“One of the biggest misperceptions about culture is that it’s something that other people have. When we talk about ethnic food, we never think about hamburgers and hot dogs. The truth is that everybody has a culture and everybody has an ethnic group. We see the world through the lens of whatever culture we are from and that is how we make decisions. Knowing why a patient believes that he or she is ill will help us to understand the whole context in which a patient is operating.”
“I’m very adamant that one must never put one’s own belief system onto someone else. If somebody believes in Allah, don’t bring Jesus into the encounter. For so many people, faith and prayer are their sources of strength. If a patient tells you that prayer is important to them, then, I believe as a physician, you may bring this into the encounter, as long as it is the patient’s method of prayer, not the doctor’s.”
The Power of Beliefs and Importance of Culture
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Michael J. Balick, PhD, Director of the Institute of Economic Botany at The New York Botanical Garden, tells a story about traveling on a bus in the backwoods of Brazil with a group of tourists. When they came upon a woman cracking open the nuts of a palm tree and extracting the fruits, everyone jumped out of the bus, circled around her, and started taking pictures. The woman immediately became hysterical, had difficulty breathing, and went into a state of shock, for which she had to be hospitalized.
“She was convinced that the people had stolen her spirit,” Dr. Balick explains. “And it was the belief, not the clicking cameras, that caused the physical reaction.”
Cultural beliefs influence health-related behavior all the time. Consider the Jehovah’s Witness spiritual concern that translates into refusal of blood transfusions. In the same vein, a heart patient with no understanding of nutrition and its role in health may not “believe” that a change in diet would be helpful, and thus he or she would not try this intervention. “The question can’t be: Are there associations between health and belief?” says David Hufford, PhD, from Pennsylvania State Medical School. “The question is: What are they?”
Understanding how social, structural, psychological, and cultural factors affect physical health and being sensitive to these factors can make an important difference in health outcomes. Beliefs affect how and from whom a person will seek care, how self-care is managed, how health choices are made, and often, how a patient responds to a specific therapy.
In “Cross Cultural Medicine,” an article published in the American Family Physician in December 2005, the authors state that cultural competency is an essential skill for family physicians and that the initial interview should elicit the patient’s perception of the illness and any potential cultural conflicts between the physician and patient including differing attitudes towards time and what is important in life. “Efforts directed toward instituting more culturally relevant health care enrich the physician-patient relationship and improve patient rapport, adherence, and outcomes,” the authors state.
Cultural beliefs are also reflected in a society’s health care system. It is not surprising, for example, that a dominant theme in Western medicine has been to fight or vanquish disease, while in the traditional medical systems of the East, the prevailing image in health care is one of balance.
Integrative medicine seeks to return balance and soul to Western health care.