In my essay “Fighting to Heal,” I described my relationship with a former prizefighter who must undergo a kidney transplant.
There was some concern about his ability to trust the medical establishment but the fears were allayed by the patient’s trust in me.
My boxing background and familiarity with its culture helped in my solid doctor– patient relationship.
Once the patient was restored to health, the trust table turned. I ventured into his world to assist him with a boxing tournament. All went well.
Browsing through the archives of Intima: A Journal of Narrative Medicine, I found an essay that talks about the give and take of clinical experience between doctors and patients from different cultures: Nita Bhatia’s essay “Medicine and Cultural Competency: What Anthropology Can Teach Us” explores the ways that a busy clinician can be culturally competent and not simply aware of oversimplified do’s and don’ts often provided to doctors.
The essay warns that a few training sessions would lead to essentialist and reductionist ideas and not transform the physician into a culturally competent physician.
What to do?
In 1927, in his lecture to Harvard medical students, the terminally ill Francis Peabody, MD provided the answer: “The secret in caring for the patient is in caring for the patient.”
I would like to be more sophisticated in my caring, but I am busy taking care of patients from different races, cultures and creeds. My patients and colleagues have become quite diverse. Courses on cultural awareness would be very much appreciated and interesting but are not widely available or convenient. So until I become well acquainted with several different cultures I, out of necessity, must default to being kind and acting like a gentleman.
An example comes to mind. I was asked to consult on a Muslim youth, who was stricken with terminal cancer. I could have obtained all I needed to know from the aseptic soulless computerized medical record, but instead I took a time–consuming, tedious history through a translator on Skype. The family was present. It was very important in the establishment of trust.
They thanked me. The men shook my hand and when I extended my hand to one of the women she kept her hand at her side. I realized this to be a cultural faux pas.
It also breaches gentlemanly conduct—for Emily Post etiquette dictates that a gentleman never extends his hand to a lady unless she extends hers first.
She smiled at me. I smiled back, lesson learned, lesson remembered.
“Smile at me, I will understand because that is something everybody in the world does in the same language.” (Crosby, Stills and Nash)
Despite our differences we have a shared humanity that in the intense medical drama transcends all— and should excuse much if done from the heart.