The Spirit Catches You and You Fall Down

I. The Spirit Catches You and You Fall Down - The Eight Questions (page 260-261)
Arthur Kleinman, a psychiatrist and medical anthropologist at Harvard Medical School, developed a set of eight questions that are intended to get the patient to explain their thoughts on health problems.

1. What do you call the problem?

2. What do you think has caused this problem?

3. Why do you think it started when it did?

4. What do you think the sickness does? How does it work?

5. How severe is the sickness? Will it have a short or long course?

6. What kind of treatment do you think the patient should receive? What are the most important results you hope the patient receives from this treatment?

7. What are the chief problems the sickness has caused?

8. What do you fear most about the sickness?

Anne Fadiman said that any cross-cultural medicine discussions she came across quoted these eight questions and that first glance she found them to be so obvious but after rereading them many times found them to be quite genious. She pondered how discussing these simple questions between Lia's doctors and her parents might have made a difference in her treatment and her outcome. She filled in the questions with the answers she thought the Lees would say and contacted Arthur Kleinman to hear his thoughts. None of the speculated answers surprised him as Anne thought they would, and she asked him if he had any suggestions for Lia Lee's pediatricians. In brief he suggested, "get rid of the term 'compliance.' ...look at a model of mediation. ...understand that as powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful. If you can't see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else's culture?"

II. American Academy of Family Physicians - Cross-Cultural Medicine
(http://www.aafp.org/afp/20051201/2267.html)
(http://www.aafp.org/afp/20051201/2267.pdf - PDF Version)

This article from the American Academy of Family Physicians states the need for increasing cultural competency on the part of our physicians due to the continual increase of cultural diversity in the United States. The article describes in detail the proper way to hold a cultural interview between a physician and patient including sample questions to ask as well as a list of web-based resources for cross-cultural medicine.

III. Analysis

"A person's worldview (i.e., basic assumptions about reality) is closely linked with his or her cultural and religious background and has profound health care implications." (Cross-Cultural Medicine from the AAFP) The more a physician knows not only about an illness but the patient the illness is affecting, the better the treatment and the possibility of saving the patient. The gap between physician and patient, especially those patients of a different cultural background, needs to be bridged if the physician is to give and the patient is to receive optimal care. While this article and Kleinman's eight questions weren't even considered by any of Lia's doctors, this does attest to the fact that western medicine is taking steps, as small as they may seem to the public, to cross cultural borders and improve upon the medical treatment of different ethnic groups. I believe the communication between the patient and his or her doctor needs to be a two-way street, and although the doctor will probably be the one who will need to open that line of communication everything should be put onto the table. "Remember that a stance of mediation, like a divorce proceeding, requires compromise on both sides. Decide what's critical and be willing to compromise on everything else." (Kleinman) As Nao Kao Lee said, "you need a little bit of medicine and a little bit of neeb."

http://hmonghealth.org/
http://www.hmongnet.org/