Culture and Medicine

Along the same vein as the last post, culture has strange influences and tendrils in medicine. We learn in medical school to respect different cultures, to understand why some may be reluctant to trust physicians while others want paternalistic physician-driven decision making. We try to be culturally sensitive, adjusting our approach to patients in a way that honors their perspective and values. These politically-correct statements sound obvious and easy but the practice is not so straightforward.

My last call night on labor and delivery, I met several patients of a particular ethnic background. In each case, when the nurse called me to discuss an epidural, I met a husband that completely dominated the conversation. When I asked the laboring patient something, the husband would interject with the answer. When I tried to obtain consent for the procedure, the husband would want to give it. As I explained what she might feel with the epidural placement, he reinterpreted my words and fed it back to her. It was as if she didn't speak English - but she did. He acted as an interpreter even though there was no language barrier.

It was a bizarre and jarring experience. Coming from a Western culture that tries to empower women, I was taken aback. How could it be that these women had no voice? I tried to engage them directly, but they shied away. They wanted their husbands to broker the interaction with the physician. I was torn. To try to foist everything on the woman seems to be forcing my point of view on her. But to allow the husband to be the sole spokesperson seems to perpetuate this feeling of discounting the patient. I was surprised how much I struggled with this one. In the end, I wanted to give each patient at least several opportunities to speak up and express her wishes and desires. If it was clear they wanted their husbands to speak for them, then I felt more comfortable with this strange patient-doctor relationship.