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Common culture problems in Medicine...

Discussion in 'Medical Students - MD' started by fizzbot, Feb 26, 2007.

  1. fizzbot

    fizzbot Member
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    Hi, does anyone by any chance have a good/quick list about common culture problems in medicine or perhaps one quick and complete article about common problems physicians face when dealing with all sorts of culture problems? I am going to be speaking to my group about it and haven't found much sort of "all-encompasing" stuff on pubmed and google.

    Anyways, any help would be greatly appreciated, I hope everyone is doing well,
    Sincerely,
    Fizzbot
     
  2. sirus_virus

    sirus_virus nonsense poster
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    You could always throw in the whole Jehovah's witness "we dont accept blood transfusions".
     
  3. OP
    OP
    fizzbot

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    ya thanks, but i mean is there like a short paper or maybe a sheet with all of those things like (jehovahs witness, hispanics with pain medicine, etc. etc.) Kinda like a list of cultures and their associated med problems? Real succinct you know?
     
  4. Jejton

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    It really depends on what population you will be working with. I am not an MD, yet ( official disclaimer) but have worked as an EMT with very disparate communities, as well as with patients in a major hospital, been a patient, etc. so I do have experience.

    If you are working in NY, for example, you will have to be familiar with Jewish religious observances ( kosher, Sabbath and holy days, etc. ). Then there are also fairly large West Indian, African and Central American communities. So Spanish is useful. If you were to work in a hospital like Downstate, a rudimentary French would be helpful. If you are working in the southwest or Southern Cali, you will need some good Spanish skills and familiarity with Mexican, Central American folk culture ( i.e. Catholicism, ancestor worship,e etc ). In some cultures you dont inform the patient if they have a terminal illness, but their family. In others, you inform the patient and noone else. Cultural competency is something that you will have to acquire through some basic classroom/book learning to get some background information on the community you work with and then mostly just hands on experience.
     
  5. OP
    OP
    fizzbot

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    Ok, but does anyone have like a paper or a .doc that they could link me to? I could cite it in my presentation is kinda what I am looking for, sorry if I was unclear.
     
  6. OP
    OP
    fizzbot

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    Ya so basically what I am trying to find is an article or brief list of common cultural problems in medicine (like jehovahs witnesses and organ donation, hispanics and pain ... sorry about being confusing. Any help would be greatly appreciated.
     
  7. jocg27

    jocg27 Senior Member
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    I agree with this, and I think the idea of getting some background on the community of interest and then learning the rest via hands on experience is an important point.

    And the original request for a single sheet with a statement about each culture reminds me a bit of why I really don't like this kind of stuff taught in med school, despite the fact I think it's important info for a doctor to be aware of, and I'm really very interested myself in different cultures and their interactions with the medical establishment. (I am not knocking you fizzbot, I'm really not, I understand what you're asking for and that you need to cite stuff for a required assignment, so please don't think it's towards you).

    But the fact is, to me defining this topic as "Cultural Competency" and sticking it in a curriculum has this effect of boiling down entire cultures to little blurbs that, as med students, we want summed up and put into a nice little table to go into First Aid so we can memorize it for boards:
    Black Americans: Some supposed cultural trait, vaguely offensive
    Latinos: Some other cultural trait, apparently implied to be true of all Spanish speakers ever
    Jehovah's Witnesses: Something else
    Asians: Whatever else, true of course of all Asians...etc etc

    To me this isn't what cultural competency should be, but if it's part of a required curriculum in med school, it's what it inevitably will be due to the nature of med students and the considerable, and honestly much more pressing, time demands on us. It shouldn't just be a checkbox, like you've completed Cultural Competency training in the same sense as you've completed, say, your medical center's fire safety training or something, or completed your immunization requirements...It's not something you get by sitting in a lecture hall for am hour per semester. Language and culture color everything about the human experience. People can study and be completely immersed in a culture that's different from their own, and not even begin to fully understand it for years. And that's just one! No one, not even the most open-minded anthropologist, fully understands all cultures they might encounter in medicine -- that's not the point of cult. competency, to have a list of characteristics about each culture to memorize so you're prepared when they come in your office. So to me, this idea of attending one lecture on cultural competency and reading a sheet with a list of supposed characteristics, and then saying "Now I am culturally competent!" drives me absolutely crazy.

    To say nothing of the fact that they're the most preaching-to-the choir classes I personally have ever taken...The people interested in the topic don't become MORE sensitive to other cultures, and the ones who go in not caring spend the whole time rolling their eyes and then leave still not caring...

    I apologize for the rant, I know that's not what you were asking for...It just annoys me to no end that this is the kind of thing they have people doing for this kind of class.
     
  8. justwondering

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    if u want to include cultural issues relating to muslims, there is a publication that u can order called the " A Health Care Professional's Guide to Islamic Religious Practices." (u can order it by emailing: [email protected]). im not sure if u have time to order it. i havent read it, but the organization is pretty credible as far as info.

    sorry moderator,i dont know if we're not allowed to post emails here, if not, pls delete.
     
  9. Aures

    Aures Medicine is boring
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    I'd like to add that some infections, intoxications are due to the hygeinic/alimentary habits/traditions of the people. I suppose that's cultural as well.

    Curcumcision <---> STD
    Food preparation <---> Foodborne infections
    etc etc

    (And srry to FizzBot, I think this isn't answering your question)

    Aur.
    [​IMG] [​IMG] [​IMG]

    [​IMG] [​IMG]
     
  10. Critical Mass

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    My biggest culture issue is when physicians order them unnecessarily or ask for irrelevant susceptibilities on the organisms that grow on them. Group A strep is always sensitive to beta lactams, for instance.

    Also, knock it off with the heavy quinolone usage. It makes it harder on the rest of us who haven't yet acquired flora with heavy drug resistance.
     
  11. Church

    Church Snark-free since 2008
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    Are you trying to argue that circumcision INCREASES or DECREASES risk?
     
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  12. OP
    OP
    fizzbot

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    so there is really no just sort of cheat sheet? By no means do I mean to marginalize or categorize any sort of color/religion/creed, i was just almost thinking as more of a cheat for docs in training of major issues to be aware of. I hope I didn't start a fire with this thread, just looking for help is all, but these responses have opened my eyes as to how voluminous this issue really is.
     
  13. smq123

    smq123 John William Waterhouse
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    Isn't there a chapter in one of Barbara Fadem's books that focuses on this issue? "Behavioral science in medicine" - it's a green book. I think Chapter 20 "Culture and illness" talks specifically about cultures that are common in the US.
     
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  14. Dakota

    Dakota Senior Member
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    Some cite studies done in Africa that show decreased HIV transmission rates among circumcised males as compared to uncircumsized males.
     
  15. Hook17

    Hook17 Senior Member
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    #15 Hook17, Feb 26, 2007
    Last edited: Oct 9, 2010
  16. Aures

    Aures Medicine is boring
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    >>Church:
    >>>Are you trying to argue that circumcision INCREASES or DECREASES risk?

    >Dakota:
    >Some cite studies done in Africa that show decreased HIV transmission rates among circumcised males as compared to uncircumsized males.

    Decreases, as Dakota said @ Church.
     
  17. LuckyBambooGirl

    LuckyBambooGirl Junior Member
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    I think there is a chapter on it in the Behavioral Sciences Grid Book. I remember reading it last year.
     
  18. OP
    OP
    fizzbot

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    ya hook, im here, where you end up?
     
  19. AmoryBlaine

    AmoryBlaine the last tycoon
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    I think it become a "number-needed-to-treat" issue though, how many circs do you have to do to prevent one xmission of HIV?

    I'm not really sure of the answer, but I learned the hard way that if you ask some docs (esp FP/Peds) what they think about circumcision get ready for some yelling.
     
  20. Tired

    Tired Fading away
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    This is a stupid stupid thread, for two reasons:

    1) Cultural competency basically boils down to being sensitive to differences between people; when it is overlayed with assorted stereotypes (eg - Samoans go to their priest before their doctor!) is becomes a big pot of hooey.

    2) The OP wants homework help. Go read a book dude, I already passed undergraduate.

    So let's hijack this thread and argue about circumcision, it's much more fun.

    Pediatrics. 2006 Nov;118(5):1971-7.
    Circumcision status and risk of sexually transmitted infection in young adult males: an analysis of a longitudinal birth cohort.Fergusson DM, Boden JM, Horwood LJ.

    OBJECTIVES: Previous research suggests that male circumcision may be a protective factor against the acquisition of sexually transmitted infections; however, studies examining this question have produced mixed results. The aim of this study was to examine the association between circumcision status and sexually transmitted infection risk using a longitudinal birth cohort study. METHODS: Data were gathered as part of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children. Information was obtained on: (1) the circumcision status of males in the cohort before 15 years old, (2) measures of self-reported sexually transmitted infection from ages 18 to 25 years, and (3) childhood, family, and related covariate factors. RESULTS: Being uncircumcised had a statistically significant bivariate association with self-reported sexually transmitted infection. Adjustment for potentially confounding factors, including number of sexual partners and unprotected sex, as well as background and family factors related to circumcision, did not reduce the association between circumcision status and reports of sexually transmitted infection. Estimates of the population-attributable risk suggested that universal neonatal circumcision would have reduced rates of sexually transmitted infection in this cohort by 48.2%. CONCLUSIONS: These findings suggest that uncircumcised males are at greater risk of acquiring sexually transmitted infection than circumcised males. Male circumcision may reduce the risk of sexually transmitted infection acquisition and transmission by up to one half, suggesting substantial benefits accruing from routine neonatal circumcision.
     
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  21. Dakota

    Dakota Senior Member
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    I haven't read any of the primary literature myself which is why my response had a few qualifiers in front of it.

    I'd be interested in seeing a NNT. This would understandably be much higher here than in Africa.
     
  22. OP
    OP
    fizzbot

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    ya about that homework thing, its more of a cry for help, so if anyone gets bored talking about circumcision don't hesitate to throw me a bone. hope everyone is enjoying their mondays.
     
  23. Jejton

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    While the first part of your post makes sense the second is just WTF?
     
  24. Dakota

    Dakota Senior Member
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    If by the second part you mean food preparation, etc here's a pretty good example.

    Yupik eskimos in SW Alaska eat various "stink foods" you take something like fish, wrap it in grass (I'm a little hazy on exactly what the wrapping material is, I think it's grass . . . anyway) and burry it in the ground. The food then ferments and becomes very soft. You can munch right through whole fish. This became a problem when it was discovered that the fermentation time can be cut from weeks to days (or shorter) by putting the food in plastic bags instead of preparing it the traditional way. Now botulism is a serious problem from this improperly prepared stink food.
     
  25. Tired

    Tired Fading away
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    I dare you, at your next cultural competency lecture, to bring up "improperly prepared stink food" with a straight face. Bonus points if you describe it as "the most pressing issue of cultural competency facing American medicine". :D
     
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  26. Dakota

    Dakota Senior Member
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    It'll take a lot of rehersal for me to get the straight face thing down especially if I throw in the part about it being the most pressing issue.

    In all seriousness botulism is a problem for this group and for a PCP to be on top of things they have to understand what is causing the botulism and instruct people on how to prevent it.
     
  27. Jejton

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    :laugh:
     
  28. Jejton

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    No need to hijack this thread as there is already a hot discussion going on about it on the forum.
     
  29. 8744

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