The first two parts of this series focused on the changing cultural demographics of the American population and the importance
of the medical community being "culturally competent." The series concludes by looking at how particular cultural groups have
traditionally perceived specific disease states and treatments, and how outcomes are affected.
Cultural values
In much of the world, folk beliefs and tradition still hold sway over many cultures' ideas of disease and treatment. While
this can cause a variety of problems for practitioners of modern medicine, when these beliefs are properly understood, respectable
and effective treatment can follow. While it would seem that traditional ideas would be localized to the under privileged
and the uneducated, or to immigrant populations, folk beliefs even exist among the educated, middle class and native born.
One very common example of this apocrypha is the belief that antibiotics can be used to effectively treat a virus.
Differences in cultural values between patients and treatment providers can result in inaccurate history, non-compliance with
treatment recommendations, dissatisfaction with care and poor follow-up, all of which are of great concern for doctors. The
following are a few traditional beliefs you should be aware of. Examples of traditional beliefs
Many traditional Latino and Asian cultures have believed that a "hot-cold balance" is necessary for health. Certain diseases
are "hot" conditions and should be treated with "cold" remedies, and vice versa. Imbalances are thought to foster disease.
For instance, vitamins, a "hot" remedy, might be withheld from a person who has a rash, which is "hot."
Some Latino healing modalities differentiate natural illnesses from supernatural illnesses. Treatments include incantations
and herbs, physical manipulation, and, in some cases, potentially harmful substances, such as lead salts or mercury.
Traditional Latino diagnoses and treatments include:
Ataque de nervios (nervous attack), for which there is no traditional treatment except to calm down the patient. This belief system would discourage
psychotherapy and the use of anxiolytics.
Mal aire ("bad air") is cold air that is believed to cause respiratory infections or earaches. The traditional treatments are "hot,"
such as steam baths, compresses and herbal teas. If an infection is found, doctors must try to convince the patient to take
antibiotic or antiviral drugs, which can be a challenge.
Pasmo ("lockjaw") is believed to be caused by a sudden hot-cold imbalance, for which the traditional treatment is massage. Again,
doctors must try to figure out the medical cause, and persuade the patient toward the recommended treatment.
In some traditional Asian cultures there is great emphasis on personal honor, family values and avoidance of shame. Typically,
psychiatric conditions are well documented but they are often treated with remedies, such as teas, acupuncture, or applying
glass cups to the skin ("cupping"). Because of the traditional perception, many patients present with somatization disorders,
and can be misdiagnosed.
A few traditional Asian diagnoses include:
Hwa-byung (Korea) is epigastric pain, usually in a female, from an imagined abdominal mass. It's believed to be caused by unresolved
anger.
Shen kui (China) is anxiety and sexual complaints with no physical findings and is attributed to loss of semen ("vital essence").
Tajin kyofusho (Japan) is social phobia.
It is important to recognize these illnesses, and respect the patients' beliefs when recommending treatments.
Black Americans have a 5.9-year shorter life expectancy, and a much higher rate of hypertension and stroke, than White Americans.
This is partly due to larger levels of poverty and discrimination, which have resulted in less effective healthcare. Mistrust
of the healthcare system also exists, due to events such as the Tuskegee Syphilis Study.
