Last week’s Doc2Doc post focussed on recognising racial differences in medicine.
Go take a peek.
Several years ago I broke my leg whilst skiing and had it put right in the local hospital – obvious thing to do as it has one of the best units for that in the Alps (get plenty of practice, skiers in the winter, bikers in the summer). Post-op I was told to ask for pain relief if I needed it. I was refused by the charge nurse until the consultant asked me if I had any pain and why I hadn’t asked for analgesia. I explained what had happened and he gave the charge nurse what-for. I got my analgesia.
The hospital is in the north of Italy, the populace is a mixture of German-origin locals and Italian-origin “incomers” who have migrated here over the last 80 or so years since this area changed from being Austro-Hungarian to being Italian at the end of the first World War. Italians have hysterics at the slightest niggle – and I, as a foreigner, had been classified by the Germanic charge nurse as Italian. I soon disillusioned him of that and we got on fine after that. Beforehand he’d been most offhand and unhelpful. Race has a massive effect on how people behave in response to similar situations in the healthcare environment – it’s greatly under-rated, but it works both ways.
Interesting – but careful you don’t conflate race and cultural background. True, people raised in different cultures will behave in different ways, but how many generations does that influence last? How long before some of that calvinistic stiff-upper-lip infects the most flamboyant of cultures – or even, before the influx of people from less buttoned-up cultures begins to loosen up the good folk of Edinburgh a little?
And besides, if you were confused, ill, or hypo in Tallin or Prague, would you want their ambulance crews treating you as just another drunken Brit?
That was a bit of fantatic writing. Even by your norminally high standards.
This however, reminds me of the Avernue Q song. So sing along with me…
“Everyone’s a little bit racist
Doesn’t mean we go
Around committing hate crimes….”
It strikes me that that by present day OTT race relations standards sickle cell anaemia perpetrates a hate crime.
Great stuff! Finally someone says this out loud. When I had my leg stitched in the Alps, there was me, a Scot and an American there. There was very little complaining done. Then they brought someone else in. I couldn’t see them and didn’t speak the language, but it wasn’t one I knew. And the noise level rose considerably.
At last year’s AGS (American Geriatrics Society) conference, I got a little deck of laminated cards entitled “Doorway Thoughts: Cross-cultural health care for Older Adults.” In it are a selection of cards with titles like “Older African-Americans,” “Older Chinese Americans,” etc… with bullet pointed information on “culture-specific thoughts,” “preferred cultural terms,” “respectful nonverbal communication,” “tradition and health beliefs,” and so on. I believe it’s a useful thing, though I haven’t used it yet (not being in the most diverse part of the U.S.). Isn’t it interesting that if you couch it in the language of “respecting diversity,” you can acknowledge that culture makes a difference…..
Andt hen there’s the additional confusion about who in the family is responsible for even talking to the medic. In many Asian cultures, that’ll be the man – for himself, for all the children, and all the women as well, which makes ped, DV, or gynae emergencies even more complicated to address.
Of course cultural differences are a factor you have to take into account to treat patients appropriately, in the same way that women with cardiac symptoms often present differently than the ‘classic’ signs. To admit that these cultural differences exist is not a form of bias, people are different. You might cannulate a person with high skin melanin concentration (ie. black) differently than someone who doesn’t because there is a difference in skin resistance. You are looking after your patients better if you acknowledge peoples ethnicity and cultural background than try to pretend it doesn’t exist.
Lets not pretend that the fight against racism in the delivery of healthcare has been won and we are all now post-race. I have catergorically seen people treated badly because of their background. This wasn’t a one off either. The strange thing is that depending on which area I was working in depended on which ethnic group apparently caused all the problems of the ambulance service I was working for. This ranged from Turkish people, Orthodox Jews, Bangladeshis, Pakistanis, Indians, Irish, Russians, Kosovans and even poor whites and so on. I quickly realised that the patients background wasn’t the problem, the bigotry of some older ambulance staff was. Race does not exist, it is a social construct which has no scientific basis what so ever. Racism however certainly does exist and it certainly is present within the healthcare system.
For me the key is to accept the cultural, ethnic and class background of each patient and treat that patient appropriately. Working for the ambulance service gives you the priveledge of being invited into peoples homes and quite often being allowed to ask just about anything you want. How many healtworkers are in that position. If you let it, you can learn so much from the different people you come across. To try and pretend cultural differences do not exist, does a disservice to your patients and to yourself.
My dad was a bit of a hypochondriac. A white upper-middle hypochondriac. He had a way of saying something like “this could be tricky” that signalled he was dying but being terribly brave about it. Bet he’d have fooled you! And you couldn’t say he was exaggerating. In his late 80s his health did fail and then he just seemed sort of lost.
I’ve been reading your blog for a while now but the doc 2 doc post inspires me to comment… Not a medic but I work in disability benefits and what you write is absolutely true, some cultures and some sexes within said cultures lay it on a bit thick. I think to some extent being dragged to a foreign country, not allowed to learn the language and left in the kitchen once the kids have grown up pre-disposes one to assumed ill health.
I saw a report from an Examining Medical Practitioner doing an assessment for a DLA claim a couple of years ago; the EMP went to lengths asserting it was “cultural overlay” and to be frank he was right, although it was possibly the most controversial report I’ve read in 11 years doing what i do.
As a dyed in the wool anti racist, when this dawned on me, moving to the big city from the Lancashire heartlands, it took a lot of wringing of hands to admit it to myself.
Thank you for saying it in public. it’s not “racist” merely the objective evaluation of a given situation taking culture into account as a contributor.
Ace blog as well!
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