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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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Power distance; high/low context; saving face, language barriers

Due to possibly the language barrier and the cultural barriers, the patient did not understand the doctor and was too worried to question his authority, or to seem ignorant- trying to save face

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There was a communication barrier between the doctor and patient. 

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There was a communication barrier between the doctor and patient. 

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Some patients, especially those from Asian countries, may not want to show that they have not understood a question or that they disagree with the medical staff.

This would lead not only to their loss of face but also that of the other person.

In such instances, it can be difficult to get a clear answer from the patient. It may be better for medical staff to try to put into words what the patient may be feeling (‘I imagine that you might find this information shocking’). This might make it easier to draw out the patient’s feelings or opinions.

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The doctor failed to acknowledge the patient’s  preferences and needs.

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The doctor failed to acknowledge the patient’s  preferences and needs.

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Offer to arrange for an interpreter to be present if patient is open, re-check for understanding from patient by reiterating in a different way, potentially with more specificity/detail; and also put into words what the patient may be feeling to draw out their feelings and opinions

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 The patient is more likely to adhere to medications if the doctor respects and understands the patient’s preferences and needs. 

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 The patient is more likely to adhere to medications if the doctor respects and understands the patient’s preferences and needs. 

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 Paternalistic approach needs to be avoided. 

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 Paternalistic approach needs to be avoided. 

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 Doctor needs to look at the illness from the patient’s eyes.

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 Doctor needs to look at the illness from the patient’s eyes.

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If Mr.Faroud wont participate in understanding his daughter’s condition then it will be very difficult for her and for the family to deal with it and thus would affect amira’s healthcare specially that she is only 3,  her parents are the ones that will be taking care of her medical condition. They also need to understand the symptoms and the red flags incase any emergency situation happens they know how to deal with it. But his refusal puts his daughter at risk.

Desired outcome in an ideal situation is that the father (Mr.Faroud) participates in his daughter’s care thus making easier for his family to deal with the condition. Also Dr.Lisa, shouldnt be stereotypical to avoid bias and ham to the patient and instead she could have spoken to the entire family or involved social workers

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Why does the patient think that the medication he received from another doctor is not good for him? ANSWER

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Why does the patient think that the medication he received from another doctor is not good for him? ANSWER

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Generalizing the population to one solution; may result in misinterpretation by the family/patients

The patient’s needs should be met and careful consideration should be made when it comes to dealing with this in a culturally sensitive situation

It is important to establish rapport with the patient and their families and to ensure that all necessary information is being passed on to ensure the highest level of benefit to the patient.

It is important to advocate for the patient in terms of their care and their health

Getting the family involved in a paediatric setting is vital to be able to work in partnership with the families

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I would ask for the rationale behind the decision and try to find a middle ground for discussing our options moving forward. It may help to have an interpreter to aid in the communication between the patient, patient’s family and lisa the doctor

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I would ask for the rationale behind the decision and try to find a middle ground for discussing our options moving forward. It may help to have an interpreter to aid in the communication between the patient, patient’s family and lisa the doctor

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Provision of patient centred care that promotes patient safety and health. This means that:

The patient feels like they understand how to take the insulin.

The patient feels that their ideas and concerns and expectations have been met and addressed

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A mutual understanding between doctor and patient may not have been reached due to cultural miscommunication

Awareness of cultural norms such as "saving face" may help in identifying where culturally appropriate communication and approaches need to be taken

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Advocacy needed for cultural sensitivity 

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Advocacy needed for cultural sensitivity 

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- never to stereotype in any cultural setting
- ask questions to better understand the outlook of the patient
- find a middle ground to give the patient and the family a better outlook on care