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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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- patient autonomy:
Everyone needs to be part of the decision making of the treatment plan for the child - including both the parents and the child

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- cultural sensitivity: the doctor acted based on preconceived stereotypes and didn't actually examine the situation at hand

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Have a discussion with the entire family

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To have opened a channel of communication with the whole family to develop the best treatment plan possible

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Include both parents in discussion for management of the child

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Ensure everyone - caregivers, parents and patient understand what T1DM is and what entails in the management to better facilitate treatment of the child

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There could also be a language barrier which made the patient more hesitant to ask more

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The Face: the concept of saving face
- based on Asian/Eastern culture
- 'saving face’ can be important to maintain, especially in front of people i.e., healthcare professionals
- transgression of social norms and behaviour can lead to loss of face like in the case
- he might not want people/professionals to think less of him

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It's both the patient's and healthcare professional's responsibilities

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The patient may have had difficulties understanding the doctors instructions and may not have felt comfortable voicing these. The doctor is obligated to ensure the patient understands and is comfortable talking through their issue

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Build patient doctor relationship, have patient clearly understand the explanation

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Build patient doctor relationship, have patient clearly understand the explanation

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- facilitate the discussion in a way that he's more comfortable and build rapport with the patient so he might not prioritise maintaining in "keeping face"
- rephrasing questions and statements when needed
- allow the patient to repeat back what was discussed during the consultation/discussion to ensure the patient understands the treatment regime
- easy access to translator

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- That the patient would feel comfortable voicing any concerns they have openly
- That the doctor would have the necessary the necessary aids in this situation - a translator would be crucial in ensuring the patient accurately understood the complexities of diabetic medications and dosing

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C) He has another understanding of how medication should work on the body.

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- Placebo effect:
Improvement of symptoms may be observed despite the non-active  "treatment"; so as long there is not harmful interactions or implications of said treatment
- Respect:
Respecting one's beliefs may aid in building rapport and trust between patient and the doctor
- Increases patient compliance:
Patients will adhere to the management plan more if something they believe that works is integrated

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He knows that the patient will be most happy if these remedies are incorporated into their treatment plan. The doctor also knows that patient mindset plays an important tole in their response to treatment

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Yes, The doctor respect the patient and the patient is willing to try both medication

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Yes, The doctor respect the patient and the patient is willing to try both medication

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Yes, the doctor was amenable to the patients suggestions and formulated a plan that would incorporate both the patient's wishes and the doctor's recommendations

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if ignored - feel degraded, neglected, distrust