Cultural and Religious Issues

a signal control device that stops traffic upon the emergence of an emergency vehicle. Turn signals need to be on at 100 feet before the turn in urban areas and at 300 feet before the turn in rural or highway situations. You will need to drive slower in inclement weather and carry supplies for yourself or for other stranded motorists.

CULTURAL AND RELIGIOUS ISSUES

There is a great deal of ethnic diversity in the United States, with the impact of culture on healthcare being extremely important. Culture is defined as the shared attitudes and beliefs of a group of people; it molds their ideas of what illness and how to treat it. This leads to the need to participate in a cross-cultural interview, where you get the patient s perception of their illness and any alternative therapies they ve been using so far so you can arrive at a solution to their problem that is mutually acceptable.

In order to see that patient has understood you and knows what they should be doing, you should get them to repeat what you ve said back to you in their own words. You should try not to use friends or family as interpreters in order to protect the patient s confidentiality. You need to remember that people of different cultures differ according to their comfort with eye contact, body language, personal space, and things that are important to them.

Because of things like a more global economy, immigration, and travel, there is a great deal of cultural diversity. The largest US minority group is Latinos, followed by AfricanAmericans and Asians. About 10 percent of people in the US were born on foreign soil with minorities being nearly half of the US population by the year 2050.

While you cannot stereotype people or generalize among people of a given culture, you need to be aware of the fact that the patient s assumptions about reality are linked to their religious and cultural background. These assumptions have a significant impact on the patient s healthcare. Some patients believe in fatalism or predetermined fate so they will not often adhere to treatment, believing it will not help. Others see spiritual causes behind certain illnesses that should be understood by the provider.

You should understand that Asians and Latinos believe in a balance between hot and cold with regard to health. Hot diseases must be treated with cold therapies so you need

to know which therapies to use against which illnesses. Others believe that an imbalance between hot and cold can make the patient susceptible to getting an infectious disease. Remedies are often used in certain cultures that they may not tell you about.

In the cross-cultural interview, you need first to establish trust through small talk. Use the patient s formal name if you do not otherwise know how to address them. Know that some Islamic people and Orthodox Jews do not allow touching between people of different cultures. Other cultures will not agree to touch unless you explain what you are doing.

While you should use an approved interpreter with your interview, you should also use slow and simple language, and you should use body language. Speak directly to the patient and not to the interpreter. Know that patients may not ask questions of you out of embarrassment or incomprehension of the problem. Smiling in East Asians means embarrassment rather than anything else.

Find out what you can about what the patient s illness means to them and what they think has caused this. Provide instructions in written form when possible and determine if the plan is agreeable to the patient. Have the patient repeat their instructions in their own words.

In some cultures, it is better to relay a bad prognosis to the patient s family first and then to the patient. It is felt that a bad prognosis will lead to hopelessness, which will be a self-fulfilling prophesy. You need to find out what is preferable to the patient and family before giving them your prognosis.

The Latino culture is predominantly Mexicans but can be a person from a number of different countries. There can be distrust of healthcare professionals that leads them to avoid seeking healthcare, even though they have a much higher risk of type 2 diabetes. There are many Latino healing traditions that distinguish natural illnesses and supernatural illnesses. There are midwives that provide obstetrical care and many healing treatments that can actually be harmful to the patient. There are traditional therapies that offer balances between hot and cold illnesses.

Asian cultures can be Chinese but also can be Indian, Filipino, Korean, Japanese, or Vietnamese. The family structure is very important and confrontation is avoided. Personal honor is also important, with loss of honor a devastating thing. Expect traditional Chinese medicine, which focuses on yin and yang, which are hot and cold energies. Hot tea or hot water is favored over cold beverages.

You should be aware of the possibility of scars from acupuncture or moxibustion, which is the application of smoldering herbs to the skin or an acupuncture need. Cupping leads to large circular lesions and coining will lead to smaller burned areas from hot coins dragged on the skin. Mongolian spots are birthmarks seen in Asian, Latino, and African babies that can look like child abuse. Asians are more likely to have somatization rather than an obvious psychiatric illness.

Despite the fact that Black Americans have been in the US for generations, there is still a distinctive culture. There are so many differences in education and healthcare that lead to a shorter lifespan in this population. There is an overall distrust of white healthcare institutions. They have a genetic risk for hypertension, which leads to a much higher risk of stroke. Added to this is the fact that they often do not see this as a chronic condition.

Things you should be aware of include falling out”, which is a stress-related collapse, and bad blood”, which is often an STD. Pica or the eating of non-nutritive substances is common among black women. Religion and prayer are important influences with Ramadan, a black Muslim fasting tradition, sometimes affecting healthcare. Root medicine is practiced among witch doctors, particularly in the black south.