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  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
  • More About:

  • Hospice Care
  • Clergy and Faith Communities
  • Additional Links
    Site Index
    Back to Module 13: Cultural Issues
    Tools for Diagnosing and Mediating Cultural Misunderstandings

    Touch and Gender
    Medical Subculture
    Traditional Medicine
    Body Language
    Bad News
    Meaning of Illness
    Alternative Medicine
    Imminent Death


    • We identify depression mainly by listening to patients talking about emotional and psychological states. This is a relatively unusual expression of what is a universal pathology
      • Many languages do not have words that describe emotions and psychological states

      • Even in English, it is a fairly sophisticated patient who says, “I feel anxious and helpless”
    • We believe it is helpful to say these things out loud. That may not be universally true
    • The language of anxiety and depression may appear in dream images, the language of the body (somatization) or idioms of speech we do not recognize
        For Example
        The Cambodian expression, which translates “thinking too much”, represents depression probably associated with PTSD. In Amharic, to complain that “my stomach is too wide” also represents a depressive equivalent
    • Generally, a long list of somatic complaints with no obvious physiologic basis is likely to be depression
    • Depression is undertreated among terminally patients at large. It is very likely under-recognized among ethnic and cultural minorities
    • Spiritual and pharmacological modalities should be tried
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