I recently got into an extended conversation with several (western) Physicians who are also teaching in various medical contexts overseas. What do we do with cultural aspects of medicine that are different than our own culture?
The two aspects of this that we talked of most were:
Should you tell a patient that they are dying (if they have a terminal diagnosis)?
Should we humiliate medical students when they should be doing better?
A little background on the two… In the West, if a patient has Cancer and will probably die, we tell them that. We know detailed odds of death and life, and freely share this data with the patient with the diagnosis.
In Asia (and other cultures), local Health Care Providers may never tell bad news to the patient directly, and often paint a rosy picture of a diagnosis.
For the other topic, that of humiliation, in the West, we are not supposed to humiliate our students. But in the East, humiliation is one of the most common ways of teaching, demeaning those who don’t know the answer, debasing those who didn’t study what they were supposed to study.
So I am a Western Physician in the East…
Should I tell a patient that they have a terminal illness?
Should I humiliate my students who aren’t studying what they are supposed to?
Some of the Western Physicians newly arrived in the East wouldn’t tell their patients about their terminal illness. Those who had been here longer talked more about how important it is to tell them in the best way. We need to tell the truth, we need to tell them what the biopsies, x-rays and tests showed, but there is a way to do it that is appropriate to their culture. We may never use the word “death” or “cancer,” but we can still communicate those things. We assure them that we can help with symptoms; we assure them that we will not abandon them, we offer prayers… There are many things we can do and say, we can say it in a culturally appropriate way, but we do tell them. We do not just say, “Everything is going to be just fine.”
So we hashed through that in a reasonable way.
Then we moved on to humiliation. Everyone agreed that we saw it all around us in teaching here. No one liked the word, “humiliation.” We had a hard time figuring out how to persuade students to actively engage in learning without humiliating them, when they were used to having this fear over them.
So how do I teach? If I do not act like the “Big Man Important Doctor,” my medical students tend not to respect me. After almost 20 years of clinical practice, I clearly know a lot more than they do. But how do I get them to learn? If I ask them to look something up, they tend not to. So should I humiliate them if they don’t do the assigned reading? That is what the other local Physicians do.
So I am looking for godly, helpful, Christian ways to encourage students to embrace learning, without overt humiliation. Or I am looking for a godly way to humiliate someone. :)
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1 comment:
I've been following your blog for several months now (after it was recommended on one of the blogs I follow on a regular basis . . . forget which one) but this is my first time to comment. I must say that I very much enjoy reading your posts. I'll have to explain my interest in your blog via email sometime.
But, here is an entry into the idea of "godly humiliation." Paul, quite often (especially in Rom & 1 Cor), resorts to "don't you know," which, scholars suggest, is another way of saying "you ought to know this but you don't." He calls culpable ignorance to the mat.
AJ
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