Module 4: Cultural Beliefs about Medical Care
There are several types of cultural beliefs about medical care that may produce barriers to patient care.
Lack of Trust in Doctors
Many of the people that you encounter in the community may have had previous negative experiences with the health care system. It is also possible that they come from an environment in which the sociocultural norm is that doctors and the medical establishment could not be fully trusted.(1) For example, Chen-Li Sung’s research on Asian Americans’ cultural distrust of Western medicine suggests that
“Failure stems not from prejudice, but from a lack of understanding of, much less respect for, the systems of thought about health and illness which form the basis for the traditional or tradition-influenced Asian American patient’s approach to illness. “Noncompliant” patient behavior is misunderstood if the physician does not grasp the roots of such behavior in a system of beliefs which is not his own. Misunderstanding begets further “noncompliance,” initiating a downward spiral. The way out of such spirals lies, I argue, in seeking a more adequate understanding of the patient’s beliefs and their behavioral consequences.”(2)
Because of a lack of trust in doctors, some patients may be more likely to seek home remedies. (3) While it is important for patients to do their best to take care of themselves, home remedies often are not effective treatments. Overcoming a cultural difference in trust of doctors is important because it helps to remove or lessen barriers to care that result from patient fear of doctors. We will discuss the importance of trust (and how best to foster it) in the next module.
Cultural Beliefs about Medicine
Oftentimes each community member in a center will have a varying view of illness, disease, and health. A view commonly held is that disease results from fate, punishment of sin, sorcery, or other supernatural causes.(4) Those who believe in the supernatural causation of diseases will often fail to seek medical treatment. You may be placed in a situation where you have to balance your beliefs about disease with the closely-held worldview of a community member in need. In such situations, you must be culturally sensitive while at the same time providing the correct information and attempting to educate the community member about illness and what it means.
Part of being an effective volunteer requires setting aside ethnocentric ideas of superiority and learning to understand culturally different attitudes toward health care. While Western medicine may be more technologically advanced, it is by no means the universal approach to health care, nor is it the undisputed “best” method. As a volunteer, you may hear patients describe worldviews and beliefs about illness and health that are diametrically opposed to your own worldview. However, these beliefs should never be dismissed or ridiculed. Respecting patient beliefs is essential to relating to patients, as their beliefs are integral to their lives.(5) Additionally, as we observed in the Kielich and Miller case in Module 1, respecting a patient’s ideas about what should work as treatment may be the only way to help the patient effectively.(6)
Go To Module 5: Trust >>
Footnotes
1 Betancourt, J.R. et. al. (2003) “Defining Cultural Competence: A Practical framework for Addressing Racial/Ethnic Disparities in Health and Health Care” Public Health Reports, 118:293-302.Accessed on 4/16/09 <http://www.vdh.state.va.us/ohpp/clasact/documents/CLASact/research3/118293.pdf>
2 Sung, C. “Asian Patients’ Distrust of Western Medical Care: One Perspective.” The Mount Sinai Journal of Medicine. 66.4 (1999): 259-261. Accessed on 5 January 2005.<http://www.msonsitehealth.com/msjournal/66/v66_4_259a.pdf>
3 Berger JT. (1998) “Culture and ethnicity in clinical care.” Archives of Int Med;158:2085-90.
4 Murdock, G.P., Wilson, S.F., and Frederick, V. “World Distribution of Theories of Illness.” Ethnology. 17.4 (October 1978): 449-470. Accessed on 5 January 2009. <http://www.jstor.org/stable/3773194?seq=8>
5 See, for example, “Professionalism 101.” Child Family Health International (CHFI). Accessed on 5 January 2009. <http://globalhealthedu.org/PublicDocs/professionalism_cfhi.pdf>
6 Kielich AM, Miller L. Cultural aspects of women's health care. Patient Care. Oct 1996; 30(16): 60-76. Quoted at <http://www.amsa.org/programs/gpit/cultural.cfm>