Compliance and Culture Clashing
- avanadiashv
- Aug 29, 2023
- 5 min read
It is so easy to look at another culture and say, “those people are crazy” or what they are doing is “stupid and insane.” In fact, these types of comments may be so common that we think them without even realizing it. While oftentimes these thoughts are void of mal-intent, I believe it is worthwhile to discuss their place in medicine. The healthcare profession is filled with amazing people from a multitude of cultures who all have unique experiences, but together they make up a kind of culture in-and-of itself. In the United States, healthcare constitutes the western biomedical culture. I have always associated the term “culture” with something that is inherently imperfect and biased, so I found its association with medicine (what I have viewed as a more scientific concept) unusual. However, this unusual idea turned very concrete after reading The Spirit Catches You and You Fall Down by Anne Fadiman, which discusses how Western Biomedicine and other cultures can clash to cause detrimental effects on a Hmong patient named Lia. This type of culture clash has lasting implications in many examples of medicine today, especially in women’s healthcare.
I often hear the term “compliance” associated with medicine. Doctors want patients to be compliant with their recommendations because that is what they need to do to get better. This idea does not seem surprising at all. Of course, doctors (who have had years of education) expect their patients (who have sought out the doctor's help) to listen to them–it is their job (in a way). In the book, Lia’s parents were described as “noncompliant,” or in more blunt terms, “wrong.” While not direct synonyms, the idea of compliance does create sides–a wrong and a right one. It inherently decides that western biomedicine is the right understanding and noncompliance leaves the patient in the wrong. Now, somehow, they are to blame for the unfortunate outcome. It puts our science and tools in an infallible category and things like herbal medicines and natural remedies in the “nonsense” category. This invalidation of those natural tools and unwillingness to understand the Hmong culture created a large disconnect between Lia’s family and her doctors. This is not me saying that United States doctors should start giving out prescriptions of herbs and plants, but I am saying that this hierarchy of “correctness'' (that is found in medical terminology like the word compliance) likely causes more people to stay away from healthcare than approach it.
While under different circumstances, this invalidation of a culture’s beliefs is applicable to the invalidation that some women experience when explaining their symptoms to medical providers. According to Duke Health, “One in five women say they have felt that a health care provider has ignored or dismissed their symptoms, and 17% say they feel they have been treated differently because of their gender—compared with 14% and 6% of men, respectively.” These negative feelings create a gap between many women and providers, leading to more women avoiding medical care. Many women share their stories online, leading to an even further mistrust between women and medical providers, even those who have never experienced a negative experience first-hand. For example, Bindi Irwin shared her story online: she explained her symptoms of “"insurmountable fatigue, pain, and nausea” to a doctor who told her that those symptoms are “simply something you deal with as a woman,” leading her “[give] up entirely” and “try to function through the pain.” This “normal pain” was actually undiagnosed endometriosis that was dismissed as symptoms of “being a woman.” While I would like to say that this was just one person’s experience, (according to a 2019 Healthy Women Survey) “45% of respondents said they didn't think their healthcare providers took their pain seriously.” I speculate that one reason for these bad experiences is the inherent culture of western biomedicine. Almost every past foundational study on medical treatments and advancements was done on a male. Thus, basically every aspect of those results from symptoms to dosages are in the perspective of a male patient, leading to the mistreatment of people who are not a part of this demographic. Historically, many cultures attributed women’s health issues to the uterus (the history of women’s hysteria). This history of western biomedicine is still a part of its culture, and thus has lasting effects on how women are treated in medical care today. It is important to recognize that the foundational aspect of medicine creates disparity alongside the idea of compliance because its harmful effects still affect people every day, and this idea of “compliance” or “correctness” just solidifies ingrained issues and causes even more harm to patients.
In the end of the book, the author goes into a discussion about who is to blame for Lia’s outcome, and the overall answer seems to be nobody. Whether the outcome was inevitable or not, there seems to be no culprit. Lia’s parents tried to help her with their understanding of the right thing to do and Lia’s doctors did the same. Their approaches misaligned and collided, leading to ineffective care and likely a long-term mistrust of doctors by the Hmong community. This long line of mistrust all stemmed from a lack of understanding. Doctors saw the Hmong remedies as near pointless and the Hmong saw the doctor's remedies as somewhere along the lines of dangerous. I think this lack of blame relates to the women’s healthcare issue mentioned previously. I believe that a majority (hopefully all) doctors do not intend to hurt their patient or dismiss their fear or pain. Therefore, I view this healthcare issue as more of a cultural problem rather than an intent problem, in which a shared objective (to help) between patient and doctor is unmet due to misunderstanding and misalignment between groups of people. I think this understanding is beneficial because it creates a blame-free space to discuss solutions. While it is easy to “point the finger” and tell doctors to stop dismissing feelings, these “solutions” do nothing if doctors are not aware of their dismissal in the first place. Creating awareness about these issues is likely the first step into reducing the mistrust within medicine.
It took the treatment of one child to create a legacy of mistrust of the United States healthcare system by the Hmong people, and it took countless public stories to create a sense of fear within a portion of 50 percent of the American population. These are the long-standing effects of the “hierarchy” within medical care: the belief that doctors know best and patients should comply. Doctors are very knowledgeable and help countless people with their education and experience, so it is easy to place them on the pillar of “correctness,” despite how their humanity creates inherent error. While humanity and culture create error, it also creates great doctors with whom patients can relate to. The complicated nature of these types of social issues leaves no room for “clear-cut” solutions. Rather, (from my understanding) I think these social gaps can start to be bridged by 1. Understanding our own cultures. 2. Compromising and communicating with each other, even if it means picking treatment options with a potential lower effectiveness and more possible risk. To be clear, I am in no place to give advice to physicians, but as someone who loves the medical field, I hope new systems and understandings can be utilized to better aid the code of “do not harm.”
Sources:
The Spirit Catches You and You Fall Down by Anne Fadiman
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