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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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Involve the mother in the discussion as well

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Good communication and the ability to convey all important information to both parents, making sure they understand all the possible and best options for their daughter's Type 1 diabetes management

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Generalisations to stereotype

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Avoiding  Stereotype

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The patient may not want to show that he didn't understand the Qs.
The doctor should ask further Qs to clarify what the patient understand.

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1st Qs - the patient might find it difficult to ask more Qs. He might avoid getting a conflict with his doctor.
2nd Qs - the healthcare professionals

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Mr chang feels more taken back as he fully trust the doctor's advice without questioning him even if he doesnt fully understand

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the patient may also not want to feel inferior to the doctor by showing that he did not understand the instructions - ego of the patient 

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the patient may also not want to feel inferior to the doctor by showing that he did not understand the instructions - ego of the patient 

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As a doctor, I would clarify the details with him again and get him to explain what he has understood from it

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- asking more questions if the patient understand
- asking the questions in a simple / different way
- writing down the instructions for the patients

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For the patient to fully understand his situation and his management plan. It is also important to get him to voice out his opinion if he does not understand anything in the future if he were to return for a consultation

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Ask the patient "Can you repeat what you understand of what I explained, so that I know that I explained it correctly?"
- puts the burden of the patient's understanding on the Dr's explanations instead of the patient, allowing the patient to feel more secure

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Understanding the concept of “Face” in Cultural Healthcare especially in Asian cultures like China.

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Individual: each individual's thoughts are different; they should not be generalised according to their cultures, instead cultural context should only be taken as a guideline in approaching the case

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Individual : Mr Faroud does not view Lisa, a female doctor as someone who can provide useful suggestion due to his stereotyping mindset.

Institutional : Hospitals in different region having different policies. In this case, only men may be able to make decision in the hospital or only their opinions are considered to be accepted by the patients.

Macro : Women generally has no say in the mid-eastern countries but when they are in another country, they might feel that their suggestion / opinion does not matter as well hence making it difficult for management

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c)

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b)

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- exploring other methods to manage the diseases in other cultures
- reinforcing the patients behaviour by asking them to keep what they do and add other medication choice

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c

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b

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since the patient believes in his / her own cultural remedies, it is possible that the doctor may use this as a way for positive placebo effect. It also allows patient to be more willing to take the medication.

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If patients are ignored, they will feel that their opinions are being dismissed. They will think that the doctors see them as less knowledgable which may deteriorate the trust / relationship between them.

The desired outcome is reached as the patient has came to an understanding and agreement to the suggested therapy.

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- Addressing the cultural beliefs of the patients is essential in making the management plan to achieve optimal outcomes

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The doctor didn't involve the other family members