Medical Education Blog

An elderly war veteran never admits to the pain he feels after a diagnosis of bone cancer while in the next ward, another patient complains bitterly and demands more pain medication.

Medical schools are very good at teaching doctors how to diagnose and treat disease, but they may not be well prepared to cope with illness. As defined by Terry Tafoya, Ph.D. illness is the patient’s cultural and personal response to the disease. If the two gentlemen above are looked at through cultural lenses, Northern European cultures value stoicism (stiff upper lip) in men, while Southern European cultures believe pain and suffering should be expressed.

To further illustrate this concept here is an excerpt from http://tundramedicinedreams.blogspot.com/ about diagnosing native elders

Yupik elders often have a tendency to give long and circuitous answers to simple questions when speaking in Yupik. Interestingly, the English-speaking ones don’t seem to do it nearly so much when speaking English. It is somewhat affectionately known as “going to the moon.” A question that may be answered with a simple yes or no may engender a long story; at the end of it, the translator may sort of shrug and say “basically, she said yes (or no).” When I raise my eyebrows, the translator will say “well, she had to tell me a story about the time when her daughter…” Elders are held in very high esteem in this culture, and when an elder is speaking it is rude and unacceptable to interrupt. They go to the moon if they want to, and everyone will listen and wait until they are done.

To teach medical students to pay attention to cultural differences in a patients view of illness, Dr. Tafoya suggests using the acronym LEARN.

L isten with empathy (Active Listening)
E licit the patient’s worldview of the problem/need
A cknowledge and discuss possible differences and similarities between the patient and physician’s worldview
R ecommend a prevention/intervention/treatment plan
N egotiate a final plan