Culture, Ethnicity, and Medicine

Abstract

Culture is a part of who we are and how we manage our health and illnesses. During training, most physicians are confronted with people who represent cultures and values that are remarkably different from their own background.

Appendices

Appendix A: Tables with Possible Answers to the Vignettes

Case Vignette 14.1: Presenting Situation—Pinky

Case 1: Basic Principles and Definitions

Learning Issue Table 14.1.1

Facts	Hypotheses	Information needed	Learning issues
7-year-old child with acute gastroenteritis, and mother	Mother does not understand diagnosis?	More info needed on cultural and familial context of this situation	Define culture, race, and ethnicity
Recent immigrants	Mother does not believe diagnosis?		Be familiar with the DSM-5 Outline for Cultural Formulation
ESL	Mother is worried about another possible cause of child’s illness?
Mother crying when told of child’s diagnosis	Mother feels inadequate or has her own mental health issues?
	Language barrier?
	Are there other people involved in the child’s care?

Case Vignette 14.2: Presenting Situations—Junior, John-boy, and Lisa

Case 2: Adaptiveness of Diversity

Learning Issue Table 14.2.1

Facts	Hypotheses	Need to know	Learning issues
Filipino-Caucasian newborn with jaundice	Physiologic jaundice since no obvious risk factors? Or something more to consider?	Does ethnicity or family history put this child at risk for jaundice?	Culturally competent clinicians should be aware that certain conditions may affect certain ethnic groups more than others
7-year-old Pacific Islander (PI) boy, overweight, with stuffy nose, headache, fever	Need for a throat culture? How to address obesity?	Do current treatment guidelines for strep throat apply to this patient?
17-year-old Japanese female with nausea, vomiting, and headache, recently started in escitalopram	Is this a drug reaction or is there another cause for her symptoms?	What role do culture and family play in managing this child’s obesity?
		How is escitalopram metabolized?
		Does Patient’s (pts) ethnicity put her at higher risk for a possible drug reaction?

Case Vignette 14.3: Presenting Situation—Sammy

Case 3: Reducing Health Disparities

Learning Issue Table 14.3.1

Facts	Hypotheses	Information needed	Learning issues
25-year-old PI male	Possible contributors to “noncompliance”	Patient’s cultural context	Be aware that cultural factors may place certain groups at risk for certain illnesses
Seizures	Cost of medication	What is a useful tool for evaluating cultural factors in a clinical encounter?	Cultural differences between clinician and patient may pose a barrier at times
Intermittently homeless	Unexpected metabolism of medication	What is patient’s health insurance?	Be familiar with the DSM-5 Cultural Formulation Interview
Inconsistent primary medical care	Language barrier
Needs bus pass form to be completed	Inadequate support network
	No transportation
“Noncompliance”

Case Vignette 14.4: Presenting Situation—Julius

Case 4: Cultural Concepts of Distress

Learning Issue Table 14.4.1

Facts	Hypotheses	Information needed	Learning issues
Mixed Asian/PI toddler with bruises	Child abuse?	Cultural context of child and family, including traditional healing methods	Culturally competent physician needs to be aware of DSM-5 Cultural Concepts of Distress, including:
	Occult medical illness?	Thorough medical examination	1. Cultural syndromes
	Cultural healing practice? (Cupping?)		2. Cultural idioms of distress
			3. Cultural explanations or perceived causes
			As well as traditional healing practices

Appendix B: Answers to Review Questions

• 1. e

• 2. a

• 3. e

• 4. a

• 5. b