The culture one assimilates with plays a role in just about everything. From the clothes you wear to language and kinship, whether you’re conscious of it or not culture will affect behavior. Cultures universally provide a sense of community and belongingness, but paradigms of abstract thinking often vary from one culture to another. An example of this is variance in medicine. Although all cultures seek medicine to rehabilitate the sick and improve quality of life, the method and means to do so is not concrete. Not all Culture follows the basis of biological medicine of the new age, so we must seek to understand how culture affects our implementation and understanding of medicine.
Over 100 million people are suffering from depression in China (Ryder, 2012). Recently, public safety professionals attended to this, hypothesizing that traditional Chinese medicine is somewhat ineffective as well as many cases of depression being undiagnosed or misdiagnosed. An experiment was conducted, surveying 10 Chinese medical students. They were given a list of symptoms and were asked to diagnose the patient. These symptoms included “low mood, lack of essence-spirit, lack of energy, insomnia, lack of appetite, concentration difficulties, no interest in anything, pessimistic thoughts, worries a lot etc… Only six of the ten informants recognized this as depression in traditional Chinese medicine. Some diagnosed liver deficiency, heart and spleen deficiencies. They would recommend acupuncture as treatment. According to the students, the body is divided into 5 visceral planes, and the liver is taught to be where mood regulation occurs, as well as the qi center of the body. The Chinese believe the qi is the “basic element which forms everything” which flows throughout the body, and changes in mood are a result in movement of qi. (Kam, Zhang, 2019.) The results of this study may be shocking to the western world, but traditional Chinese medicine is just that- traditional. The concept of qi has been passed down from thousands of generations, and no matter how much new age medicine sparks, those grandfathered ideals will always be valued by some and that should be respected by all. In the mid twentieth century, the Colombian Ministry of Health passed legislation for western medicine to “cooperatively coexist” with Indian shamanistic ideology. If not for preserving a symbol of culture, shamans carry many sociocultural functions. They’re seen as “Mediators between this world and the supernatural… secular and sacred, [shamans] must be understood”.(Jackson 1995)
Cultural influences present themselves even on a hospital floor. The social hierarchy of hospitals, while systematically in place to maintain order-insinuates a caste. Doctors/physicians (traditionally male) are commonly thought to have the best education hence being the best-fit individual to pin a diagnosis. But what happens when the doctors themselves have cultural prejudice? According to Jackie, an Angelo nurse who worked in the 1990’s, that was not uncommon. She told a story of Dr. Fukishima, a Chinese Physician who ordered her to administer an 150 mg of morphine, a drug which could be lethal at this dose. Jackie refused, pleading the case that she was “obeying the system” as a patient advocate. Dr. Fukishima took great offense to her opposition, as he felt she was out of line to speak up against him. This is where it becomes less about medicine and particularly cultural. Dr. Fukishima reports Jackie to his supervisor committee, and they agree with Jackie. Afterwards, Dr. Fukishima sat down with Jackie to discuss the discrepancy. He explained that in China, when any authority figure gives you a direction you must obey. Not doing so is construed as extremely disrespectful. He mentioned what she could’ve done to maintain his respect in that situation- he proposed that she should’ve agreed to administer the 150 mg of morphine but then not actually do it. “Asians generally believe it is important to avoid conflict and comply with authority, rather than to refuse directly, it is more appropriate to agree to the supervisors face and then not follow through…” (Galanti, 2015)
Culture also affects the way physicians treat and evaluate patients. For example an Indian physician, Dr. Kumar, an orthopedic physician and surgeon receives an Irish female patient who has been approved for meniscofemoral surgery. In the weeks leading up to the surgery the patient constantly complained of burning sensations, unbearable pain, and often cried out in agony. For Dr. Kumar this is totally normal, as in India women are very vocal about their pain. The patients family began to worry and see the patients pain as an extremely abnormal response. They pleaded Dr. Kumar to perform surgery earlier than scheduled-but he refused, assuring them that she will recover 100%. When he operated, he found an infection which had spread from excess bacteria in the knee, and he was forced to amputate her limb. This discrepancy in each culture’s pain expression had major repercussions, and the patients family filed a lawsuit.(Galanti, 2015) Its cases like these which call for reconsideration of medical ethic ideology. In some places such as Canada, physicians are now trained through the Canadian Medical Protective Association (CMPA) in cultural competence. The CMPA heavily underscores the importance of being able to recognize differences in socio-cultural background and identify potential biases which may pertain to the patient as well as adjusting their style of practice to commend individualized patient needs. (CMPA, 2014)
To adequately make sense of how culture affects medicine, we must understand how roles (patient, doctor or nurse) and expectations of medicine differ from one culture to another. Some (but not all) non-western medicinal practices stem directly from spiritual or religious belief. Furthermore, those who practice spiritual medicine tend to identify with a religion which highly values spirituality. Recognizing this, attending to it mindfully and competently is critical to care. Most importantly, to rescind the notion that western medicine is the “most fit” method of treatment. Medicine is an outlet of culture.
