■ Professionalism and ethics:

Integrating professional duties, societal expectations and personal wellbeing

Exploring cultural barriers to adherence - 1

Type of activity: Video

Activity summary

The two video segments for this activity "Exploring cultural barriers to adherence" demonstrate how exploring cultural factors may enhance patient comprehension, collaboration and satisfaction. The facilitation questions and suggestions to faculty will help learners to understand the importance of cultural factors in patient care, and thereby the value of adapting their history-taking approach to explore these factors.

Transcript

Setting: Medical office setting as well as a medical waiting room setting. Patient is sitting in doctor's office during follow-up appointment.

Doctor: Your blood pressure is still quite high. I'm a bit puzzled by that, I would have thought it would have come down since you were here 2 months ago. You've been taking the medications I prescribed?

Patient: (sheepishly) Actually, no, um, after I got home, I decided not to fill the prescription. I was hoping that my blood pressure will come down on its own.

Doctor: (sharply) Okay, well, what about reducing your salt intake?

Patient: (hesitantly) Well, you know, that's kind of complicated...

Doctor: (interrupting) Listen, we went over all of this last time, right? I want to help you but you have to reduce your salt intake and take the medications I prescribed, or there's not a lot I can do.

Patient: (trying to explain) I know, it's hard for me...

Doctor: (sternly, interrupting again) I know it's hard, but your health is up to you. I can only help if you follow my advice. And from my perspective, it's really important that you reduce your salt intake and take the medications I prescribed.

Patient: (resignedly) Okay, doctor, whatever...

(In the waiting room)

Patient's daughter: So, how'd it go, dad?

Patient: (sighs heavily)

Patient's daughter: What happened?

Patient: Well, nothing, nothing, I mean I tried to explain why it's so difficult for me to take the pills and why I can't cut back on salt. But nothing, the guy just wouldn't listen at all, nothing. I mean, just like the last time, I just wasted another 2 hours of my time...

Concluding facilitation question: What could the doctor have done differently to address the patient's non-adherence?

Facilitation questions

After watching the video segment:

  1. What could the physician have done differently to address the patient's non-adherence?
  2. What reasons may have led the physician to respond in this way to the patient?

Suggestions to faculty

This activity consists of an interaction where a patient recently diagnosed with hypertension is being reassessed by his family physician. The first video segment depicts an interaction that is largely unsuccessful, due to how the physician responds to the patient's admission that he has not adhered to the physician's advice. In the second video segment, the physician utilizes a more patient-centered approach to explore the patient's underlying motivations (using the CIAO mnemonic: Concerns, Ideas, Activities, and Objectives). During the debriefing, discuss with the learners how incorporating key areas where culture and medicine intersect in the patient interview (using the CIAO mnemonic or any other strategies) may improve the patient's level of engagement and facilitate a change in behaviour.

Additional suggestions:

  1. Have learners explore their personal culture (thinking broadly about culture), either in pairs or within the large group.
  2. Assign learners to work in small groups to research the beliefs, values and practices of a specific cultural group and prepare a brief presentation for the large group.

Additional resources

CanMEDS: Communicator, Professional

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.