An introduction to cultural differences

Patients differ in many ways. Some of these differences are due to patient illness, personality, socioeconomic class, or education, but the most profound differences may be cultural. Many health professionals think that if they just treat each patient with respect, they will avert most cultural problems. But that is not always the case. Some knowledge of cultural customs can help avoid misunderstandings and enable practitioners to provide better care. Beginning next month, wjm will be running a new series on medicine and culture. Each issue will focus on a different ethnic group and provide essential information about cultural patterns for busy practitioners.

THE DANGER OF STEREOTYPING

The danger in considering cultural differences is that of stereotyping people. All of us are unique. To say, for example, that “Russians do this” and “Vietnamese believe that” is both foolish and possibly dangerous. First, it is important to distinguish between stereotypes and generalizations. They may appear similar, but they function differently. For example, if I meet a Mexican woman named Maria and assume that she has a large family, I am stereotyping her. But if I say to myself, “Mexicans tend to have large families; I wonder if Maria does,” then I am generalizing. A stereotype is an ending point, and no effort is then made to ascertain whether it is appropriate to apply it to the person in question. A generalization, on the other hand, serves as a starting point.1

Knowledge of cultural customs can help avoid misunderstanding and enable practitioners to provide better care

Consider the following case study. An elderly Irish woman was hospitalized and scheduled to have surgery at the end of the week. A few days before the surgery, she suddenly started complaining of pain to her family but said nothing to her physician. Her physician was also unaware of evidence that the Irish, as a group, tend to minimize expressions of pain.2 Confronted by the family, the physician expressed little concern because in the physician’s country, women having serious pain are much more vocal than this patient was being. The physician ignored their requests that the surgery be done sooner, deeming it unnecessary.

By the time the patient went to surgery, her condition had worsened, and she died during the operation. Her daughter-in-law, a nurse, felt that had the surgeon operated when the patient first complained, she might have lived.1

In this case, the surgeon made the mistake of stereotyping the patient—she was a woman, and in the physician’s experience, women complained loudly when in pain. Therefore, the physician failed to even reexamine the patient (in itself, bad medical judgment). If the physician had been aware of the generalization about Irish people in pain, the patient’s complaints may have been taken more seriously, which may have led to an earlier operation.

THE ROLE OF GENERALIZATIONS

A generalization is a statement about common trends within a group, but with the recognition that further information is needed to ascertain whether the generalization applies to a particular person. Therefore, it is just a beginning. Because differences always exist between individuals, stemming from a variety of factors, such as, in the case of immigrants, the length of time they have spent in the United States and their degree of assimilation, even generalizations may be inaccurate when applied to specific persons.

One of the most widely cited examples of cultural misunderstanding in medical practice involves the Asian practice of “coining.” In this procedure, a coin, which may or may not be heated or oiled, is vigorously rubbed on a patient’s back. The idea is to “draw the illness out of the body,” and the red welts that form are taken as a visible sign that the procedure was successful. American health professionals who are unaware of this traditional practice may mistake it for physical abuse, and in fact, there have been many cases of parents being arrested for employing a folk remedy that is culturally appropriate and designed to help their children.