence_of_Physicians__Demographic.16.aspx
Boutin-Foster C, Foster JC, Konopasek L. Physician know thyself: The professional culture of medicine as a framework for teaching cultural competence. 2008, Acad Med 83: 106-111. http://journals.lww.com/academicmedicine/Fulltext/2008/01000/Viewpoint__Physician,_Know_Thyself__The.17.aspx
Taylor JS. Confronting “Culture” in Medicine’s “Culture of No Culture.” Acad Med 2003, 78: 555 – 559. http://journals.lww.com/academicmedicine/toc/2003/06000
Other resources:
Fox. Cultural Competence and the Culture of Medicine. 2005, N Engl J Med 353: 1316-1319. http://content.nejm.org/cgi/content/extract/353/13/1316
Gillette G. Medical Science, culture, and truth. Philosophy, Ethics, and Humanities in Medicine 2006, 1:13 http://www.peh-med.com/content/1/1/13