Course raises doctors’ cultural consciousness

The Western scientific medical model has produced stunning achievements in extending life and treating disease.

But in the relentless march of science, some say, the doctors have lost sight of the patient.

A required course for all first-year School of Medicine (SOM) students, “Culture Matters,” aims to put the patient back in the doctor’s sights.

“There are some doctors that patients flock to,” said Assistant Professor of Emergency Medicine Iris Reyes, the course’s co-director. “These doctors understand their patients. For example, my sister-in-law came down with breast cancer a while back. She had incorporated some Japanese ideas about medicine into her thinking from her years spent in Japan.

“She went to a world-renowned oncologist for treatment. When she brought up her thoughts, the doctor dismissed them. She left.”

As Reyes sees it, this style of dealing with patients does neither the doctor nor the patient any good. While traditional folkways may not be all that effective from a medical standpoint, doctors who ignore or dismiss them may find that their patients then shun lifesaving treatment.

“Culture Matters” seeks to sensitize future doctors to cultural issues in medicine. “For instance, if a patient believes her illness is of a spiritual nature, just prescribing pills isn’t going to cut it,” Reyes said.

“If the patient doesn’t buy into a treatment program, it will fail, or [the patient] will keep shopping for a doctor they can bond with.”

Now in its third year, the course grew out of another required first-year course on doctoring. Jerry Johnson, professor of geriatrics and the course’s other co-director, and Lynn Seng, director of special education programs at the Medical School, argued that the school should devote four hours of the first-year course load specifically to cultural sensitivity issues.

“The SOM administration said that four hours is nowhere near enough,” said Reyes, who was invited to join the course after Seng heard her deliver a grand rounds lecture on cultural sensitivity. The course ended up taking 16 hours on the schedule, a sign of the importance the school places on the subject.

The goal of the course, she said, is not to place traditional beliefs on the same plane as scientific medicine, but rather to get doctors to take them into account. “Our goal is to create a bridge that [doctors] can cross over [to] understand their patients. We’re not asking them to accept [these views] uncritically. It all boils down to communication.”

Reyes offered another example from her own Hispanic culture. “Some Hispanics have a theory that you should treat a ‘hot’ illness with a ‘cold’ cure,” she said. “There was a patient with asthma [considered a ‘hot’ illness] who refused to use a drug that came in a yellow container, because that was a ‘hot’ color, but took another drug that came in a blue one,” which was “cool.”

The course has advanced to the point where senior students now serve as discussion leaders and mentors to the 150 first-year students in the class. While Johnson and Reyes are the chief instructors, most of the real learning occurs in the student-led discussion groups.

Reyes, who is Puerto Rican, grew up in the Bronx, but sees herself as the product of many cultures. “You can be Russian, you can be gay, you can be a physician—we’re a culture too.” She sees the course as the key to producing a new generation of more effective physicians. “Though every physician should be interested in this subject,” she said, “it’s very difficult to teach an old dog new tricks.

“We’re hoping this new generation of physicians are more culturally sensitive.”

Originally published on September 18, 2003