Opinion: Should All Doctors be Culturally Sensitive?

  • Oct 20, 2017
  • By Vanessa Bak

By: Dr. Gabriel Andrade, Lecturer of Behavioral Sciences

 

Prior to teaching Behavioral Science at Xavier University School of Medicine, I was for many years a professor of Critical Thinking. I taught the principles of the scientific method, some of the most common cognitive biases we fall into, and some of the fallacies that charlatans use, and that unfortunately sometimes persuade us.

 

So, given my appreciation of rationality and critical thinking, I never sympathized with alternative or folk medicine. In fact, I joined organizations that debunked quackery such as reflexology, homeopathy, reiki, and so on.

 

I have not changed my mind. I firmly believe that scientific medicine is superior to any other treatment. But, as I now encounter medical students, and as I prepare lectures on the cultural aspects of illness and patient interviewing, I have come to change my mind as to how ethical it is to tell a patient from another culture that her beliefs about illnesses are wrong. After all, the bottom line in the doctor-patient relationship is getting the patient to comply. And, if that requires not refuting a patient’s cultural beliefs, then so be it.

 

One big factor that has accounted for this change of mind, was reading a wonderful book by Anne Fiedman, The Spirit Catches You and You Fall Down. It tells the true story of Lia Lee, a child from the Hmong tribe (in Laos), that migrated to the US. In her new home, Lia Lee was diagnosed with epilepsy. Hmong tribesmen explained this illness as a result of spirit possession, and in order to treat her, they brought shamans to the hospital, and followed their own magical procedures. The medical staff did not think this was a good idea, and inasmuch as Lia Lee’s parents did not adhere strictly to the treatment (which was very complicated), they sought a court order to remove custody.

 

This only made things worse. Lia Lee’s conditioned deteriorated, and eventually, the court gave custody back to her parents. Contrary to the doctors’ prognosis (they believed Lia Lee would die soon), she lived to the age of thirty. The book is far from judgmental, and tells the story from many perspectives, including both Lia Lee’s parents, and the doctors. Yet, its argument is clear: doctors need to be culturally sensitive when treating patients.

 

I agree with Fiedman’s argument, but not wholeheartedly. I believe that, yes, doctors need to be culturally sensitive. But, outside of hospitals, and in settings that are not set within the doctor-patient relationship, they must do everything they can to educate people from other cultures and correct whatever mistaken folk beliefs people may have about health and disease.

 

Ethicists recommend doctors to tolerate folk practices that do not get in the way of scientific treatment.

 

So, if Hmong tribesmen want to bring shamans to the hospitals to visit an epileptic relative, so be it. I agree with that. But, it must also be kept in mind that not all folk or alternative medicine is as harmless as it may seem. Even if they are not intrinsically harmful, folk and alternative medicine always have the danger of substituting effective scientific treatment. Perhaps the most notorious tragic case of this kind is that of Steve Jobs, whose probability of survival was actually quite high, had he followed conventional science-based therapy for his cancer. Instead, he chose treatments from alternative medicine, and he died. Taking shamans to hospitals to do magic on epileptic patients is fine, as long as they do not sabotage the neurologist’s job.

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