Other Factors

In most cultures, the physician is expected to be serious and professional, showing concern and appreciation of the patient’s fears and worries.

Your “Face”:
Particularly for elderly patients, physicians have considerable authority and are treated with great respect. This makes it difficult for patients to disagree with physicians, to admit to something of which the physician might not approve (such as not taking medications), or to disappoint or embarrass the physician (e.g. that a treatment did not have good results). Questions frequently have to be asked such that neither the patient nor physician loses face by the answer.
e.g. “One of my other patients told me these pills worked well for her heart but sometimes made her feel nauseated: have they worked that way for you?”

 

Health problems are regarded as highly personal and confidential by most western societies but this is not the case in many cultures.

“The Family”:
For many groups, the health problems of an elderly patient are of significant concern to a large extended family and others. In some societies, “family” includes relatives by biology or marriage plus “fictive kin” i.e. individuals who are treated as family members and take responsibilities similar to full family members but have no legal or biological connection with the patient. This is most frequently encountered in care of children but can be important in the care of the elderly. You may find yourself called upon to conduct an interview with several family members in the room, to provide information to multiple family members, and can be certain that everything you said or implied during the interview will be thoroughly discussed with many individuals. Elderly patients may not want to commit to a treatment strategy until they have fully discussed it with family and others (see ETHNICS mnemonic). Allow time for this to occur and pay special attention to follow-up.

 

Finally, patients and families may believe that many factors influence prognosis in addition to medical care.

“The Future”:
This can range from simple superstitions to deeply ingrained cultural practices. In several cultures being very positive and optimistic without acknowledging the power of divine intervention is equivalent to inviting a bad outcome. This is deeply ingrained in Moslem cultures but can also be seen in phrases equivalent to “God willing” used to qualify hopes for recovery in many Catholic cultures. A similar concern is that excessive praise, especially of a child, can incite jealousy in evil spirits who will harm the one who is praised.