Cultural Issues

Informed consent is extremely important in treating the emergency patient. Remember that consent can be written, verbal, or implied. Treating a patient without consent, even if it is to do something like starting an IV, can be called battery. Most consent in EMS care is implied unless the patient is alert, oriented, and able to sign a consent form. Implied consent involves caring for the patient who cannot give consent but any reasonable person would give similar consent if able to.

People under the age of 18 years cannot give consent legally so a parent or legal guardian must give consent for them. A teacher or principal of the school will be able to give consent until the legal guardian becomes available. Only emancipated minors, such as those who are pregnant, in the armed services, or who are married are considered legally emancipated.

Any adult or emancipated minor has the write to refuse medical care, regardless of reason. This is true, even if the lack of treatment is detrimental to themselves. What you have to do is prove that the patient understands the risks of treatment, the benefits, and the alternatives available. The EMS provider should document whether or not the patient has the capacity to refuse treatment. If things like restraints are necessary but refused, you should document why they are best for the patient’s safety or the safety of others.

One federal law that is followed is the federal HIPAA law. This law specifically addresses confidentiality of patient care with the only exception being mandatory reporting. Mandatory reporting is necessary for things like gunshot victims, stabbings, sexual assault, elder abuse, or child abuse. EMS providers are mandatory reporters of these kinds of things.

CULTURAL ISSUES

Healthcare in just about any part of the US can be complicated by language and cultural barriers. There are features of the western medical system that are not shared by everyone who receives it. There are differences in the medical concept of disease and the patient’s concept of illness. This is even more magnified when there are cultural

differences between the patient and the providers. These things can stymie any attempt at treating the patient who is ill.

The communication between patient and provider involves some type of socialization, diagnostic questioning, planning of care, negotiation, the setting of goals, treatment, and education. These things can all be interfered with because of cultural boundaries, which influence the patient’s reality about their illness. Complicating matters is the fact that the interaction between patient and provider tends to be provider-dominant.

You need to remember that patients do not generally use just biomedical methods of solving their healthcare problem. They use other things, such as folk medicine, popular treatments, and religion. Just because they are asking you for care doesn’t mean they are not using other treatments and therapies. Popular and folk remedies may or may not work but you need to consider all of the possibilities for how these remedies will work for the patient.

The culture of a patient involves a pattern of behaviors, customs, and ideas shared by a group of people. It is ever-changing. Cultures will evolve rapidly whenever there is migration of a group from one area to another. Cultures can be divided into those that are “collectivist” and those that are “individualist”. You should attempt to define what type of culture your patient comes from.

Culture has a huge influence on health and healthcare. Culture will affect the patient’s perceptions of illness, health, and death, the causes of disease, how illness and pain are experienced, and what type of care the patient seeks. Both the provider and the patient will have cultural influences with regard to healthcare.

While culture is important, it is always dynamic and evolving; there are many influences on culture so it is important not to over-generalize about it. It tends to be passed from generation to generation, and is shared by a group of people. It manifests itself through dress, language, music, and behaviors. It is integrated throughout the patient’s life and not just related to healthcare.

There will be diversity within any single culture and there are many factors that influence a patient’s experience besides culture. The negative effects of cultural

influences may be well-hidden by the patient. Migration to another area of the world will accelerate the changing of cultural influences, particularly in children.

There is actually a continuum between collectivistic and individualistic cultures. These will give rise to different view on human health, the treatment of illness, the causes of disease, and the diagnoses. Family members will or will not be part of decision-making, depending on the culture. The differences between the two cultures involves the following:

Collectivistic cultures focus on “we”. They promote interdependence between members and value connection to the family. Respect and obedience are valued and the focus is on group goals, harmony and cooperation among the members.

The individualistic culture focuses on “I”. Autonomy is valued as is the ability to make individual personal choices. Individual achievement is emphasized and there is a lesser influence of group values and views.

Culture helps patients view disease and health in different ways. The causes of disease are somewhat culture-dependent. Some cultures are more fatalistic about the outcome of a disease process, believing that things cannot be changed. Some cultures highly stigmatize certain diseases, particularly mental health issues. In some cultures, for example, being overweight is equated with being strong rather than being unhealthy. Other cultures believe in stoicism, while there are those that strongly express their pain. Compliance with cares is also very culture-dependent.

Different cultures will have alternative theories about who should be told about an illness and when. Preventive care is something some cultures do not practice. Death and dying practices vary according to culture. If there is a language barrier, there might be some things that are not discussed through an interpreter. Eye contact can be thought of as polite or rude, depending on the culture. Gender roles are also culturebased.

As a healthcare provider, you should understand your own belief system. You should understand the different cultural biases and work with them rather than against them. Listen for cultural influences on your patient’s behavior and presentation. Know that families and patients will often use alternative therapies or complementary treatments.