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Cultural safety


Respect for patients and families

Treating vs. helping to heal


  • Every patient encounter is potentially cross-cultural in nature.
  • When physicians treat people equally they ignore differences. When physicians treat people equitably, they recognize and respect differences.
Hands offering different treatments

Patients may subscribe to two types of healing: conventional western medicine and a medicine linked to personal beliefs.

Patients may often seek care from both a conventional western medicine physician and an alternative healer but may not inform you of that fact.

Misunderstandings can occur when culturally-shaped beliefs about health intersect with the accepted scientific model of disease. These might manifest as

  • discomfort with the discussion(s)
  • non-adherence to treatment plans
  • loss of trust in the doctor-patient relationship

Patient behaviours that physicians often find frustrating include non-adherence to treatment plans and repeatedly missing appointments.

  • Rather than assuming there is a lack of cooperation, strive to understand the reason behind the behaviour.

Dealing with a habitually tardy patient
An elderly First Nations male

Background

A 60-year-old First Nations male with diabetes and hypertension frequently arrives 45 to 90 minutes late for his appointments without having called to make alternative arrangements. When this occurs, his physician feels this is disrespectful to his and the other patients'’ time and refuses to see him.
Doctor checking his watch

Background continued

After 3 late arrivals, the family physician tells his patient that unless he arrives on time for the next appointment, the doctor-patient relationship would be terminated. Upon the fourth late arrival, the patient is told that he will have to find a new physician. The patient’'s daughter complains to the regulatory authority (College) about the physician'’s inappropriate attitude.

Think about it

How might the physician have provided better care and potentially prevented the complaint?

Suggestions

  • The physician could have informed the patient of the effects of tardiness on other patients.
  • Exploring the reasons for the tardiness may have led the physician to learn that generally, in First Nations culture, the meaning of time is very different than it is for him.
  • The physician might have been able to find ways to accommodate the patient. For example, he might have learned to be less rigid with his time schedule, to offer to see the patient at the end of the day, or to anticipate habitual tardiness and account for it in his schedule.

Lessons learned

Remind yourself of your own cultural and professional biases and how they influence your perception of others.
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There are several key areas in which culture and medicine intersect. The CIAO mnemonic illustrates how you may incorporate these areas when interviewing patients.

  • Asking the right questions in an empathic manner can provide an opening to explore barriers to communication and treatment, and to determine whether cultural factors are playing a role.

Concerns Truth-telling, impact of illness/disease
Ideas Conceptions of illness/disease, faith and healing
Activities Daily routines (including food), special rituals, family/community
Objectives Decision-making

Gold ruler

The golden rule that your parents may have taught you in childhood states:
"Treat others as you would like to be treated."

Platinum Ruler

To be an effective cross-cultural healer, strive to apply the platinum rule:
"Ask others how they want to be treated."