THE PATIENT-DOCTOR DICHOTOMY

“Self-care management is essential for effective chronic disease management. Yet prevailing approaches of healthcare practitioners often undermine the efforts of those who require on-going medical attention for chronic conditions,

emphasizing their status as patients, failing to consider their larger life
experience as people, and most importantly, failing to consider them as people with the potential to be partners in their care.” (McWilliam, 2009)

McWilliam goes on to explain the importance of understanding the patient as a whole and that there should be a balance in power between the patient and the health care provider. The patient centered model of care is the new school of thought, yet it seems there are some health care professionals who are having a difficult time adopting. Recent class discussion suggests that for some future health care providers this trend is continuing.

In having an expert role, it is important for the health care professional to take into consideration the opinions of their patients both because it is morally right to treat patients as equal individuals in care and because it improves overall adherence to health care advice. Patients seek medical attention because they feel that there is something that is not quite right. There are at times individuals who, after an internet search of WebMD have convinced themselves that they are more ill than they may be, but that does not excuse health care professionals from dismissing patients concerns. Patients should have their concerns heard.

It is of equal importance to ensure that health care services are culturally sensitive. Similar to the above argument, the outcomes of care in the form of clinical, cost, and client satisfaction improve when the care is culturally congruent. (Narayan,2001).

Narayan lists caring, empathy, openness, and flexibility as the four core attitudes of clinicians who provide effective cross-cultural health care. As with any individual, patients of differing cultural beliefs, values, and practices tend to adhere better to the plan of care and tend to improve faster, and feel more comfortable and satisfied as a result when that care is adapted to their beliefs. (Narayan, 2001) It is important as HCP’s to be aware of differing cultural norms, to recognize the values and situations considered taboo and to be cognizant of when they have offended a patient. There are vastly differing views of what is culturally appropriate for the amount of eye contact considered appropriate, the content of medical advice that should be shared with the individual and the amount of biomedical practices that are deemed necessary. While it is impossible to be aware of all cultural norms, HCPs should be sensitive to differing cultures and not force their own personal views on their patients.

As any individual interacting in a new situation, it is important both be open to learning some of the cultural norms and mannerisms and to not employ stereotypes. Individuals of the same ethnicity or religious belief will differ. Stereotyping is the belief that all individuals from a particular culture share the same beliefs, values, and practices. To avoid this, the LEARN model was developed by Berlin & Fowkes in 1983. This framework provides guidelines for physicians to enhance effective listening, education, and negotiation. The physician must first understand the patient, they must convey their opinions in a way that can be understood, and together they need to develop a solution that benefits both parties (Covey, 1989).

Campinha-Bacote & Narayan in a paper written in 2000 suggest that clinicians need to approach cross-cultural patient encounters with humility. By acknowledging that the patients and their families are the experts about their cultural norms and that they, themselves as always striving to become more culturally competent, will achieve the most effective outcomes with their patients of diverse cultures.