What Can We Learn from Lia Lee's Case?
At the end of the chapter, Anne Fadiman asks Arthur Kleinman for "retroactive suggestions" that might have helped Lia's doctors to better understand the family's perspective. He offered the following three suggestions.
- Get rid of the term "compliance," because it implies moral hegemony. You don't want a command from a general, you want a colloquy.
- Use a model of mediation instead of a model of coercion. Find a member of the Hmong community or find a medical anthropologist who can help you negotiate. Remember that a stance of mediation, like a divorce proceeding, requires compromise on both sides. Decide what is critical, and be ready to compromise on everything else.
- Understand that as powerful an influence as the culture of the Hmong patient and her family is on how this case played out, the culture of biomedicine can be equally powerful. If you can't see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else's culture?
Anonymous provider
In my own practice, I have learned to do joint manipulations to help with back pain and headaches. Many patients prefer this hands-on approach, and it provides an alternative to using medication. I try to discuss any herbal treatments patients may be taking and often try to get them translated so I can check for drug/herb interactions. I believe that asking about herbs is helpful in showing that I respect their beliefs and take their medical problems and treatment as seriously as I would if they were on any Western medication. I hope that my behavior models respect for my patients and their choices, and indicates my concern for any harm or benefit that any treatment, Western or traditional, might cause. Finally, I think it is important to be mindful of the rising cost of treatments and the control issues that patients experience when they commit to a treatment for their illness. |
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