"Spirit Catches You and You Fall Down"

[calmike2001]

Have any of you read this book? Any thoughts on it? Who was to blame for how the child ultimately ended up? I figure if people can start new threads about jerking off I should be allowed to start one about book reviews...

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[eurotrash]

I blame the parents and their unyielding view of the world.

 

[calmike2001]

yeah! thats what i felt, but when i say stuff like that people just say im biased towards western medicine. it seems like if the parents really believed in shamanism, then they never should have brought the child into the hospital in the first place. at least that way she would have died in infancy. as it was, they'd only bring her in during a crisis, and then refused to give her the meds properly, causing her to become gradually ******ed and ultimately a vegetable.

 

[citygirl]

This book is actually required reading for MS1 here.

I don't think anyone was really to blame. The book is intended to show how a little cultural sensitivity can make a big difference.

 

[Celestron2000]

i blame faulty programmers

Are you Sharky reborn?

 

[calmike2001]

so in this case, how would cultural sensitivity have made a big difference?

 

[citygirl]

so in this case, how would cultural sensitivity have made a big difference?

For one, understanding that a complicated medicinal routine was probably beyond what the parents were willing or capable of doing. Instead of striving for perfect seizure control, a simpler routine would have probably been more acceptable. Lia may have had a few breakthrough seizures but the outcome would have been different. Also, just in general, it is important to understand what herbal or other alternative therapy patients are using to avoid problems. For example, Dilantin can have a lot of interactions.

 

[oldman]

how many of you see hmong patients? in minneapolis we have one of the largest if not the largest hmong population in the country.

it's interesting that my class only has 1 hmong student.

 

[madtowngirl]

We see quite a few Hmong patients in Madison, WI. I do not think any of my classmates are Hmong though. The book is a part of the curriculum of several elective classes we have here; I haven't read it but mean to this summer.

 

[Hosehead]

It is required reading for MSI at MSU-CHM as part of our cultural sensitivity and professional responsibility training. By the end of the book I was ready to tear it to shreads. I thought the doctors really got a really raw deal in the book and I always found myself defending them.

One thing that I thought was interesting was how Lia would have most likely died within a few months after her seizures started if she stayed in SE Asia. Even though she received substandard care by our standards, it enabled her to spend time with her family(although not under the most ideal situations). Any thoughts?

 

[badgergirl]

I read this book a year or so ago, and was reminded of it during a lecture on complementary and alternative medicine this past semester. We were discussing all sorts of common folk treatments and so on that could be beneficial, harmful, or have no effect. When doctors don't recognize alternative therapies, the outcome may be impacted (e.g. mixing herbal supplements with prescriptions, or mistaking coining for child abuse). The art is to address both treatment strategies (and identify them!) when coming up with a plan, and explaining the reasoning when treating the patient. There's your cultural sensitivity, calmike2001. They should have sat down, from the beginning, and laid it all out for everyone to see. I felt so frustrated with the parents, and of course the doctors were stuck between a rock and a hard place. Everyone wanted the best for Lia, it was just the means to the end wasn't viewed the same way by any of her caretakers - family and heath care alike. It's a sad, frustrating book, but I think everyone should have to read it.

 

[labangel]

Would someone mind giving a summary of the story? I've never heard of this book.

 

[Catalyst]

I read this book a year or so ago, and was reminded of it during a lecture on complementary and alternative medicine this past semester. We were discussing all sorts of common folk treatments and so on that could be beneficial, harmful, or have no effect. When doctors don't recognize alternative therapies, the outcome may be impacted (e.g. mixing herbal supplements with prescriptions, or mistaking coining for child abuse). The art is to address both treatment strategies (and identify them!) when coming up with a plan, and explaining the reasoning when treating the patient. There's your cultural sensitivity, calmike2001. They should have sat down, from the beginning, and laid it all out for everyone to see. I felt so frustrated with the parents, and of course the doctors were stuck between a rock and a hard place. Everyone wanted the best for Lia, it was just the means to the end wasn't viewed the same way by any of her caretakers - family and heath care alike. It's a sad, frustrating book, but I think everyone should have to read it.

My thoughts exactly. I particularly liked Fadiman's mention of Arthur Kleinman's key points for being a culturally sensitive physician towards the end of the book. If I can find the book soon, I'll post them.

 

[DireWolf]

This was required reading for us as well. It was easily the worst book I've ever read. Very little substance and lots of fluff.

 

[DireWolf]

I wipe my a$$ with that book.

 

[Hosehead]

I wipe my a$$ with that book.

I thought I was alone in my feelings. Everyone at my school drooled over it like it was the best book in the world.

 

[ItsNotATumor]

I don't think anyone was really to blame, it's just a tragic case of circumstance and misunderstanding.

 

[OldLady]

and we have to write an essay about it too.

 

[sophiejane]

I think one of the things the book points out is that there were so many things that went wrong on both the part of the family and the hospitals and doctors, that it's pretty much impossible to lay blame on anyone. It was just a terrible series of mistakes from the first step. You can hardly say that the western doctors and nurses behaved in the perfect way for the situation. I think they did their best, but there were times when they could have been a lot more understanding of the family if they had some background in their culture.

 

[freddydpt]

I'm bumpin' this thread up... I'll be an entering 1st year at GW and we're required to read it over the summer to be able to discuss sometime during the fall semester. Honestly, cultural differences are nothing more than getting the patients and family's point of view. Talk to your patient and you're ok. It's impossible to understand every culture but it is possible to talk to every patient and ask them how they are doing with the therapy they are receiving. This seems to be a big issue in PT as well and I never understood the ultra significance that everyone makes it out to be... can anyone elaborate?

Thanks!

 

[DrMom]

This was required reading for us as well. It was easily the worst book I've ever read. Very little substance and lots of fluff.

I had read the book well before med school & really liked it.


I think that the assignment we had in the middle of everything else really made our class detest the book. For some reason our instructors made us do a book report (apparently we went back to 5th grade) and then marked us down for our opinions

This pic summarizes our class' opinion of the whole thing (kudos to Fenrezz)

 

[Wrigleyville]

Great pic! We had to read a few pages of the book for one of our classes-- must be some kind of a medical school trend.

 

[DrMom]

Great pic! We had to read a few pages of the book for one of our classes-- must be some kind of a medical school trend.

Seems to be so. Again, I thought it was a good book, but it was a silly thing to add on top of path, pharm, psych, etc. It just became something we resented.

 

[madtowngirl]

I'm bumpin' this thread up... I'll be an entering 1st year at GW and we're required to read it over the summer to be able to discuss sometime during the fall semester. Honestly, cultural differences are nothing more than getting the patients and family's point of view. Talk to your patient and you're ok. It's impossible to understand every culture but it is possible to talk to every patient and ask them how they are doing with the therapy they are receiving. This seems to be a big issue in PT as well and I never understood the ultra significance that everyone makes it out to be... can anyone elaborate?

Thanks!

The biggest problem in the book was that they couldn't talk to each other, largely because of the language barrier and also because of the lack of understanding and respect the doctors and the family had for each other. And the patient being a child didn't make anything any easier in this case. I have to confess, if someone told me that they were treating an ill person by sacrificing a cow for her, I'd probably think they were odd too. I'd like to think that I'd try to identify with them, but at first I'd be a bit taken aback.

 

[automaton]

I had read the book well before med school & really liked it.


I think that the assignment we had in the middle of everything else really made our class detest the book. For some reason our instructors made us do a book report (apparently we went back to 5th grade) and then marked us down for our opinions

This pic summarizes our class' opinion of the whole thing (kudos to Fenrezz)

this is possibly the best post ever out of your 19182 posts.

 

[lotanna]

It is required reading for MSI at MSU-CHM as part of our cultural sensitivity and professional responsibility training. By the end of the book I was ready to tear it to shreads. I thought the doctors really got a really raw deal in the book and I always found myself defending them.

One thing that I thought was interesting was how Lia would have most likely died within a few months after her seizures started if she stayed in SE Asia. Even though she received substandard care by our standards, it enabled her to spend time with her family(although not under the most ideal situations). Any thoughts?

i still havent read it i've 2 weeks to do so, are u in my class?

 

[pureofheart]

"One thing that I thought was interesting was how Lia would have most likely died within a few months after her seizures started if she stayed in SE Asia. Even though she received substandard care by our standards, it enabled her to spend time with her family(although not under the most ideal situations). Any thoughts?"

I'm not sure what you're suggesting here. Are you saying that her family shouldn't complain about the "substandard care" since what they have in America is so much better in SE Asia?

 

[principessa]

We're supposed to read this book before class starts. The author is coming to discuss it with us.

The book disturbed me and left me kind of ambivalent. The idea that even though you're a competent, caring physician and you have your patient's best interests at heart, that even then you could fail your patient, not because the problem just got out of hand but because of a cultural clash - this scares me. Also, the idea that you can try your best to be a good parent and fail your child because you are doing what you feel is right and what everyone you trust feels is right - that's scary too. I don't think the author was unfair to the physicians or the parents, but I think that most people outside of medicine who read this book will come out on the side of the parents. If you notice, most of the critics whose comments are included on the inside cover seem to favor the parents. And I imagine most people in medicine would place more blame on the parents. I think it's frustrating that the family did not want to learn to navigate through American society, that they didn't try to learn any English at all even though they knew the language barrier was causing them problems. I would certainly learn the local language if I relocated somewhere else. But then you have to remember that they were forcefully relocated, that they were stuck where they were and it wasn't really where they wanted to be. I also think they had unrealistic expectations of Western medicine - that it could give Lia a quick fix, that she wouldn't have to take medicine for the rest of her life. There were unrealistic expectations on the physicians' end as well - that the family understood what was happening, that they really understood the instructions, that they could manage a complicated regimen. They also failed, from the very beginning, to gain the family's trust. This, I think, is where the cultural competence comes in. If they had understood how Hmong society worked, they might have been able to gain the Lees' trust, and the Lees might have taken their advice more seriously. The major fault that I see is on the part of the hospital and the community - they didn't do much to foster understanding between the Hmong and the rest of the community, including the hospital staff. The hospital could have employed more competent interpreters for both the language and the culture, they could have educated the staff on Hmong beliefs with regard to illness, authority, etc. They could have tried to help the Hmong understand what to expect from American medicine.

Anyway, I've rambled long enough about this book. I'm glad I found this thread, though, because I've been dying to discuss it.

 

[SarahGM]

We also have to read it before school starts -- and I just finished it this morning, in fact! Glad to have found this thread.

I also found myself identifying with the physicians who asked, "My patient thinks he's sick because a spirit stole his soul? Why should I indulge in these delusions?" However, I liked the quote towards the end of the book by Francesca Farr: Our view of realityis only a view, not a reality itself." I took that to mean that as a physician, you can believe all you want in terms of diagnosis and treatment, but unless you work with your patient inside their realm of reality, you may never find a common ground upon which to begin treatment. Sometimes you have to give up on the most effective and expedient form of therapy and settle for something that fits more with the patient's world view. Some patient compliance is better than none, and establishing doctor-patient rapport from the beginning is crucial!

 

[SarahGM]

At the same time, I don't want people to think that I'm saying physicians should cow-tow to every whim that any patient who comes in has. I think physicians should give their professional opinions on the best mode of treatment, encourage patients to speak with family members and spiritual community leaders, and then meet again to discuss the actual treatment the patient will receive.

 

[principessa]

At the same time, I don't want people to think that I'm saying physicians should cow-tow to every whim that any patient who comes in has.

I agree. Especially when the patient is a child and the whims are those of her parents. I think I would feel more comfortable giving ground with adult patients because they have the right to decide for themselves, even if they choose something that goes against a physician's recommendation. But children? I think a pediatrician ought to put the patient above the parents. I mean, the parents are like an extension of the patient, and you should try to gain their trust, but if they're doing something to endanger her you ought to worry about her first. For all you know she could grow up and reject her parents' beliefs or affirm them, but until she is of age you just don't know and you're better off giving her the best chances of growing up so that she can decide for herself.

 

[pristine21]

I liked the book, and I think it says more about stuff other than cultural differences. My father had epilepsy, and everyone was so angry at him for not taking his meds, but he was an artist and they made his skills falter, so he preffered to have seizures. I think the book just taught me to listen to my patients in general, because you couldn't walk a day in their shoes even if you wanted to.

 

[Karl_Hungus]

Dredging up an old thread, but...

MS1, I had to read the book also.
I also had to sit through an agonizing discussion of the book where my classmates spent about an hour all rephrasing the statement "the doctors (or nurses, social workers, etc.) should have done more..."

Other viewpoints were considered culturally insensitive. Then someone else would take the microphone and re-state how she thought the doctors could have done more to help the family.

I felt as Hose did; while reading it, mentally I was defending the physicians. My classmates were quick to jump in the shoes of the immigrant family and defend each of their actions and viewpoints. These same people seemed unwilling to consider this situation from the physicians' point of view (ironic, given that it should be an easier perspective to imagine).

One person made the excellent point that these events took place in the early and mid 1980s. There was no "language-line" to call for rapid translation services. The internet did not exist in its present capacity for instant infomation on infinite topics (including Hmong culture). Not to mention that the Hmong migration was really just beginning and the Hmong were not really established, nor were there experts in the culture or readily available translators.

 

[ahd929]

I liked the book, and I think it says more about stuff other than cultural differences. My father had epilepsy, and everyone was so angry at him for not taking his meds, but he was an artist and they made his skills falter, so he preffered to have seizures. I think the book just taught me to listen to my patients in general, because you couldn't walk a day in their shoes even if you wanted to.

this was required reading for M1's at michigan too. the problem with the comparison to your father is that he is an autonomous adult who presumably knows and understands the consequences of his actions. lia was a child. not just a child, but an infant. the doctors had a responsibility to advocate for her, especially given how clueless her parents were. we are told repeatedly in the book that the hmong are by nature stubborn and resistant to assimilation, and that is why they wouldn't accept western medicine or even try to learn english. well, they use toilets, right? they drive cars? they shop in american stores, using money? these are all things that they didn't do in the mountains of laos. if they're willing to compromise on the ritual sacrifice of dogs (something they don't do here because they know it conflicts with our culture), why can't they compromise on something that matters, like the medical care of their daughter? furthermore, why do we hold hmong immigrants to a different standard than all other immigrants? my great-grandparents came to this country with no money, no family, no jobs, and no english. the other thing they didn't have (thank god) was a room full of med students trying desperately to make excuses for them.

fadiman makes it clear that she thinks the american docs did not have enough respect and deference for hmong culture. well, lia's parents had insufficient respect for our culture. our culture includes western medicine and the basic tenet that we don't allow children to suffer and die because their parents can't or won't give them their medicine.

and, for the record, in my group discussion of this book, i was the only damn person in the class willing to speak so strongly on this matter. we get a lot of empty platitudes about cultural competence, and not enough focus on the fact that there is a brain-dead girl here!

 

[Tired]

we are told repeatedly in the book that the hmong are by nature stubborn and resistant to assimilation, and that is why they wouldn't accept western medicine or even try to learn english. well, they use toilets, right? they drive cars? they shop in american stores, using money?

More importantly, they repeatedly sought medical care from the very physicians the author spends so much time vilifying for their "lack of cultural sensitivity". This child might never have come to the attention of the medical community had the family really thought "the spirit was catching her", because they would have kept her at home. Instead, they knew something was wrong, and they called 911. No one forced medical care on them, they asked for it. I don't believe in alternative medicine, so I don't go see Naturopaths. Duh.

From my perspective, the author was creating a cultural conflict that didn't really exist. The problem was not that the family had one view of her illness while the doctors had another. The problem was the family sought medical care, then didn't fulfill their own responsibilities to see that the care was carried out adequately. End of story. This was sensationalist crap by a touchy-feely sociology major who wanted to write an anti-Western Culture novel.

My med school made us read it also. What crap. It's ridiculous that any school would require this as reading. What next, Kevin Trudeau's "Health Secrets *They* Don't Want You to Know About"?

 

[pagemmapants]

They made us read "My Sister's Keeper" which, while the ending pissed me off to no end because it was a cheap way out of a complex and interesting situation, seems to have been a far more appropriate choice. Less of the "holycrap, let's vilify physicians for not knowing everything about everything and saving everyone" and more of the ethical debates that might actually end up facing us as our technology improves . . .

 

[Trepp]

Portions of this book were required for us at U of Kansas. I thought it was horrible, and I think most of my class hated it. Its full of political correctness run amok. Why is is always the American doctor that must change based on someone else's culture? I like to be cognizant of where other people are coming form, but I like to practice evidence based medicine!

 

[Tired]

Why is is always the American doctor that must change based on someone else's culture? I like to be cognizant of where other people are coming form, but I like to practice evidence based medicine!

And there was absolutely no solutions offered. All she did was bitch and moan about how insensitive they were, but she offered no alternatives about what they should have done differently.

 

[Wizard of Oz]

I figure if people can start new threads about jerking off...

Link please?

 

[mshheaddoc]

the OP is from 2004 ...

 

[Wizard of Oz]

the OP is from 2004 ...

No wonder I've never heard of this book.

 

[Tired]

the OP is from 2004 ...

I'd rather see a 2004 post revived, than have the same damn thread recur a thousand times under different names . . .

"Please advise on MCAT score"
"Is my MCAT score good enough?"
"Should I retake the MCAT?"
"How high is high enough?"

and on and on and on and on . . .

 

[Karl_Hungus]

the OP is from 2004 ...

Though the OP was in 2004, the book is still being used; I had to read it this past fall (2006) in a 1st year medical school class.

 

[mshheaddoc]

Oh I wasn't referring to that, I was referring to the fact that someone wanted the link to the "referenced jerking off thread" in the original post

I know many students are required (some even willingly) read this book.

This was a good bump on the bumpers part ... I was just pointing out that there aren't any threads about jerking off currently in this forum.

Wow, I'm smilie happy tonight

 

[janedoe4]

I like to be cognizant of where other people are coming form, but I like to practice evidence based medicine!

Whatever kind of medicine you like to practice, what you want won't happen unless the patient is on board (at least/especially with an outpatient). If you got nothing else out of the book, how about just that?

 

[DrMidlife]

I've found it useful to consider the content of this book as a "this kind of thing is going to happen to me as an MD" case study, as opposed to a "this thing happened, what went wrong?" problem. It's a terrific introduction to the real world of things that shouldn't happen but do: disorder, inconsistency, us vs. them, long term consequences of political instability, staffing problems in social services, shall I go on?

I suggest that the individual emotional response to this book is great information in choosing a specialty and location, and possibly in learning to manage stress. Lots of people get excited about EM, for instance, and that might be a poor choice for someone who gets excessively angry or depressed about controversial life/parenting/health choices. Even as an MD I expect lots of "who the hell are you to tell me how to live?"

But doesn't it seem like reading this book would be a better use of time in a premed curriculum?

 

[Wizard of Oz]

I'd rather see a 2004 post revived, than have the same damn thread recur a thousand times under different names . . .

"Please advise on MCAT score"
"Is my MCAT score good enough?"
"Should I retake the MCAT?"
"How high is high enough?"

and on and on and on and on . . .

Only a member for a month, yet you've already got it figured out.

 

[Tired]

Only a member for a month, yet you've already got it figured out.

Yeah, but I was always this cynical, SDN had nothing to do with it.

 

[8744]

Have any of you read this book? Any thoughts on it? Who was to blame for how the child ultimately ended up? I figure if people can start new threads about jerking off I should be allowed to start one about book reviews...

I don't read crap.

Sorry.

 

[zenman]

I don't read crap.

Sorry.

I have to confront you about this as you do read the posts here on SDN.