Partners in Care:
Curiosity, Cultural Humility and Tailored Informed Consent Counseling in Medical Decision- Making by Nicole Bichir, MD
As immigrants across the Commonwealth are being impacted by negative messaging and legal changes this year, it is a perfect time to examine the many assumptions we hold and dedicate attention to our practices in cross cultural communication. The immigrant population in Louisville is incredibly diverse, with unique stories and factors that can impact every medical decision. Imagine something as simple and seemingly benign as the snack that we offer a hungry patient in the clinic or hospital setting: a common option may be the classic sandwich. One could argue that in this act of kindness, there couldn’ t or shouldn’ t be any specific options. However, in the attempt to satisfy the hunger and truly show kindness, that sandwich reveals many assumptions we’ ve just made about the patient. These include a lack of dietary restrictions related to allergies, lactose intolerance, vegetarian or vegan needs, as well as familiarity with and interest in a sandwich. As both a traveler and an immigrant health advocate,
I recommend options that cater to a broader audience and may be more easily recognized and palatable, such as rice, roasted vegetables or plain fruit.
Taking this concept of thoughtfulness and inclusion, and applying it to health care decisions, we can see that every single decision we make with a patient-centered approach is not as simple as following a guideline, or“ usual care.” It is most appropriate to start the process with many more questions than answers. In global health, there is a concept called“ Majority World Healthcare,” in which we zoom out from US-centric norms, and consider what is usual in most of the world, including in low- and middle-income countries( LMICs). In LMICs, there are often disparities in access to care: both severe provider shortages and the lack of guaranteed medical care even in the emergent setting. For instance, the patient may choose initially to go directly to the pharmacy, where one can obtain any drug available without prescription. Or some will first see a healer with generational
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