Why Your Culture Does Not Matter To Me

flying cadeuciiI am a student in a health care profession. I see many different people every day that come to seek treatment at my school. Most patients are local to our area, but many come to our school’s clinic from different countries, cultures, and backgrounds. Our curriculum has recently been updated in accordance with the board of accreditation that our state mandates for professional schools. This curriculum includes a course entitled ‘Cultural Awareness.’ The goals of the course, as stated by the syllabus and our professor, is to:

  1. Emphasize, illustrate and analyze how patient’s background, culture, beliefs and norms may impact health and health outcomes;
  2. Enhance understanding of legal boundaries and provider’s responsibilities in the delivery of care;
  3. Enhance the students understanding of cultural, various societal values and traditions that must be considered during the delivery of care, doctor-patient interactions and treatment outcomes;
  4. Increase awareness of the challenges and mechanisms for providing services to special populations. Except for the second objective, I am not interested in learning about any of these. I am going to illustrate to you why classes like these are a farce, a waste of our time as professionals, and demeaning to every intelligent culture.

As a professional healthcare worker, I am bound by a code of ethics. In fact, this code is a defining aspect of the culture found among healthcare professionals. This code includes virtues like veracity, nonmaleficence, justice, beneficence, and patient autonomy. These virtues lay the groundwork for almost every aspect of clinical decision-making in healthcare. It is a defining aspect of healthcare culture. This code is well recognized by people within and without the healthcare system as it is the basis for the credibility patients give to their doctors, nurses, dentists, optometrists, etc.

When a patient walks into a clinic and wants treatment, this culture allows them to be sure of what they are walking into. The code of ethics is unchanging and unwavering. It is a cornerstone of healthcare because without it, patients could not trust their healthcare providers to give them a high quality of healthcare.

Why do I mention professional healthcare culture? Because when a patient walks into the office, it is the only one that truly matters. Do not misunderstand me. I respect my patients. I would never be intentionally rude to them or purposefully disrespect their culture without reason to do so. What I am saying is that when it comes to the treatment of my patients, the ethics of my profession are the only ones that matter because they are rooted in scientific fact and are designed to emphasize the patient’s best interest.

The cultural awareness class that we are taking required us to read a book called ‘The Spirit Catches You and You Fall Down’ by Anne Fadiman. The book describes the medical treatment of a girl from Laos whose family is part of the Hmong culture, which have some beliefs that are not typical in Western culture. The girl, Lia Lee, began having life-threatening seizures at a very early age and was hospitalized many times in her childhood before eventually becoming severely brain damaged and dying. Throughout the family’s experience, they would take Lia to the hospital, try communicating with doctors, and either refuse treatment or not follow up with adequate home care due to their beliefs stemming from the Hmong culture and the language barrier that was present in the family. The Hmong are believers in medicine men and shaman. They also have beliefs about medicine that conflict with available scientific research, such as animal sacrifice and spirits that can affect our physical world.

These beliefs by Lee’s parents was the reason for many of the communication problems with her doctors, their unwillingness to cooperate with the advice of their healthcare providers, and their refusal to follow through with much of Lia’s needed homecare. The book describes the doctors being unwilling to try to adapt to the Lee’s culture and try to understand the Lee’s point of view.

What exactly is there to understand in this case? The doctors knew the illness, knew the medically reasonable treatment for her illness, and, perhaps most importantly, the Lee’s sought their help. The Lee’s were in no position to try and prescribe treatment for a sick child. They had no prior medical training and their culture was at best quirky and at worst a system of beliefs that run directly against logic and reason. The doctors were in an American hospital regulated by laws of the profession. They had no reason to adapt. They were on their home turf and the Lee’s were coming to them.

It is fine if the Lees or any other people who wish to participate in a culture do so in their own personal lives, but when they come to medical professionals, it is not their place to endanger other people’s lives by interjecting their own unsubstantiated cultural remedies in place of scientifically proven treatments. Additionally, cultures exist everyone and for every individual. It is absolutely ridiculous to think that everyone should be accommodating and adaptive to every single person. It is impractical. Respect cultures according to the situation.

I was recently looking at Facebook and on my wall, I ran across two posts that made my blood boil. One was an anti-vaccine supporter and the other was a person complaining about the mercury in amalgam cavity fillings. The anti-vaccine supporter was angry that their child was required to get a mumps shot for school and were convinced that the doctors were going to give her baby autism. The complainer about mercury in amalgam was ranting about her teeth and the dentist that was going to remove all the ‘harmful’ fillings she had received over the years. These are the sorts of culture that I refuse to respect in any way, shape, or form. They are blatantly wrong. Amalgam has been used in fillings for decades and numerous studies have confirmed its safety. Vaccine use is mandated because it not only immunizes people against horrible diseases, but it also provides herd immunity to those with weakened immune systems. It has been repeatedly shown that vaccines and the instances of autism have no correlation. The doctor responsible for the study claiming that they were is an absolute fraud and has been stripped of his medical license.

Today’s culture has become obsessed with political correctness and acceptance of all people and beliefs. You are entitled to your beliefs, but I am also entitled to mine. I will not respect you if you are contradicting known medical facts with the garbage you learned on Dr. Oz or the neighbor selling essential oils. I will tell you that you are wrong and that it is my duty to tell you so. You will receive high-quality, evidence based care from me regardless of your culture. I will be as polite and accommodating as I can practically be, but you are in my office. Your beliefs do not supersede mine. At most they are equal. I will not trample your beliefs unless they are stupid. I define stupid as ideas that are not supported by evidence done in a medical trial.

Your culture does not matter when healthcare professionals are treating you. Your health matters. Your livelihood matters. Everything else is secondary. I am not advocating for a total ignorance of cultural differences. They belong where manners and etiquette are involved. Life and death situations or those involving the health of individuals does not have any room for cultural beliefs that are contrary to the practitioner’s method of care. You are entitled to your opinion even if you are wrong, but I will not accommodate you, respect your judgment, or treat you in a manner that is not consistent with the best treatment available.

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13 replies »

  1. This is what male pattern physician burnout looks like when the little voice in someone’s head is allowed to post anonymously. I pray this person is not in a faculty position in a residency or medical school.

    Man oh man … don’t we all wish the world were this black and white — that I am right and you are wrong and I can get away with refusing to acknowledge the possibility of a valid alternate opinion. Trying to bludgeon the world into this level of certainty is a real source of stress to most. Just reading this article wears me out.

    There is so much grey area here we could potentially discuss … but I would be talking to myself since the author has ruled him/herself out as being even microscopically open to any opinion that strays off their path of the righteously indignant.

    I would not trust this person – assuming they are a physician – with anything other than pathology, radiology or laboratory science. They should not be seeing living human beings. This is venting, pure and simple from a person with no compassion whatsoever … who feels that stance is justified at this point. This is a screed that screams burnout. I hope the author can look in the mirror and see they don’t have to keep going down this path. It does not have to be this way and things can get better. Take yourself out of the game to get some help before you have a stroke or something.

    I make these comments just to make this point. This is not “healthy venting”. It has consequences to the quality of care this physician provides. This level of cultural hostility is not justified based on any example that can be quoted.

    My two cents,

    In full disclosure
    Dike Drummond MD

  2. A rule for “Cultural Awareness” from Jesus Christ who spent time with Jewish High Priests, fishermen, tax collectors, Romans, Syrians, prostitutes and beggars:
    “do unto others as you would have them do unto you”.

  3. “the ethics of my profession are the only ones that matter because they are rooted in scientific fact”

    Well, the student could have left it at that. But, putting aside potential issues of reductive Western scientism, given that this post would never have made it onto ScienceBasedMedicine.org (my own first daily stop), well…

  4. “I am a student in a health care profession.”
    “As a professional healthcare worker…”

    So, which are you?

  5. I’m afraid you have missed the point of cultural awareness. You are not being taught to disregard medical science in deference to your patients’ beliefs (if you are, you might have mistakenly enrolled in a school of homeopathy). Simply, you are being encouraged to attempt to understand your patients’ beliefs and where they are coming from. Health and livelihood are not the only things that matter to people.

    I have not read The Spirit Catches You and You Fall Down for many years, but my take away from the book was that the medical professionals in Lia Lee’s case failed her by not finding a way to communicate with her family that would have allowed her to get the medical treatment she needed. You are certainly free to dismiss anyone who does not take your advice blindly, but do not fool yourself into thinking that you bear no ethical responsibility in the outcomes that follow.

    Perhaps consider a career in pathology.

  6. “Today’s culture has become obsessed with political correctness”
    “I would never be intentionally rude to them or purposefully disrespect their culture without reason to do so.”


  7. Professors have no protection either. This is auto-censorship – i.e. we’re behaving as if big brother is watching but big brother doesn’t give a flying rat’s tail