Cultural Clashes in Medicine (Book Review)

Although most of my day is spent studying for my pre-clinical science classes, I am also taking several courses that teach me the doctoring skills I will need as a physician. One of these classes, "Clinical Skills" is a course that spans over my first two years that  specificaly explores the social/psychological/cultural aspect of medicine. This semester, it has been split into two parts. The first was centered around how to conduct a patient interview. This class was structured with a few lectures, 4 mock-patient interviews, and weekly small groups to review the recorded videos of these interviews. The first interview I completed was INCREDIBLY nerve racking...but after that, they became much easier and much more natural. I am so glad that we had these mock interviews, because I feel I am now much more prepared to talk to patients when I am conducting physical exams, participating in shadowing experiences, and during my clinicals starting in my third year!

The second part of the semester in Clinical skills is called the "IPPR: Introduction to the Patient-Physician Relationship." Last week's lecture and small group focused on how cultural diversity affects how a doctor and patient interact. We had a lecture from a faculty member who is originally from Oregon, but spent several years practicing in Greece. She described some of the differences she faced while working as a physician in another country and about how shattering some of the realizations she had were. For example, the American health care system is largely centered around a collaborative patient-physian relationship that encourages communication and combined decision making. In Greece, however, our lecturer was looked down upon and somewhat discredited when she tried this method. This just demonstrated one of the many different paradigms of medicine in this different society.

In small group, we discussed a novel that we were required to read called "The Spirit Catches You and You Fall Down." When I saw this on my reading list for the semester, I was not excited to read it initially. I knew that my semester would become hectic and reading a novel was not in the picture. However, on my road trip over to Michigan (which seems like a lifetime ago), I started reading it and actually really enjoyed it!

The book centers on a Hmong family who brings their daughter, Lia, in to the Emergency Room in a hospital in Merced, CA because she was having a seizure. It turns out that Lia had a severe and life-threatening epileptic condition that often ended with Status Epilepticus (which basically means a seizure that doesn't stop or a series of seizures that occur one right after the other). Although the doctors recognized this, were able to diagnose it, and came up with a treatment plan, the communication and cultural boundaries between the medical team and the family were too large to get over. The Hmong believe that everything happens because of one's soul. They interpreted her seizures as a Spirit entering Lia's body and knocking her down (hence the title of the book). So, as much as the doctors tried to explain that this was a true medical condition that needed to be treated, the parents didn't give Lia her correct medicine and did not follow her treatment plan because they simply could not understand what the doctors were trying to convey. The story takes a lot of tragic turns, including CPS being brought in because Lia's parents (somewhat) unknowingly not giving her medications and Lia having "the big one" that ended up leaving her in a vegetative state. That author questions whether or not Lia's state at the end of the book could have been avoided if the physicians would have attempted to understand the cultural differences more or if the parents would have followed the physician's orders. Like I said, I really didn't think I would enjoy this book coming in, but it really has changed the way that I will look at my career. For my med school blog readers, I really recommend this book if you have not yet read it!