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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
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    Site Index
    Back to Module 13: Cultural Issues
    Tools for Diagnosing and Mediating Cultural Misunderstandings

    Touch and Gender
    Medical Cultures and Cultural Misunderstandings Suffering
    Traditional Medicine
    Body Language
    Bad News
    Meaning of Illness
    Alternative Medicine
    Imminent Death

    Medical Cultures and Cultural Misunderstandings

    Medicine as a Subculture

    • As a health care professional you are a member of a subculture with a shared vocabulary that is likely unfamiliar to outsiders
    • The subculture is further divided by discipline. Much of the rub between physicians and nurses for example is due to slightly different vocabularies, different skills and different jobs, which members of the other profession may not completely understand. Why else do we have team meetings? So much the more for patients


    Clues to Cultural Misunderstanding

    • The following clues may signify that a cultural misunderstanding is taking place:
      • Repetitious questions from a mentally competent patient or family member
      • Unexplained refusals
      • Polite resistance and “non-compliance”
      • Repeated demands or requests for treatments that are not indicated
    • Remember that the concept of palliation itself, which seems universal, may not be so. People come to doctors and to hospitals in expectation of cure. They may seek palliative care outside the setting of formal medical care. Therefore it is important to ask every patient about their expectations of outcome for their illness and their goals for care
    • Understand that some patients actively engage from the start, while others do not. Non-U.S.-born, limited-English and limited literacy patients may not be so assertive out of respect or intimidation or an unrealistic expectation of medical or miraculous cure


    Life Experiences Contributing to Distrust of Medicine

    • Ethnic and racial minority patients may be deeply and justifiably suspicious of health professionals who seem to be withholding care
      • African-American men were used as unwitting subjects for unethical research (the Tuskeegee Study)

      • Soviet hospitals were used as places of internment for political prisoners

      • Holocaust survivors may be very upset by some medical and nursing procedures

      • Former POWs and refugee survivors of torture may have re-emergent trauma in times of stress
    • Therefore it is very important to understand the life experience of patients who seem uncooperative
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