Culturally diverse Medicine at Home and Abroad 2007

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Diverse Medicine at Home and Abroad 2007 Gregory Juckett, MD, MPH Associate Professor of Family Medicine West Virginia University gjuckett@hsc.wvu.edu

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America is Changing "Worldwide Village": We now live in multi-social, multi-ethnic social orders both at home and abroad By 2050, half of U.S. populace will be included minorities Today's "Plate of mixed greens" versus Yesterday's Melting Pot U.S. minority populaces are entirely different and not restricted to urban ranges

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What is Culture? Convictions and practices that are found out and shared by individuals from a gathering World perspective of a culture may profoundly affect medicinal services e.g. capitulation to the inevitable Cultural Competence (information, mindfulness, regard for different societies) is currently an essential clinical objective for which we ought to endeavor Cultural Sensitivity/Humility : minding mindfulness which tries to abstain from offering offense to those of another culture (achievable) Importance of R-E-S-P-E-C-T

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Cross Cultural Terms Stereotyping (terrible) : the mixed up presumption that everybody in a given culture is indistinguishable—shut to special cases (finishing point) Generalizing (alright): familiarity with social standards—open to instructive, generational contrasts (beginning stage) Ethnocentrism : the normally oblivious conviction that ones claim culture ought to be the standard—this is just about an all inclusive human characteristic Racism : the misinformed conviction that ones possess race/ethnicity is better than that of others Discrimination: treating individuals distinctively because of partiality might be oblivious: "you individuals"

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Remember that each individual is one of a kind

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Scott Cottrell Cultural Dynamics Influencing the Clinical Encounter

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Cultural Dynamics Influencing the Clinical Encounter Scott Cottrell

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Cultural Dynamics Influencing the Clinical Encounter Scott Cottrell

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Cultural Dynamics Influencing the Clinical Encounter Scott Cottrell

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The Cross Cultural Interview & Exam Developing Trust (see this as a venture of time that pays you back later) and listening to quiet Eliciting germane history — dependably ask (non-judgmentally) what elective treatments your patient is utilizing and what suppliers have they as of now observed ("chain of importance of care") Understanding how the ailment is seen ( its "significance") and recognizing contrasts in perspective Culturally Sensitive Physical Examination Explaining conclusion to patient and family in reasonable terms Negotiating treatment arrange and follow-up — have persistent rehash your guidelines and have them recorded (if patient or relative is proficient) Teach-Back Knowledge of dialect and culture = Effectiveness

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LEARN Model for Cross Cultural Interview Listen to the patient and the family's ideas of the ailment. Clarify your restorative analysis in justifiable terms. Recognize contrasts (and similitudes) in social points of view. Prescribe your indicative and remedial methodologies. Arrange all territories of care. Reference: A showing system for culturally diverse medicinal services. Application in family rehearse. West J Med. 1983 Dec;139(6):934-8.

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ETHNICS Mnemonic: a system for socially proper care Explanation : why do you have this issue? Treatment : what have you striven for it? Healers : who else have you looked for assistance from? Transaction : how best do you think I can help you? Mediation : this is the thing that I think should be finished. Joint effort : by what method would we be able to cooperate on this? Most profound sense of being : what part does otherworldly existence play in this? Kobylarz, Heath, Like. The Etnics Mnemonic: A Clinical Tool for Ethnogeriatric Education. J Am Geriatr Soc 2002; 50: 1582-89

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The Spirit Catches You and You Fall Down by Anne Fadiman Poignant tale about a Hmong displaced person tyke from Laos with immovable epilepsy Clash of Hmong-U.S. social insurance societies with troublesome results for all included Asks what inquiries could have prompted to better multifaceted comprehension? Ought to be required perusing in restorative schools

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Kleinman Cross Cultural Interview What do you call the issue? What do you think has created the issue? Why do you think it began when it did? What do you think the disease does? How can it function? How serious is the affliction? Will it have a long or short course? What sort of treatment do you believe is fundamental? What are the most essential results you plan to get from this treatment? What are the main issues the disorder has created? What do you fear most about the affliction? Adjusted from Kleinman An, Eisenberg L., Good B. Culture, Illness and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research Annals of Internal Medicine 1978; 88: 251-258. Continuously get some information about option treatments, herbs and supplements the patient might utilize—in the event that you don't ask, the patient is probably not going to volunteer this data.

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Center for the Health Professions Applying Kleinman Questions and LEARN Information Example

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Applying Kleinman Questions and LEARN Example Information Center for the Health Professions

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Applying Kleinman Questions and LEARN Information Example Center for the Health Professions

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Cross Cultural Interview Establishing trust (and seeing each other) may take significantly more time—regularly doubt is innate Eye contact issues : might be maintained a strategic distance from among less Westernized Asians (unless of equivalent status/sexual orientation) Personal space/Touch issues (low touch) Gender issues and easygoing touch Facial expressions/Body Language e.g. grinning as humiliation rather than bliss Time and Punctuality : Agrarian "elastic time" versus Mechanical time

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Interpreter Pitfalls : Family or Friends Limits extent of request : far-fetched to share private or humiliating points of interest (family brutality, sex, emotional sickness) Lack of preparing : therapeutic phrasing might be either misjudged or mistranslated out of shame No secrecy ensure Sometimes relative has an individual motivation Better to utilize prepared medicinal mediators if accessible; however in the event that inaccessible must perceive the restrictions Try to talk specifically to the patient , not to the translator

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Name Conventions Best to utilize formal title (particularly with more established patients) until offered consent to be casual—never accept it's alright Chinese and SE Asian names are normally composed and purported "in reverse": Surname goes before given name if not as of now U.S. acculturated: e.g. Xumiao is Dr. Xu. Hitched ladies for the most part don't take their significant other's name. Latino names : complex surnames regular ( father's name goes before mother's ) e.g. Senorita Maria Sanchez Rodriguez gets to be Senora Maria Sanchez de Gutierrez (for the most part Senora Gutierrez) after she weds Senor Gutierrez—mother's name is typically dropped; some Latinas simply hold their family name be that as it may or receive U.S. traditions Maria's kids will pass by Gutierrez-Sanchez Don and Dona show regard for more established Hispanic patients If in uncertainty, simply ask "How would you wish to be tended to"?

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Language and Body Language Signals Embarrassment or regard keeps the asking of numerous important inquiries Patients will say they comprehend when they truly have no idea… rather have them rehash what you need them to do Nodding energetically may demonstrate deferential consideration yet not assention or comprehension!!! Try not to confound Indian head swaying with difference! It implies I hear what you're stating. Talk gradually and basically however not boisterously (unless your patient truly is hard of hearing!) Short sentences! Eye Contact in non-western societies may demonstrate lack of respect of power or potentially sexual intrigue Avoid sayings and don't utilize negative inquiries "You don't… " or "you wouldn't see any problems if… )

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Culturally Appropriate Gestures Beckoning ought not be with pointer (S. America, Asia) since this is either held for mutts or considered extremely discourteous. Rather the palm of the hand ought to be held down and all fingers utilized Displaying your feet is offending in Asia—never touch anybody with your feet Patting a tyke on the head is an affront in SE Asia since the head, as the seat of the spirit, is holy "Thumbs up" sign is the same as the U.S. center finger in Iran

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Reciprocity and Gifts In numerous societies, it is required to exhibit one's appreciation with a blessing and its refusal may well purpose offense However, endowments are frequently offered to guarantee most ideal tend to the patient (a "delicate" fix for the parental figure!) If blessing is improper (e.g. cash), recommend an option, (for example, sustenance) that could be imparted to staff

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Giving Bad News In numerous different societies, it is standard to first advise the family and let them choose if and when the patient ought to be educated—abuses U.S. HIPAA directions Anger against the supplier is frequently communicated if this custom isn't took after as it is felt that giving somebody a terrible forecast takes away any trust as well as turns into a self-satisfying prescience. At any rate in the U.S., ask the patient how they might want their family included . Disclose to the family that advising the patient first is the standard U.S. hone

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African-American and African Immigrant Culture Historically the biggest U.S. minority however as of late supplanted by Hispanics (some African-Americans are additionally Hispanic) 12.3% U.S. populace—22% live in destitution and future 5.9 y less (2x stroke passing, 36% B w/HTN versus <25% W, manslaughter #1 reason for death in youthful dark men 15-34) Health Care Inequity and Race Most are long haul U.S. occupants however movement from Caribbean and African nations is expanding (migrants have preferable futures over local blacks!) Mistrust of white organizations basic place (and infrequently verifiably advocated e.g

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