The Art of Acceptance

Question: How will I incorporate and be understanding of persons with different cultural perspectives who come into my practice?

After a PCM presentation highlighting a Chinese naturopath and an M.D. having a mostly Hispanic patient population, I asked myself the question above. Our reading indicated that 70-90% of patients manage their sicknesses outside of the realm of formal healthcare and that our individual cultures play a powerful role in how we care for ourselves. Specifically, our material describes folk remedies that exist in all cultures and which vary tremendously from one culture to the next. So, how can I learn and apply knowledge of complex, culture-based care?

I think the answer consists of two parts: Gaining practical, on-the-ground experience and through independent study. Before I can do either, however, I must realize who my patient population typically will be or could potentially be as I begin to interact with them. I will likely have easy access to this information if I join an existing group practice or hospital. Or, if I begin a solo effort, other local providers or the community composition in the location I select will provide the initial profile.

As a first effort, I will need to read all I can discover concerning the cultures I expect to encounter. Each patient will present with different concepts of family, ideas of social justice, hierarchies among relatives, decision-making authority, folk remedies, and how they will approach their healthcare based on the cultural solutions they are familiar with and of which they are convinced have value. I will need to understand what each patient truly believes will make a difference for them and whether it will truly improve their health. Of course, much of the reading will be found in medical journals – and much of it will not. It may be uncovered in cultural periodicals, stories of persons who live in or originate from those worlds, and articles that describe their practices and beliefs as written by persons who are members of the fold. I will simply have to devote a good deal of my personal time to learning about my patients and until I have a firm grasp of who they are and what they believe will impact their health.

As a second means of learning, I will need to gather information directly from the patients themselves. Since this learning will occur one patient at a time during individual encounters, it will transpire at a much slower rate, but, as I am attentive to each person, I will steadily acquire this understanding. It will require a humble attitude that allows me to hear, and I will have to be open to new ideas and accepting of habits I don’t understand. I will need to inquire consistently as to their ideas and cultural remedies, and seek nonjudgmental compromise as we work together in their plan of care. Indeed, as indicated by Dr. An, the naturopath, some persons believe that the body only heals itself, and we merely need to attempt to get out of the body’s way or remove any impediments to the body being able to heal. And, as long as their methods are not deemed harmful, it may be best to negotiate a treatment plan whereby patients pursue their chosen remedy in addition to any I may deem beneficial or necessary. Possibly, their positive belief and outlook may make a remedy worth pursuing.

As I progress through medical school I will likely gain valuable insight into many cultures and practices. There will always be more to learn. I will continue to seek out new information and clarify my understanding of every culture I encounter. And, as a generous side benefit, my patients will educate me about new cultures in depth, and I don’t even have to purchase a plane ticket. Nice bonus.