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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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Do not make assumptions about family structures

Be cautious of ques if the patient is uncomfortable and be ready to change plans accordingly

Treat the patient as an individual.

​​Don’t stereotype we are all individuals first

View culture as an influence and not a determining factor of behavior.

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Apologize to the family/father for assuming, and proceed with a discussion with the family about who will be making the decisions

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Micro level: Reflection, learn cultural awareness, ask colleagues

Meso level: Training, awareness of cultural differences but also avoid stereotyping

Macro level: exchange programs

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Provide adequate information about the diagnosis and allow the family the time to absorb the information and take a division collectively on the treatment plan of the child

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Understand whether they prefer individual or collective approach

A patient-centered approach for treatment where the treatment is tailored for what is best for suited for the patient and her family

An individual from the family will take charge

A decision maker for the patients treatment

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Failure of communication

Lack of cultural sensitivity

Assuming the role of the father as the decision maker

Generalization

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Concept of Face is prevalent in Asian cultures.

Patient did not want to seem “stupid” or ask “stupid questions”

high/low context (delivery on instructions on the Dr’s behalf may not have accounted for cultural differences)

Dr. did not follow up on the patient regarding Mr. Chang’s adherence to his treatment plan.

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The patient might have been  hesitant to sound unknowledgeable

Embaressed to not understand

Doesnt want to waste doctors time

The doctor should ask the patient if they understood and ask them questions to make sure they have understood

The doctor must also be aware of the culture and how someone like Mr. chang is less likely to ask questions if he did not understand his treatment regimen

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Speak directly to the patient about his understanding of how to take his insulin

Be sensitive towards the cultural barrier and try to adjust your way of speaking to fit his best understanding

Give written instructions as well

Allow time in the consultation

Make sure to emphasize on follow-up appointments.

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communicate well with the patient in order to understand how he is feeling.

be aware of cultural differences in communication

give time and consideration to all patients

be aware that people have different ways of learning information best

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Patient well informed and not hesitant to ask questions

Better patient outcome

Patient feels comfortable to ask questions and go back to the doctor in the case of confusion

Efficient communication and open space with no judgement or fear of it

Doctor is aware of cultural factors that might come into play, so that the structure of the consultation is more fitting to the patient.

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Misconceptions about the effect / benefit / drawbacks

Relying on word of mouth and false information

Non evidence based knowledge

Dr may not have been considerate about his culture and did not offer a happy medium

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Important to educate patients

Conventional + CAM approach

There’s more than one way to do things

Biopsychosocial model

Importance of a patient-centered approach where the patient’s beliefs are considered in creating the treatment plan that best suits the patient and their beliefs

It’s important to find a happy medium between the patient and what he/she is comfortable with and the treatment the Dr recommends