Cancer: A Failure to Communicate - Reflections by Dr. Sheik
Hassan and Dr. Hossam E. Fadel
Comments: Let us begin with two general questions:
- " Was a biopsy done to establish the diagnosis of small
cell carcinoma?
- " Did the nurses attempt to schedule a meeting with
the patient's son and/or wife to obtain information?
Specific comments on the case:
- " One must be sensitive to both religious and cultural
values. Muslims from different cultures, even within the same
country, may have different values and may interpret some
aspects of the religion of Islam differently.
-
" The nurses/physicians caring for the patient could
have arranged a set time for the son to be interviewed with
the patient to obtain the history. This could also have
been done by telephone. Of course, federal law (HIPAA) necessitates
that the patient's permission must be obtained. It is preferable
that communication with the patient be done via a non-family
member in order to reduce the likelihood of not telling
the "whole truth." The best option would be a
professional translator. The son probably wanted to protect
the father from the bad news and felt he was helping him;
but in reality he may have harmed him, because not knowing
the seriousness of the disease may have led the father to
refuse treatment that may have been beneficial.
-
" Muslims are prohibited from eating pork or anything
with pork products. This includes foods that may have been
prepared with pork or its products (before or after cooking),
even if the products are removed before serving. Thus any
Muslim who is following the religion of Islam to any degree
will not take such food. Some Muslims will take the food
if they are assured that the food was prepared without pork
or pork products. Other Muslims may not take the food even
with assurances, but particularly if they have had (or have
heard of) prior experiences where pork or its products were
found in the meal, despite assurances to the contrary. (We
have personally experienced this sort of situation several
times in the past.) The chief nurse's comment that "…while
religious belief is important…" minimizes the
religious belief and shows a lack of sensitivity to the
values of the patient. She should have assured them that
she would ask the dietary department to prepare pork-free
meals for Mr. Tabrizi. She also should have voiced strong
support and encouragement of the family and friend to bring
outside food for the patient.
-
" Most Americans are aware that Muslims pray five
times daily. The nurse or doctor asking the patient what
the hospital can do to facilitate his prayers would likely
have gained his confidence.
-
" Dr. Looke conducted himself appropriately when he
asked the patient's permission to have someone translate
his findings and plans. Recognizing that the patient does
not speak English, Dr. Looke could have presented the bad
news to the son away from the patient first. This would
allow the son to clarify any questions he had, and he would
have been more prepared to inform his father of the diagnosis
and treatment options. Since Dr. Looke did not speak Farsi,
he could have allowed the son to discuss the matter with
the patient. He would later enter the room to answer any
additional questions.
- " Dr. Looke should have explained the consequences
of no treatment and contrasted those consequences with the
possible improvement in the patient's quality of life, even
for the relatively short period of additional survival that
the treatment would bring about. He also should have more
carefully described the side effects of the therapy in a way
that Mr. Tabrizi could have better understood them.
Return to the case
Introduction
to Culturally Competent Care
Introduction
to Culturally Competent Care for Muslim Patients
Sheik Hassan, M.D., is Associate Dean for Academic Affairs
and Associate Professor of Medicine at the Howard University
College of Medicine in Washington, D.C.
Hossam E. Fadel, M.D. is a Clinical Professor of Obstetrics
and Gynecology at the Medical College of Georgia and specializes
in maternal-fetal medicine at University Hospital, Augusta,
Georgia. He is also the chairman of the Ethics committee of
the Islamic Medical Association of North America (IMANA) and
the Editor-in-Chief of its journal (JIMA).
February 2008
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