“There is an improved therapeutic relationship when doctors and patients share a language, culture, or belief,” Dr. Li says. “There’s a level of comfort that you are going to be understood and nothing will be lost in translation.”
A patient’s culture may drive decisions contradictory to traditional Western medicine, and hospitalists need to make the time to listen and respond. Recently, Dr. Grewal treated a dying, elderly Asian patient whose family insisted on administering an unknown, water-like fluid to cure the loved one. First, the family requested giving the fluid to the patient by mouth. Dr. Grewal denied the request, and told them the water would end up in the patient’s lungs because he was comatose and could not swallow. Then, the family asked if they could add it to the intravenous line. Again, Dr. Grewal denied the request, and told them water in an un-buffered solution could be harmful to red blood cells.
“It was frustrating for them,” Dr. Grewal says. “I told them, ‘It’s not that I don’t believe the water will cure him. Maybe it will or maybe it won’t. But from a medical standpoint, I know there will be complications and I just cannot do this.’ ”
Eventually, the family asked if a tube could be inserted into the patient’s stomach. When the request was denied, the family decided on comfort care for their loved one. Eventually, he passed away. The family, Dr. Grewal says, was grateful for the hospital staff’s care and effort, even though their requests to administer the fluid were denied.
Firm cultural beliefs may lead patients to resist treatment. Manish Patel, MD, a hospitalist and assistant professor with the division of General Internal Medicine at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick, N.J., recalls working with an elderly member of the Indian community who refused to be transferred to a rehabilitation facility. Dr. Patel took time to speak to the patient and learned she came from a tradition that encouraged younger generations to care for the elderly. The patient interpreted her transfer to a rehabilitation facility as a sign her family was abandoning her, Dr. Patel says.
“Sometimes you have to probe to learn more,” Dr. Patel says. “Once we understood her fears, we were able to convey to her that this was a temporary situation and that her family could not provide her with the services that she needed at that point in time.”
Dr. Patel also interacts with Hispanic and Indian patients—many of whom revere doctors and defer to them for treatment decisions. In these situations, he uses the same approach as he does with patients who question his treatment recommendations.
“The patient may defer to you, but it’s important to empower the patient and give them all the information they need to make major choices in their healthcare.”
Hospitalists may prefer to be upfront about a patient’s condition and treatment, however, cultural norms sometimes dictate who receives information—and how much. For example, Scott Enderby, DO, a hospitalist at Alta Bates Summit Medical Center in Berkeley, Calif., says some Asian families prefer medical staff deliver bad news about the patient to them first. The family then decides what they will tell the patient, he says.
These situations create challenges and opportunities, Enderby says. Medical staff tries to establish a patient-centric care system, so it is important to continue appropriate communication with the patient. It also is important for healthcare providers to avoid putting the family in the middle and marginalizing the patient, he says. Healthcare teams can become frustrated when family members are at odds about decisions and options, and the patient is not involved at the family’s request, he says. In these cases, Dr. Enderby sees an opportunity to further engage the family, and, therefore, the patient.