Question

Thought regarding patient in the hospital stereotype the physician who is taken care of them.

There are negative effects of stereotyping patients and that can directly impact their health outcomes. Interestingly, though, the bias is not one-way; there are many patients who refuse to be seen by 'foreign' physicians. Chen (2013) writes an interesting piece on what happens when the patient is racist and explores how care can be impacted when a patient demands an American doctor, a white doctor, a male doctor,

Answer 1

Americans can take some pride in the fact that attaining what the medical profession calls "cultural competency" is a goal of most health care institutions. However, achieving this goal in today's health care environment, filled with diverse patient and provider populations, is no easy task. In addition to the complications imposed by the proliferation of managed health care, American hospitals are increasingly being staffed by and serving diverse populations. This creates the ideal breeding ground for conflict and misunderstanding, which can result in tension among the staff and inferior patient care. Hospitals can be a source of stress and frustration for patients and their families, since they are most vulnerable when they are there and are placed at the mercy of values and beliefs not their own. It is common for people from other countries to travel here for health care since the United States offers the finest in medical technology and expertise worldwide. Since our hospitals were built by European Americans for European-Americans, their values, such as autonomy, independence and privacy, prevail in our institutions. Patients who have immigrated or are visiting from other countries often value the family over the individual or view the male head of household as the decision maker for the patient. Families may be more apt to assist the patient in "self-care" functions while the medical staff thinks the patient should value gaining independence as a critical goal of recovery. The U.S. health care system tries to provide privacy for patients by limiting visiting hours and rarely offers sleeping accommodations for visitors. Many non-Anglo patients prefer just the opposite. In this article I will address some of the problems that can result from a lack of attention to cultural differences, as well some ways they can be remedied. I have chosen examples of individuals who have not assimilated to a great degree and whose beliefs and behaviors deviate from those expressed in the American health care system. It should not be inferred that all or even most members of these groups would act in the manner described. We must also recognize that assimilation occurs in unpredictable stages and that many people work hard to rightfully maintain their cultural traditions despite prevailing American values and traditions.

Stereotypes versus Generalizations

Anthropologists commonly make statements about groups of people; it's what we do–we look for broad patterns of similarity among groups. However, in the health care arena we cannot make the mistake of assuming that all members of a group fit the same pattern. This is particularly important when a health care provider's logic can mean the difference between life and death. By distinguishing the difference between stereotypes and generalizations as they apply in a health care environment, we can identify the point at which our health care system breaks down and suboptimal patient care results. 1 While these two thought patterns appear to be the same, they are very different. A generalization is a beginning point; we recognize a cultural pattern and then look to see if the individual fits that pattern. Making the appropriate generalization in health care situations can be a useful tool that narrows the field of thinking and can sometimes help save a life or prevent medical complications. A Chinese nurse told me about a Mexican woman who suddenly developed a severe condition requiring immediate surgery. The nurse, knowing that older Mexican women commonly view their husbands as the family decision-maker, told the physician she would call the patient's husband. The doctor told her it was unnecessary, saying that once he explained the situation to the patient, she would undoubtedly sign the consent form. The nurse ignored the physician and called the patient's husband anyway. When the physician finished talking to the patient and asked for her consent, the patient refused, saying she would wait for her husband. Since time was of the essence, the physician could not wait much longer before sending her to surgery. Fortunately, her husband arrived at that moment and convinced his wife to give consent for what turned out to be a successful surgery. Had the nurse not acted upon her generalization of gender role patterns in traditional Mexican households, the patient's outcome might not have been as positive. A stereotype, on the other hand, is an end point and can be dangerous. In this form of thinking we develop conventional, formulaic and oversimplified conceptions and opinions. It then becomes easy to categorize a patient as being a certain way and make no further effort to learn whether the individual in question fits the conception. Take the statement, "Mexican women often express their pain loudly." If I have a female Mexican patient who is moaning about her pain and I ignore her, thinking, "Don't worry; Mexican women express their pain loudly," then I am guilty of stereotyping. If, on the other hand, knowing that female Mexican patients often express their pain loudly, I check with the family to see if this particular woman is vocal when in pain, and follow up by checking her complaint, then I am generalizing. For example, a 62-year-old female Mexican patient who had a bypass graft on her leg could have suffered serious complications had the nurse not acted, despite his stereotypes. When she awoke in the recovery room she began screaming in pain. Her nurse immediately administered the dosage of morphine the doctor had prescribed, but to no avail. He then checked her vital signs and pulse and found that all were stable. Her dressing had minimal drainage. To all appearances, the patient was in good condition. The nurse soon became annoyed over her outbursts, stereotyped her as a "whining Mexican female who, as usual, was exaggerating her pain," and took no further action. After an hour of cries, the nurse called the physician. The surgical team opened her wound dressing to find a large amount of blood, which was pressing on the nerves and tissues in the area and causing her excruciating pain. She was immediately sent back to surgery. Had the nurse held on to his stereotype and the physician not discovered the problem, the patient could have suffered severe complications. In a less fortunate situation, a physician was guilty of both stereotyping and lacking knowledge about the patient's culture, when he treated my student's Irish mother-in-law who was in the hospital for surgery. Her family became very concerned when she suddenly started complaining of pain. They knew she was typically Irish in her stoicism, so they spoke to her doctor, who was from India. The physician, however, was not concerned. In his country, women were usually vocal when in pain, so he mistakenly assumed his female Irish patient would be as well. He refused the family's requests that the surgery be done sooner, thinking it unnecessary. 2 When he finally did operate, he discovered that the patient's condition had progressed to the point where she could not be saved. My student, an RN, felt that had the physician recognized her culturally atypical expressions of pain as a sign that something was very wrong and had operated sooner, she might have lived. This is a case where the physician made the mistake of stereotyping the patient based upon what he knew about women, without any knowledge of cultural differences between groups. Even if he knew nothing about the common Irish response to pain, he could have listened to the reports of the family who knew the patient's complaints were atypical.