Below is a limited word response to the question of how individual context shapes ones world view in medicine. It is as published in a discussion in a graduate course I am taking. Assumed is having read the article by Blackhall, Frank, Michel and Murphy (2001) found here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3456201/. I encourage you to read the study for some interesting insight in patient feelings about the truth of serious diseases.
Although these considerations are written in light of physician truth telling, it is relevant to the per-hospital provider who is faced with degrees of information shared with patients. Is it always right to tell the frank truth, or can some relativism to your patient allow insight into how to communicate the truth in a way that makes your patient’s trust in your care beneficial to both parties. Perhaps we shall call it tact?
The question this week is practically philosophical. It begins with our individual experiences within the context of a world we are thrown into at birth and through our human development as Heidegger’s (1962, p.1) Sein, German for Beings, that are acted upon and act upon the world around us simultaneously. The context is a question of views that while we are in our daily lives, surrounded by those who think like us, is considered normal. Once we are forced outside of our own cultural context, and into a different context, we find our views are different. In illness this view of the world clashes with the world’s trend toward Western medicine to battle complex diseases.
The context is clear in Blackhall, Frank, Michel and Murphy’s (2001) research on truth telling of serious diseases in African-American, European-American, Korean-American and Mexican-American ethnicities where Korean- and Mexican-American’s displayed objection to knowing either the diagnosis or prognosis of diseases. Although some of the cultural reasoning between the two groups may differ, a trend of conflict in their perception of knowing the truth and the tendency of providers to want to tell the truth signals a quandary for the provider who seeks to inform patient’s in variable cultural contexts that an individual holds.
The formation of these concepts are in the familial upbringing and social context provided to children. The Korean- and Mexican-American cultures rely heavily on familial relationships and care for the feelings of their family members (Blackhall, Frank, Michel & Murphy, 2001). It is also evident in the Hmong patients treated in the United States and their distrust for physicians almost to a punitive style of compliance (Fadiman, 1997). The fact that these cultures have close familial ties is not enough to explain how the context influences their view of the world. It is that narrow view of the world and the intersection with other views, which are likely equally narrow, that holds as some evidence that the context is from the close rearing of the child and close familial ties. Education and ability to speak and read English among the Korean- and Mexican-American respondents were comparatively more open to truth telling (Blackhall, Frank, Michel & Murphy, 2001, p. 61). Higher education and learning a non-native language widen a comparatively narrow view. Narrow versus educated should not be taken to mean that the uneducated are somehow wrong, or lesser because of their narrow view.
The ability of the those educated and integrated (through language) to be more open to truth telling should be taken as a cue for providers to understand that they also suffer narrow views, the view that telling the truth is right. Clearly patients don’t think categorically that it is right. This signals a need for more cultural reflection on the provider’s part to integrate with her patient’s cultural needs. Truths may be told, but how they are told is significant. It is natural for our narrow view to be considered right, across humanity. So who is most right?
Blackhall, L. J., Frank, G., Murphy, S., & Michel, V. (2001). Bioethics in a different tongue: The case of truth-telling. Journal of Urban Health, 78(1), 59-71.
Fadiman, A. (1997). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus & Giroux.
Heidegger, M. (1962). Being and time. New York, NY: HarperCollins Publishers