Significance for Physicians

• Primary care physicians take pride in individualizing health care and in incorporating family and community perspectives into that care.

  As an individual’s culture determines much of how they perceive and manage health issues, physicians need to be alert for cultural factors that could be used constructively to promote health – and aware of those that have the potential to sabotage plans for disease management or health promotion.

• Every individual assesses the significance/meaning of a health problem and the best way to deal with it based on personal experiences influenced by the culture of origin and factors in the current environment.

  For elderly patients, the culture of origin and experience of the ethnic group in the US can be powerful influences but the elderly may also be significantly influenced by family members, friends and community leaders (see decision-making) and by external influences such as TV, newspapers, radio, movies and “pop culture”.

• Factors from the culture of origin and group experience can be surprisingly strong despite substantial acculturation and are found in white as well as other groups.

  (See cases) Within groups, there are multiple variations so an individual patient may not be aware of or espouse the health beliefs commonly attributed to their cultural group. Physicians should always ASK the patient or family members what they believe is causing the condition and solicit their input in management (see the ETHNICS framework for interviewing in Communication section). Cultural beliefs can frequently be effectively utilized in the medical plan but if ignored or ridiculed, they can certainly sabotage treatment.

• Cultural issues are particularly important in elderly patients as they have accumulated a lifetime of beliefs, expectations, attitudes, and behaviors that are crucial in how the perceive and deal with their health issues – and with physicians.

• Working with patients, culturally determined important differences are most apparent in:

  • risk for certain health problems
  • perceptions of the significance of certain symptoms or conditions
  • decision-making about how to handle health problems
  • expected role and behavior of physician
  • appropriate treatment (including complementary and alternative practices)
  • anticipated outcomes

NEXT: Clinical Communication With Minority Elders