Healthcare’s assault on American independence

Posted on March 22, 2010. Filed under: American culture, healthcare | Tags: , , , , , , |

Many Americans argue that healthcare reform goes against our country’s founding principles and will destroy American freedom. How will it do that? By forcing us, against our will, to take care of our fellow citizens. Americans take their independence very seriously.

According to Geert Hofsted, (whose 5 dimensions of culture are foundational to intercultural theory) America scores the highest of all countries in the dimension of Individuality.  We value the self first,  the concept of the individual second, and believe in personal independence and personal responsibility. If Americans have the highest score of all nations in the dimension of individuality, that means we are extremists in this area. And extremism, unless we’re talking shoes or chocolate, rarely leads to much good.

For most Americans, having a communal or group focus is antithetical to their cultural beliefs. Why should I put the benefit of the group above the benefit of the individual??? I’m not responsible for you. Take care of yourself.

Most industrialized  countries already have a national commitment to the health of their citizens.  I’m glad we’re heading in that direction.

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American medicine and accupuncture

Posted on April 8, 2009. Filed under: American culture, Asian culture, cross cultural, healthcare | Tags: , , , , , , , |

My elbow is killing me. It hurts to drive, write, and basically do anything. Next week, I am having surgery to correct the problem. I originally wanted to try acupuncture, but it was not covered by health insurance. I have had great success with acupuncture for other things.  

The insurance company wouldn’t cover accupuncture, but it would cover surgery. Comparing the two, acupuncture is cheaper, less invasive, has no side effects or recovery time, and best of all, is less painful. So why isn’t it covered by insurance?

When I was diagnosed with a torn tendon, I asked the doctor if acupuncture could help repair it. He said without a pause, “Voodoo. That’s all acupuncture is. Voodoo. There is no written literature anywhere on its effectiveness.” (He is no longer my doctor.) The second doctor said he didn’t know much about acupuncture, but “whatever works for you is OK.”

American doctors know little about Eastern medical treatments that have been used by billions of people for thousands of years.  If they bothered to learn about them, they would have a greater understanding of possibilities and options, as well as insights into their Asian patients. 

The insurance company may see covering such unproven and voodoo medical practices as a slippery slope. If they agree to cover the cost of accupuncture as well as surgery, what’s next? Covering dried tiger penis powder as well as Viagra?

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The culturally competent healthcare provider

Posted on March 17, 2009. Filed under: American culture, arab culture, Asian culture, cross cultural communication, diversity, Hatian culture, healthcare, hispanic culture | Tags: , , , , , , , , , , , , , |

Healthcare providers face multiple challenges when working with patients from different cultures. Unlike managers and employees who work with diverse coworkers and customers, healthcare providers interpretations and decisions impact the patient’s life and future.

I enjoy delivering culture training to healthcare workers. They usually “get it” and understand the importance the role culture plays in their interactions, as well as the idea that culture is more than  just ethnicity.

Still, I often hear the frustration healthcare workers encounter when providing services to members of other cultures. Even though they have the best intentions, they often don’t know how to address these differences.

Examples include:

1. Only immediate family were allowed to visit a patient in the hospital. About 12 members of an extended Hispanic family showed up, wanting to see the patient. When the provider said, “only immediate family” the response was, “We are immediate family!”  To them, the idea that a cousin or aunt is any less immediate was ridiculous.

2. A woman from Jordan was in consultation with a physician, her elder brother by her side. Before she would make any decisions or offer any responses, she would look at her brother, have a quick conversation in Arabic, and then the brother would provide the answer. The physician thought she could build a better relationship with the patient without the brother in the room. When she asked him to leave, the patient panicked and started to cry.

3.  An Hispanic patient brought her 3 children with her for her MRI, even though the healthcare provider explained that the testing would take about 1 hour, and the children could not be left unattended in the waiting room.

4. During intake at a psychiatric hospital, an Asian woman refuses to make eye contact with the healthcare provider. The provider isn’t sure if it’s cultural or related to a mental illness.

One workshop participant told a story that showed the importance of active listening, clarifying, summarizing and probing for more information. She said she was offering bereavement counseling for a Haitian woman who had just lost her 3-year-old daughter. In discussion, it came up that the woman did not attend her child’s funeral with the rest of the family. At first, the counselor was shocked at what she initially saw as a horrible thing for a parent to do. Without judging the Haitian woman, she engaged her in further discussion, only to learn that she was pregnant, and didn’t want to risk the life of her new baby by going into a cemetery. She was, by her cultural standard, being a caring and protective mother. A fact that only came out because the provider took the time to learn more.

 What cross cultural issues have you encountered in the healthcare system?

 

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