Reference no: EM133093996

Part 1

Scenario 1 - Hmong family

Kao Sua Fang, 80, is a patient at Riverbend City Medical Center. Mrs. Fang is a Hmong immigrant who was born in Laos. Because of upheaval during the Vietnam War, she lived with her husband and children in a refugee camp in Thailand for two years, and then she and her family immigrated to Riverbend City. Mrs. Fang has six children and fourteen grandchildren. She has been a widow for the past five years, and lives with her oldest daughter and her family. The family lives in a community with a large Hmong population, and this is where Mrs. Fang is most comfortable. Although she is proud to be an American, she feels very strongly about preserving Hmong traditions. In particular, she is suspicious of Western medicine and prefers traditional Hmong healing practices.

Mrs. Fang is in the hospital because of an infection that became serious due to her unwillingness to go to a doctor. After she was taken to the emergency room by ambulance, about 25 relatives crowded the waiting room. The receptionist was taken aback by this and told the family that only immediate family should be there. Family members considered this rude, as in Hmong cultures, all family members see themselves as close and "immediate." During Mrs. Fang's visit, she was visited at the hospital several times by a shaman, who performed several traditional healing practices.

Mrs. Fang is about to be discharged. She will need to adhere to a complicated schedule of oral and topical medication; otherwise, the infection could become deadly. Mrs. Fang's doctor asks to speak to the family members who will be helping Mrs. Fang with her medication. Mrs. Fang insists that the doctor speaks to her son-in-law, even though her daughter and granddaughter will be the ones helping her with her medication. This is typical in traditional Hmong families; women are the caregivers, but they see communication with authority figures (like a doctor) as outside their realm.

The doctor speaks to Mrs. Fang's son-in-law about the complicated medical regimen. She repeatedly asks if he understands, and he repeatedly says yes, and he does not ask any questions of his own. The doctor is unsure if he truly understands. In Hmong culture, questioning authority is taboo. Asking a doctor questions may be seen as questioning authority. The same is true of telling a doctor that one does not understand instructions.

Question 1.

What are some of the key differences between Hmong culture and the norms and expectations in this healthcare setting?

Question 2.

How can the doctor adapt her communication approach with respect to Hmong cultural norms?

Question 3.

What cognitive challenges might the doctor also need to consider when communicating with the patient and her family?

Scenario 2 - German Family

Petra Richter, 80, has lived in Riverbend City for ten years. She lived for most of her life in Frankfurt, Germany. Mrs. Richter's daughter came to the United States fifteen years ago with her husband to pursue a job opportunity. Nine years ago, Mrs. Richter came to the United States and now lives with her daughter, son-in-law, and grandchildren. She does not have strong English language skills.

Mrs. Richter was admitted to the hospital because she was suffering from severe pain. The doctors discovered that she has bone cancer. The cancer is not curable, and without medications, her prognosis is probably less than a year. Chemo and medications could possibly extend her life, but may decrease the quality of her life. An elderly patient like Mrs. Richter may or may not choose to undergo this treatment.

A doctor at the hospital needs to break this information to Mrs. Richter and her daughter. The doctor approaches the daughter and suggests that the two of them talk before Mrs. Richter is brought into the conversation. Mrs. Richter's daughter is upset by this. "My mother is a not a child," she says.

The doctor then meets with Mrs. Richter and her daughter, who is needed to translate. He breaks the news gingerly, emphasizing that the treatments may improve the quality of her life and possibly give her more years. He is hesitant to give the actual prognosis; this, he feels, should be left to her oncologist. The doctor sees his role in this situation to concentrate on "bedside manner," and to give the patient as much hope as possible.

Mrs. Richter and her daughter, naturally, are upset about the diagnosis. But to the doctor's surprise, they are also annoyed by what they see is his vagueness. When the daughter asks him questions, he continues to talk gingerly about the disease. Finally, she says, "Doctor, why are you not being direct with us? What's the prognosis if the cancer is not treated, and what's the prognosis if it is?"

The doctor then answers the questions honestly and directly. Later, he speaks with another doctor who worked for a time in Germany. This doctor explains that Germans are very direct in their communication, and are uncomfortable with excessive small talk and "beating around the bush." Their behavior may come across as brusque to Americans, but to Germans, efficient communication is polite communication.

Question 4.

How can the doctor adapt his communication approach with this patient and her daughter?

Question 5.

What cognitive challenges might the doctor also need to consider in this situation?

Part 2

Share your reflections on the Cultural Versus Cognitive Influences on Learning interactive activity. What other situations could the families encounter that might highlight cultural differences? What workplace experiences have you had in which cultural differences are significant factors educators must consider? Share one or two experiences or ideas here, making sure to keep any participants' identities confidential.