We have
talked a lot about culture and health in this class. I mean we have practically
beaten it to death with a big, critical, scholarly stick. However, I have been
reading this book called “Medicine and Culture”, which discusses the
differences between the ways medicine is practiced in four developed countries:
the U.S., Germany, France, and Great Britain.
It is so fascinating. We often talk about the different diseases that
plague countries, and how social standing and geographical location affects the
types of diseases and social problems you encounter, but this book looks at it
from a different angle, and illuminates the differences in medical diagnosis,
treatment, and care provided to patients. One World Health Organization report
found that doctors from different countries diagnosed different causes of death
when given identical information on the patient and death report.
For
example, if the same patient were to go to a physician in each of the four
countries with the same ailment, such as fatigue, the diagnosis and treatment
would differ due to each culturally acceptable medical response. In the U.S., a
physician would tell the patient that he/she had a virus, mostly for the
patient’s comfort of having a diagnosis; in France, a physician would attribute
it to the liver and suggest a natural remedy; in Germany, a physician would
consider the patient to have a cardiac insufficiency, but that is a casual term
that doesn’t warrant worry from the German patient like it would in the U.S.
Not only
are the diagnoses different, but the treatments vary as well. A coronary
by-pass in the U.S. is an extremely popular procedure for patients with heart
problems, but the American rate of coronary bypasses is 28 times higher than
European countries, and has been shown that they rarely need to be done
immediately. One of the most common procedures in the U.S. for breast cancer is
a mastectomy; however, in France and Great Britain, they consider this
barbaric, and rarely an option, usually opting for the “tylectomy” (British
term for lumpectomy) (Payer1996). Causing even more room for confusion, what we
consider common medical terms for illness don’t necessarily mean the same
things in other countries: peptic ulcer and bronchitis don’t mean the same
thing in Britain as they do in the U.S. These discrepancies lead to a somewhat
alienated profession, whose members barely read medical journals outside of
their own country (Payer 2006), and prevent true collaboration.
All four of
these countries have a certain amount of cultural bias that creates this notion
that their country is doing it the “right way” and is the most scientific, but
really each country just has a different definition of what illness is, what
the symptoms looks like, and a different preference for the way they want to
treat it. I really like this book because we often times lump all developed,
westernized countries together as being very similar, but really, there are a
lot of subtle cultural dissimilarities that create different ideas of what
makes up the term “scientific”.
Payer, Lynn. 2006. Medicine
& Culture. New York: Henry Holt
and Company, Inc.
This is a very interesting post, Emily. We have talked about how as international/public health advocates, we should approach different populations/personalize programs according to how their culture views issues. I consider your point about coronary bypass is just another example of that and it boils down to diet. Looking at the differences in diets, hamburgers, hot dogs, fries, and steaks make up a typical American menu. On the other hand, European menus have a much larger variety of food (including vegetables) and fresh dishes rather than fried items. Another cultural aspect to notice as well is time. When I lived in France, although the school day lasted all day, there was 2 hours allocated for lunch every day. Children in America have to find time to literally scarf down lunch in less than half an hour before returning to class. In Europe, time is taken to enjoy not only the food, but also each other. Time is taken to enjoy the food. As this article in USA Today reported (http://usatoday30.usatoday.com/news/health/wellness/story/2011/08/Students-feel-rushed-at-school-lunch/50027612/1), eating an apple will take more time than eating apple sauce, and kids are picky, so they'll choose to eat their chicken nuggets first before their carrots, so when crunched for time at school, chicken nuggets win the race. Another factor is portion size, which I'm sure everyone has heard about. Add all of these effects up over the years and coronary heart disease and/or obesity become an issue. But I think the way medical professionals deal with medical conditions are dependent on how their respective healthcare system is set up. In America, doctors try to make as much profit as possible so they'll likely recommend surgery over an alternative treatment. So in some ways, the countries' thinking that they're dealing with issues the "right way" may not be so far-fetched, but in terms of public health, this superiority complex needs to be put aside for collaboration and medical advancements' sake.
ReplyDeleteThanks for your great and insightful post. That sounds like a book I would like to read. The differences in perspectives and diagnoses are rather fascinating rather than contradictory to me. I assume that in both countries, you end up getting a cure for your illness even though the diagnoses and treatment methods are different. More doctor told me that medicine is both a science and an art. It is a science in the sense that there are certain scientific fundamentals that each doctor has to adhere to in spite of your country. It is an art in the sense that the origin of some diseases differ from country to country. For example, due to my job that leads to a sedentary lifestyle for 40 hours in a week, I am tired and fatigued by the end of the week. I may experience muscle aches and headaches. If I go to see a doctor here in the USA, he will prescribe a muscle relaxing and and pain killer. If I present the same symptoms to a doctor in South Africa and he knows that I sit for 40 hours a week, he will tell me to go and work in my garden. Do both methods work? Yes they do. Is working in my garden a better option and has no side effects? Yes. So I agree that culture has a great impact on how medicine is practiced and perceived.
ReplyDeleteThis is an interesting post, as are the responses. Onias, you bring up what I think is a very telling example of the extreme differences in medical systems- not just between "western" or "eastern" medicine, but in our conceptualization of disease and symptom. I think it is easy to see that in the U.S. the preference is for a pharmacological response to symptoms, without much interrogation to root causes. I believe you hit the nail on the head when you mentioned that the doctor in South Africa would likely know that you sit for 40 hours a week. Although there are certainly doctors here that take the time to know their patient as well, in my experience it is much more likely that they will be overbooked and the entire visit will be rushed. Your example exhibits the American tendency to treat the symptom, versus the tendency in other countries to treat the actual problem (in this case, needing to move more). I cannot begin to imagine how alienated newcomers to the U.S. (or any country for that matter) must feel when visiting the doctor for the first time. I don't think that there is any one "right way" to perform medical care, only the way that is right for the individual patient. Doctors would be well served by getting to know other medical systems and their patients a bit better.
ReplyDeleteI think perhaps many factors may come into play here that may be misconstrued as cultural differences. For instance, the increased number of coronary artery bypasses may be due to the underlying health policy that influences physician payment for services rendered. Additionally, pharmaceutical companies may have more influence in the US as compared to France, resulting in an increase of pharmaceutical prescriptions as opposed to more natural remedies as seen in France. Certainly, culture does play a role, however the conflation of the multiple (and seemingly limitless) factors affecting health often misconstrue our perception of what really affects what. My concern is that policy and infrastructure problems may be falsely interpreted as cultural differences thus diverting attention from the systematic problems facing health systems and medical practice.
ReplyDeleteThank you for the book recommendation, it sounds fascinating! I agree that the American culture is to medicalize and treat everything. It goes back to the focus on treatment instead of prevention. We don't want to learn about what we can do to prevent it, we just want a simple, easy way to fix it. As Onias mentioned, the South African doctor is more likely to recommend something that will prevent the problem from continuing instead of prescribing pharmaceutical interventions to treat the symptoms. There needs to be a culture shift from just treating the problem to preventing the problem from occuring in the first place.
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