The Spirit Catches You and You Fall Down

Recent conversations I've had around cultural sensitivity and clinical practice have inspired me to revisit this fabulous piece of literature first published in 1997.

The story of Lia Lee, a Hmong child diagnosed with severe epilepsy in the United States, is a tragic account of how cultural misunderstandings can be so very detrimental to a patient's well being. Both Lia's family and her treating Western doctors wanted only the best for Lia. However, their different perspectives on illness and management generated a torturous healthcare journey for all of them, not just Lia.

Sadly, communication failure seemed to be at the crux of many of the problems. 

Most poignant, in the case of Lia, is that many of the doctors and health professionals associated with her care genuinely felt that they were capable and competent communicators.

Anne Fadiman brings incredible perspectives to her analysis of Lia's journey through the American health care system. She draws our attention to a simple but effective tool developed by by Arthur Kleinman, the psychiatrists and medical anthropologist at Harvard Medical School: A Patient's Explanatory Model (refer to page 260).

A Patient's 'Explanatory Model'

This model comprises a set of eight questions for a doctor to ask of their patients and carers, to gain insights into the cultural and belief systems that will impact the care and management of the patient:

1. What do you call the problem?

2. What do you think has caused the problem?

3. Why do you think it started when it did?

4. What do you think the sickness does? How does it work?

5. How severe is the sickness? Will it have a short or a long course?

6. What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment?

7. What are the chief problems the sickness has caused?

8. What do you fear most about the sickness?

Promoted with a cross-cultural focus, the book also addresses issues that extend beyond simply cultural ones. Notions of trust, incorporating mutual respect and willingness to concede to difference are important issues in doctor-patient communication. With respect to the culture of biomedicine, Arthur Kleinman's quote (p. 261) stands out:

"If you can't see that your own culture [biomedicine] has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else's culture?"

I highly recommend this book for anyone passionate about healthcare communication.

See more information at the book's website.

Author: Kara Gilbert @ KMG Communications