diocese related article on page 515...

diocese related article on page 515

Imagine that all of our patients are invited to attend a "cultural competence" workshop called "Understanding the Medical Culture" where they will learn for what reason the strange and mysterious environment of medical practice affects physicians, thus that their otherwise incomprehensible behavior assumes at least somewhat understandable. They will be put forwarded handy tips that would allow them to predict physicians' behavior, of that kind as the following:

* Physicians always want to be in direction and typically interrupt patients after they have oral for about 18 seconds.

* Physicians believe in always "doing something," unruffled if there is little scientific basis for it--especially if it is well-reimbursed.

* All physicians take Wednesday afternoons not on to play golf.

This imaginative exercise should remind us of pair important points. First, as physicians, we bring our improvement (or cultures) to the clinic just as often as patients bring theirs. As was taught nearly 30 years ago, (1) and as we have been reminded more lately (2) every physician-patient encounter is a cross-cultural exercise--even if the physician and patient grew up forward the same street in the same small town.

inferior although the efforts of Searight and Gafford (3) in this issue of American Family Physician are well-intentioned and potentially beneficial, ultimately we must fare beyond focusing on the unfamiliar cultural characteristics of certain subgroup We cannot predict a patient's predilections and values by categorizing him or her into a hyphenated ethnic clump any more than someone besides could predict exactly how we will behave through categorizing us as physicians. What begins as a genuine desire to venerate our patients can too easily deteriorate into an attempt to over-simplify "culture" into something that can be diagnosed and treated. (45)

constant cultural competence requires humility and curiosity, and the willingness and flexibility to understand and accord to our patients' beliefs and the way they wish to be treated. It may not be appropriate for certain patients to be told the reality about their condition or to be asked explicitly about end-of-life care planning or advance directives. unless it is very unusual for parts from any culture to harbor resentment frank inquiries into the nature of their avow cultural beliefs and practices, in like manner family physicians need not fear beginning in the same state [i]or[/i] condition a dialogue.

Avoiding cultural dissonance does not require physicians to learn the nature and history of a whole variety of cultural beliefs and practices. Instead, physicians involved in end-of-life care should be sensitive to the arbitrariness of their admit cultural beliefs in the value of telling the reality to patients and allowing them to participate in decision-making. Effective cross-cultural care in this setting requires a willingness to learn each patient's prioritys and to negotiate mutually acceptable alternatives. For example, patients who choose not to know their prognosis should be allowed to designate a representative to receive information and make decisions for them.

Searight and Gafford remind us that there is at least as often variation within other cultures as there is in the white European-American population. Furthermore, many patients who might be awaited to be closely aligned with our "physician culture" are instead turning to a variety of alternative therapies and practices. Allowing our patients and their families to be our educators and informants, and developing mutually acceptable alternatives to our habitual practice, takes time and resources. Family physicians should appreciate the great value of making this necessary investment and the deep-felt cost of failing to do so

REFERENCES

(1) Kleinman A, Eisenberg L virtuous B. Culture, illness, and care: clinical lecturings from anthropologic and cross-cultural research. Ann Intern M 1978;88:251-8

(2) Carrillo JE new AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern M 1999;130:829-34

(3) Searight HR Gafford J Cultural diversity at the extremity of life: issues and guidelines for family physicians. Am Fam Physician 2005;71:515-22

(4) chase LM. Beyond cultural competence: applying humility to clinical settings. Accessed online January 10 2005 at: http://www.parkridgecenter.org/Page1882.html.

(5) Santiago-Irizarry V refinement as cure. Cultural Anthropol 1996;11:3-24

HOWARD BRODY MD PHD is University Distinguished Professor in the Departments of Family Practice and Philosophy and in the Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing.

LINDA M chase PH.D., is associate professor in the Department of Anthropology and in the Julian Samora Research Institute at Michigan State University.

Address correspondence to Howard Brody MD PhD Department of Family Practice, B-100 Clinical Center Michigan State University association of Human Medicine, East Lansing, MI 48824-1315 (e-mail: brody@msuedu) Reprints are not available from the authors.

COPYRIGHT 2005 American Academy of Family Physicians

COPYRIGHT 2005 Gale Group