Healthcare and Cultural Diversity

More than ever before healthcare professionals are subjected to dealing with a number of vast and various cultural diversities. As cultures within the U.S. continue to grow the understanding of how to deal with them must also grow. If cultural differences are not communicated appropriately it can cause uncomfortable and confusing situations for both the healthcare provider and patient. This can cause the patient to suffer due to loss of trust and respect causing the patient to be less likely to follow a treatment plan. Culturally competent healthcare is considered a human right, and increasing numbers of culturally inappropriate lawsuits filed in court are being won. Some cultures, such as Ethiopian, Islam and Chinese have very different laws, views and beliefs about healthcare. Because there are so many differences there are many legal implications that could possibly arise from cultural ignorance in healthcare.

Ethiopian traditional belief is that health results from equilibrium between the body and the outside world and that illness arises from disequilibrium. Ethiopian culture also believes in the use of herbs and spices for medicinal purposes which can sometimes have adverse interactions with western medicine. For example, large amounts of garlic and ginger are used for the common cold which can act as an anti-coagulant in high doses. Cinnamon is also used for the common cold which increases stomach acid and may inhibit tetracycline (an antibiotic used for many bacterial infections). Basil is used for headaches and insect repellent which acts as an anti-coagulant and has hypoglycemic agents due to the oil extract increasing blood clotting time and synergistic interactions with insulin. Most studies show people of different cultures do not tell their physician about their traditional medicine use out of fear of being judged. One legal implication that can arise while treating an Ethiopian may be a physician treating for a bacterial infection with tetracycline unknowing that he or she is taking large amounts of cinnamon for a suspected oncoming cold. If the cinnamon interacts with the tetracycline the bacterial infection can spread causing further harm even potentially fatal harm resulting in a legal dispute.

The Islamic culture considers an illness as a punishment for their sins. Abortion and assisted suicide is not permitted. Pork and alcohol is forbidden and Muslim women can’t be touched by men who are not immediate family members. Muslims also fast from dusk to dawn for one month a year. Some legal issues that can arise may be a result of a physician prescribing insulin or heparin which contains pork ingredients to a practicing Muslim, or a cough syrup containing alcohol. A Muslim may not be aware that our western medicine contains these products. In addition, if a Muslim is fasting at a time of illness causing weakness and dehydration this can be seen as the physician not providing proper care, all possibly resulting in a legal dispute.

Some Chinese theories about health are based on the observed effects of Qi. They believe Qi defends the body from pathological factors, provides movement and supports growth and development. They believe things like poor diet, poor lifestyle or strenuous work can deplete one’s Qi. Yin and Yang is probably the most significant theory followed, it is the balance between opposites like cold vs. hot or excess vs. deficiency. The Chinese believe some bodily organs contain more Yin and others posses more Yang and will relate this to hot and cold with health complaints. For example one may complain of a “weak kidney” and insist their kidneys be tested when in reality they may be having back or knee pain or diarrhea. A “hot liver” is a common complaint which can refer to itchiness, skin eruptions or emotional stress. Medicine is also considered to have hot and cold effects. This makes it common for Chinese people to take less medication then prescribed to “balance” out the effects, and many would not tell their physician because they believe they are in the best position to judge their own health needs. So there could be a possibility of legal disputes if a liver complaint is made and the physician orders diagnostic tests and possible medication for the liver if in fact the complaint was made only due to emotional stress or itchiness. There can also be a possible legal dispute if the physician did not explain the importance of taking all of a prescription and the patient started taking less to balance their Yin and Yang and the medical issue persists or gets worse.

In conclusion, as one can see there are many different healthcare beliefs in different cultures. Some of these differences can cause confusion and misunderstandings for both the physician and patient. And although most western physicians will try to address an ailment of someone from a different culture in their best interest, it may conflict with their beliefs. Healthcare and cultural ignorance amongst all physicians is a subject that needs to be addressed. Proper training in cross-cultural healthcare will ultimately lead to a better understanding of the patient’s needs and complaints, more respect for the physician and better adherence to treatment causing less legal disputes and a pleasurable, successful experience for the patient.

Here is a short video pertaining to health care and cultural diversity http://www.youtube.com/watch?v=XF8yZRgcSkg