Providers of health care and patients often begin their relationship separated by a huge cultural gap. As providers of health care we are socialized into the culture of our profession. This professional socialization teaches us a set of beliefs, practices, habits, likes, dislikes, norms and rituals, factors that comprise a given culture. We speak a different language (medical terminology) and our understanding and beliefs regarding health and illness differ greatly from the population at large. Patients and staff also differ in social class. Doctors are often wealthy and nurses are fairly well off, in contrast, patients are disproportionately poor and suffer misfortunes which compound each other.
The Health Care Provider Culture (Spector, 1979)
Western medicine by its nature treats patients as medical objects, a biomechanical entity. Patients are detached from their own lives and life stories and physically taken from their home settings into the unfamiliar setting of a hospital, to be treated by different specialists. But patients often resist this treatment in a number of ways and the resulting conflicts express themselves as "ethical problems."
Given the cultural and economic gaps between health care providers and patients, it is not surprising we often make moral judgments on the behavior of patients. Even if we deny the reality of the situation, as health care providers we must understand that we are ethnocentric. Health care providers adhere rigidly to the western system of health care delivery and with few exceptions, do not sanction any other methods of prevention or healing. We fail to recognize or use any source of medication that has not been proven to be effective by scientific means.
So how can we as providers of health care, meet
the perceived needs of the patient as defined by the patient, when we
do not recognize nor sanction others beliefs regarding health and
illness, prevention or treatment ?
Galanti (1991) makes two important points regarding disease etiology. First, the treatment must be appropriate to the cause. If the germs cause disease, kill the germs. If the body is out of balance, restore balance. If the soul is gone, retrieve it. If a spirit has taken over the body, exorcise it. If a rule has been broken, do penance. If an object has entered the body, remove it. All these remedies are perfectly logical. Whether these etiologies are the true causes of the disease is irrelevant. A patient who believes he or she is ill because of soul loss will not be cured by any amount of antibiotics. The mind is very powerful, as the placebo effect demonstrates. The patient's beliefs, as well as body, must be treated.
Second, we must not let our ethnocentrism blind
us to the merits in the beliefs of other cultures. They may be
right. It is easy to look down on other systems, citing science
to support Western medical beliefs. But all medical systems are
based on observed cause - and - effect relationships. The major
difference with the scientific approach is that science is
falsifiable. A scientific hypothesis can be proven wrong.
The beliefs of other systems cannot.
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