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Treating Patients from Different Cultures

Discussing sex with patients can be awkward and uncomfortable even in the best of circumstances.  But if patients come from a culture different from your own, that can pose another challenge.  You want patients to be open with you so you can get accurate information.  However, not every culture treats sex the same way.  What can you do as a provider? 

One starting point is understanding.  Your perspectives and those of your patients aren’t always going to match.  Try to see where your patients are coming from. 

Remember that what’s “wrong” in your culture isn’t necessarily “wrong” in another.

Let’s look at female circumcision (often called female genital mutilation or FGM) as an example.  FGM is a cutting of young girls’ genitals for no medical reason.  It can have some serious health repercussions, including infections and infertility.  While the ritual is quite common in some African countries (such as Egypt, Ethiopia, Somalia, and Sudan), most western healthcare providers consider it unacceptable and a violation of human rights. 

Why are young girls cut in this way?  Many of these cultures place a high value on female virginity and believe that a woman’s libido can be controlled by FGM.  A girl who has been circumcised is often seen a more attractive marriage partner. For some girls, the ritual is a rite of passage and a time of celebration.

This does not mean that you have to accept FGM.  However, understanding its rationale can help you work with a patient who has undergone FGM or is considering it for a daughter.  You can then explain the western perspective, the serious risks and consequences, and the reasons it is not done here.

Respect modesty.  Assign same-sex providers when appropriate.

In some cultures, women must be covered at all times and cannot be seen by a male provider.  It is best to assign same-sex providers in these cases. 

Respect gender roles.

Men are the decision-makers in many societies, such as in Asia and the Middle East.  Some patients will only accept treatments or sign consent forms if a male family member gives approval.  Men may also answer questions for their wives or female family members.  Or, patients might only accept instructions from male physicians.  This situation may be contrary to what we know in the United States, but it can be respectfully handled by including men in the decision-making process.

Explain things as clearly as you can and check understanding.  Use an interpreter if necessary.

Words associated with sexual health may not translate directly from language to language.  For instance, Helen Osborne (2005) notes that there is no word for “cervix” in Vietnamese.  Be ready to explain what a body part is and how it works.  Keep in mind that in some cultures, girls get no sex education.

Watch body language.

For example, direct eye contact between males and females is considered a sexual invitation in some cultures.

Realize that not all cultures are open to discussing their problems with healthcare providers.

You might feel that sex therapy or couples counseling might benefit a patient.  But in some cultures, it’s unheard of to discuss personal issues with outsiders.  Those conversations are held only with family members or with members of a church.  You might need to find a different strategy or explain why talk therapy could help.

Any referral to counseling should be handled with care.  Some patients may see this as an suggestion of mental illness, which is highly stigmatized in some cultures.

Remember that even people who grew up in the same country can be of different cultures. 

Even if patient and therapist grew up in the same city, their experiences might be vastly different.  For example, Galanti (2008) explains that some African-American patients might not be open to therapy because many practitioners are white.  These therapists are not likely to relate to the African-American experience. 

Remember that you are still treating an individual. 

Be careful about over-generalizing.  Avoid stereotypes.  You might be treating a patient from another culture, but that does not mean that person follows every practice of that culture.  Keep an open mind.  For example, it’s inaccurate to think “All African women experience FGM” because that simply isn’t true.

Look for opportunities to learn more about cross-cultural communication and healthcare. 

See if your facility offers cross-cultural trainings.  If none are available, suggest some.  If your setting treats diverse populations, see what you can find out about the healthcare beliefs and practices of those groups.  Get to know people from these groups when you’re out and about in your community.

Treating patients from different cultures can be a challenge, especially for busy practitioners who are pressed for time.  But taking the time to understand where your patients are coming from can build trust and ease communication.  This should make the office visit go much more smoothly.