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Amira Faroud was a three-year-old Middle Eastern patient, newly diagnosed with type 1 diabetes. Understanding the importance of involving the entire family in the patient’s care, Lisa tried to get the patient’s father, Mr. Faroud, to participate. She had seen other fathers being the “heads” of families and believed involving him was the best thing to do because Lisa the doctor in this case believes that all Middle-Eastern Culture people defer to male authority for ALL desicions. But in this case Mr. Faroud would not even consider her suggestions. 

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Amira Faroud was a three-year-old Middle Eastern patient, newly diagnosed with type 1 diabetes. Understanding the importance of involving the entire family in the patient’s care, Lisa tried to get the patient’s father, Mr. Faroud, to participate. She had seen other fathers being the “heads” of families and believed involving him was the best thing to do because Lisa the doctor in this case believes that all Middle-Eastern Culture people defer to male authority for ALL desicions. But in this case Mr. Faroud would not even consider her suggestions. 

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Dr Jones is part of a healthcare team helping a newly diagnosed Chinese diabetic patient to understand & manage his diet and insulin levels. He has just explained to the patient how to take his medication. Dr: “Have you understood how & when to take your insulin Mr Chang? Do you have any questions ?”Patient: “I understand Doctor, thank you for your time” (Patient leaves in a hurry)Some weeks later Mr Chang returns & is very unwell, his insulin levels are elevated & when interviewed by the Medical team it is clear that he had not clearly understood how & when to take his Insulin 

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Dr Jones is part of a healthcare team helping a newly diagnosed Chinese diabetic patient to understand & manage his diet and insulin levels. He has just explained to the patient how to take his medication. Dr: “Have you understood how & when to take your insulin Mr Chang? Do you have any questions ?”Patient: “I understand Doctor, thank you for your time” (Patient leaves in a hurry)Some weeks later Mr Chang returns & is very unwell, his insulin levels are elevated & when interviewed by the Medical team it is clear that he had not clearly understood how & when to take his Insulin 

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An American doctor enquires about the type of medication a Latin American patient (P) took against his hypertension symptoms: D: In order to help you with your current complaint as well as possible, we would like to know what kind of medication you take on a regular basis or that you have taken recently.P:  I do not take any medication on a regular basis but  The doctor I went to a week ago suggested I take something. But I didn’t do it. I do not think it is good for me.D: Can you tell me more about this, what do you feel you should do or take ? P: Yes, look, the doctor I went to wanted to give me something. But I do not think this medicine is good for me. I am not sure this is the right one. We say that when one feels like I do one should take something which contrasts the symptoms.D: “one should take something which contrasts the symptoms’? What do you mean exactly? Do you mean that in your country patients are given other remedies against the symptoms?you should do? P: Yes, exactly, , they give some teas and I believe they are very good.D: We will see what we can do. If you would you like to continue to drink these teas adding to another form of medication which we would suggest & I will explain to you now, I think you will benefit from both.P : Oh that would be great doctor! Thank you very much. 

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An American doctor enquires about the type of medication a Latin American patient (P) took against his hypertension symptoms: D: In order to help you with your current complaint as well as possible, we would like to know what kind of medication you take on a regular basis or that you have taken recently.P:  I do not take any medication on a regular basis but  The doctor I went to a week ago suggested I take something. But I didn’t do it. I do not think it is good for me.D: Can you tell me more about this, what do you feel you should do or take ? P: Yes, look, the doctor I went to wanted to give me something. But I do not think this medicine is good for me. I am not sure this is the right one. We say that when one feels like I do one should take something which contrasts the symptoms.D: “one should take something which contrasts the symptoms’? What do you mean exactly? Do you mean that in your country patients are given other remedies against the symptoms?you should do? P: Yes, exactly, , they give some teas and I believe they are very good.D: We will see what we can do. If you would you like to continue to drink these teas adding to another form of medication which we would suggest & I will explain to you now, I think you will benefit from both.P : Oh that would be great doctor! Thank you very much. 

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Cultural differences and a collectivism oriented system led Lisa to believe that she must get the dad involved.

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Cultural differences and a collectivism oriented system led Lisa to believe that she must get the dad involved.

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Doctor made assumptions and generalizations about the patient and the family

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"all Middle-Eastern Culture people defer to male authority for ALL decisions" this assumption is not accurate. What if the patient's guardian was a single mom?

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"all Middle-Eastern Culture people defer to male authority for ALL decisions" this assumption is not accurate. What if the patient's guardian was a single mom?

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I would explain to the father that patient's thought should still be considered even if this is not how it is done in their culture.

I would put my attention towards the patient's mother, as my attempt with the father has failed.

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I would explain to the father that patient's thought should still be considered even if this is not how it is done in their culture.

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I would explain to the dad the severity of his daughter's situation and get the mom involved too

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I would explain to the dad the severity of his daughter's situation and get the mom involved too

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Resolve the issue in a way to optimize patient care as a type 1 diabetic.

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Understand the father's perspective and identify ways to incorporate treatment with the father's culture

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Ensure that the patient gets proper care for her diabetes

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Ensure that the patient gets proper care for her diabetes

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I would apologize to the patients parents and try to figure out the best way to solve this situation. 

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I would apologize to the patients parents and try to figure out the best way to solve this situation. 

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I would ask the mom or whoever brought the patient to the clinic if they would like to get the father involved, but not take an action before I ask

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I would ask the mom or whoever brought the patient to the clinic if they would like to get the father involved, but not take an action before I ask

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Make sure the patient’s safety is a priority

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Ensure the patient is happy with the situation, that they understand their case and is welling to move forward in the treatment plan. For a 3 year old with chronic disease, it will be difficult for them to stick to life-long plan of restrictions. They need to be emotionally and psychologically supported.

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Treating the patient with professionalism and not ask if I am uncertain about some cultural aspects before making any decision in involving other family members

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Treating the patient with professionalism and not ask if I am uncertain about some cultural aspects before making any decision in involving other family members

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I will inform the father about the importance of his involvement, if he refused I will involve another family member

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I will inform the father about the importance of his involvement, if he refused I will involve another family member

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Get the father to understand that this is all for the benefit of his patient. And that taking patient's suggestions will ensure that the treatment plan is well adhered to.

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Some patients do not want to admit that they haven't understood what the healthcare staff said so that they do not lose face. This is especially prevalent with those from Asian countries.

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Some patients do not want to admit that they haven't understood what the healthcare staff said so that they do not lose face. This is especially prevalent with those from Asian countries.

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It is the doctor's job to make sure that the patient clearly understands what they're being told

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It is the doctor's job to make sure that the patient clearly understands what they're being told

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at individual level: the doctor should not make assumptions/ stereotype every patient based on what the culture norms are.

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Micro: ask the guardian if they would like to get the other guardian involved.

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Micro: ask the guardian if they would like to get the other guardian involved.

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Meso: make sure there are protocols to follow for such situations

Macro: make sure that there are laws in place to protect pediatric patients in such situations

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Lisa made a generalized assumption based on stereotyping, since the patient comes from a Middle-Eastern family.

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I'd explain how to use insulin to Mr Chang in simple terms, I'd get a translator if there is any language barrier. After explaining to him, I'd ask him to repeat what I said to ensure that he understood me.

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I'd explain how to use insulin to Mr Chang in simple terms, I'd get a translator if there is any language barrier. After explaining to him, I'd ask him to repeat what I said to ensure that he understood me.

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For the patient to administer insulin regularly and to avoid getting infections from improper needle use

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For the patient to administer insulin regularly and to avoid getting infections from improper needle use

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I will try to explain to the father once again the importance of his participation. In case he failed to listen, I will try to involve the mother instead.

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Patient should remain the centre of the doctor's care. And taking their perspectives will ensure adherence to treatment plans.

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This is because the patient comes from a high context culture. The doctor should have dealt with him differently to ensure the patient understood everything properly

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This is because the patient comes from a high context culture. The doctor should have dealt with him differently to ensure the patient understood everything properly

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High context cultures communicate with indirect messages. There is much reading between the lines and non-verbal communication is important in decoding meanings correctly

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High context cultures communicate with indirect messages. There is much reading between the lines and non-verbal communication is important in decoding meanings correctly

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Cultural misconceptions on medication and that natural remedies are better

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Ensure the whole family understands and knows how to deal with Amira's diabetes diagnosis, keeping in mind the new lifestyle that must be implemented.

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Generalisation about cultures norms should only aid understanding a conflict.the doctor should not deal with the patient based on their culture background only.

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The patient comes from a different culture

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The patient comes from a different culture

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such a direct style of communication may appear unfriendly and unclear to patients from this culture. It is the doctors job to ensure the patients understand everything

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he hasn't as he has refused to intake it

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Patient may have been embarrassed to ask more questions. It is the role of the doctor to ensure patient understands the treatment

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correct, as his culture implies that alternative remedies should be given to counteract the symptoms

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Demonstrate to the patient how insulin is taken which can be done via visual aids, videos, etc. Then make sure the patient understands by repeating back to me the steps/showing

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Correct, medicine should counteract the symptoms

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I would make sure the patient is comfortable and that my language is clear, I would spend more time explaining and try not to seem emotionally distant

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I would make sure the patient is comfortable and that my language is clear, I would spend more time explaining and try not to seem emotionally distant

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Meso: Establish certain protocols in the hospital to better deal with situations like these in the future

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Patient receives adequate treatment

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This is a known concept in some cultures. they would be trying to save their honour and the doctors honour and show that they understood the topic even if they did not.

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from their culture point of view, they take herbals for their treatment. the patient had another understanding of how their meds should work.

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The doctor understood that integrating a herbal tea with their meds will be suitable for this patient.

Since from a biopsychosocial  point, knowing that aspects of the patient like their understanding of their disease and treatment influence their disease progression.

So in these cases we should incorporate the patients thoughts since it won’t do harm to them.