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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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1. Not respecting the patient's autonomy
2. Assumptions / Preconceptions on every patient from the region is wrong.
3. Breach of patient confidentiality. Follow Irish policy & rules.

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1. Apologise to the father for the assumption
2. Ask him for any boundaries i.e. if he would like to know further; or what are the patient's best interest

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1. Mr Chang most likely is used to Asian culture.

2. Concept of saving pride, embarrassment, and dignity.

3. Felt embarrass to ask for clarity from the doctor about diebetes

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Mr Chang also might have felt that he would embarrass the doctor if asked further questions as it would imply that the doctor didnt explain thoroughly. He was trying to 'save the face' of the doctor as well.

It is the doctor's job to use methods such as teach back to ensure the patient understood

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- patient is trying to save his own "face" (typically found in Asian culture)
- patient might feel ashamed if he ask the doctor for clarification

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 It is the doctors job to ensure that the patient has fully understood the task and when to consume the medicine. The doctor should be more aware of the cultural background of the patient, and to acknowlege that even though the patient says he understands the task, there is a high chance that that he doesn’t. 

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 It is the doctors job to ensure that the patient has fully understood the task and when to consume the medicine. The doctor should be more aware of the cultural background of the patient, and to acknowlege that even though the patient says he understands the task, there is a high chance that that he doesn’t. 

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Ask Mr.Chang a more leading question to try and draw concerns from him without the patient feeling they have lose their sense of 'face'. 

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Ask Mr.Chang a more leading question to try and draw concerns from him without the patient feeling they have lose their sense of 'face'. 

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example: " taking the medication can be complicated, let me explain it further"

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The desired outcome would be for the patient to repeat what he understood about the situation back to the doctor to ensure that he has fully comprehended the dosages and when to take them.

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1. Doctor is unaware of the face culture. Usual behaviour involves patient asking whatever they are unaware.

2. Does not mean the doctor is at fault.

3. With this knowledge, the doctor should try to prompt the patient in future management & provide means for the patient to enquire further unclear information in the future while "saving face"

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- Explain the regime slowly in small chunks. pause in between and ask if the patient have any questions.
- ask the patient to explain it back. correct any errors.

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Tell ask tell

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The desired outcome would be for the patient to repeat what he understood about the situation back to the doctor to ensure that he has fully comprehended the dosages and when to take them.

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1. patient feels that if he raise any questions to the doctor, it might paint himself as being a "difficult" patient and the doctor as being unclear. Hence, it's a two way street whereby patient is trying to save him and the doctor's "face".

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1. All parties be informed & happy. Yay

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- doctor to be aware that patient might not ask a lot of questions.
- use different methods (ask questions etc) to make sure patient understood fully.

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Create an environment that makes him feel comfortable to express his views

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The issue would be resolved & Lisa would learn to be more considerate & patient in the future.

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have the patient to repeat back what I have explained and ask questions to the patient regarding the topic you gave eg. drug prescription

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In cultures where saving face of yourself as well as others is important, make sure to spend as much time as needed to explain, ask questions and and re-explain

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3. Hold a family meeting with the doctor, mother, father and other healthcare professionals if necessary

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Doing this will help facilitate trust & care in the patient-physician relationship.

Patient's will feel that the doctor is more accepting & caring for them since the management approach is strictly catered to them.

Hence, patients are more likely to be compliant & follow the treatment management programme

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B) ?

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C)?

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Helps to establish trust. Will make the patient feel that their opinions are valid and respected the doctor

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Its possible that the patient felt that the previous doctor didn't listen to the patient's perspective so the patient is less likely to trust the doctor and follow his instructions. This is demonstrated when he seemed happy to take the medications prescribed by the new doc

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being considerate of patient's request makes the patient think that the doctor is listening to their "problems" which can build a good rapport and trust between patient and the doctor.

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Also try to create a friendly & inclusive environment, to promote patient interaction & foster patient-physician trust.

This may help the patient to break the "face" concept & feel more comfortable describing they're issues to you the healthcare provider

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Better patient outcome, as it's an example of a combination of complementary alternative medicine and conventional medicine

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Question 4: What do you think the effects of ignoring or not integrating a patient’s approaches or beliefs would make them  feel? Do you feel the desired outcome was reached in this case and why ? 

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Question 4: What do you think the effects of ignoring or not integrating a patient’s approaches or beliefs would make them  feel? Do you feel the desired outcome was reached in this case and why ? 

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Be considerate of patient's beliefs. Every individual has a different life experience, our beliefs & experience & knowledge do not triumph the patients.

Instead, consider & integrate they're expectations & experience into the management plan to provide a WIN-WIN situation.

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B ?
The doctor did not want to disrespect the patient's view and integrating both sides is considered a win-win situation for both the patient and the doctor.

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Patient will not feel that they're heard, leading to poor patient-doctor relationship, leading to poor adherence

yes the desired outcome is reached as both parties benefit (win/win situation)