Session 7 Flashcards
(10 cards)
Give a definition of cultural identity
[*] Many definitions of vulture – not value free
[*] The concept of culture, cultural identity or belonging to a cultural group involves active engagement
[*] Dynamic process
[*] Problematic to assign cultural categories externally on single characteristics
[*] Identity draws from culture but is not simply formed by it
What is the AAMC definition of culture?
- Culture is defined by each person in relationship to the group or groups with whom he or she identifies
- Based on heritage as well as individual circumstances and personal choice
- Cultural identity may be affected by many factors such as race, ethnicity, age, language, country of origin, acculturation, sexual orientation, gender, socioeconomic status, religious/spiritual beliefs, physical abilities, occupation among others
- These factors may impact behaviours such as communication styles, diet preferences, health beliefs, family roles, lifestyle, rituals and decision-making processes.
- All of these beliefs and practices in turn can influence how patients and healthcare professionals perceive health and illness and how they interact with one another.
[*] The AAMC definition is
- Patient-centred/individual-centred clinically applicable
- Through interplay of external and internal meanings construct a sense of identity and unique culture
- Patients define which aspect of their cultural belonging is relevant at any particular point
- Dynamic definition allowing for change in clinical contexts at different life stages and on the clinical presentation itself.
What is meant by Diversity?
[*] Diversity: imprecise and inconsistent use
May mean diversity of ethnicity for which the term ‘multiculturalism’ is often used (e.g. Culhane-Pera et a 1997, Loudon et al, 2001)
Much broader range of difference relating to individual characteristics beyond ethnicity
Give examples of ways in which culture can impact on patients’ presentation to health services
[*] Service presentation influenced by culture in:
- The way they think about mental health and mental health problems
- The way they make sense of certain symptoms and behaviours
- Their view of potential services and the services they choose to accept
- The treatment and management strategies they find acceptable
- The way in which those who have mental health problems are perceived.
- Issues of access (overplayed); experience of service use; visibility of services
[*] Problems for young people that may be related to culture
- Pressures to conform to practice their family’s religion or other practices that do not sit comfortably with the young person
- Pressures to conform to expected gender roles (boys wanting to pursue careers generally considered to be in the female domain such as nursing, child care and vice versa)
- Pressures to conform to the social norms e.g. the expectation that a young person will go onto further education despite this not being what the young person wants
- Pressures to conform to family expectations that different from what the young person wants (e.g. an expectation that the young person works in the family business).
- Sexual orientation
- Impending forced marriages
- Difficulty in reconciling the culture in the private and public domains
What does it mean to be a reflective clinician?
- To provide a sensitive and respectful service acknowledging cultural need and belief
- How: history taking, tick-box checklist regarding sociocultural dynamics
- To respect cultural individuality whilst maintaining patient-centred curiosity
- How: care planning and/or cultural information sharing without making assumptions or falling back on stereotypes.
Give reasons why organisation and delivery of healthcare needs to take diversity into account
[*] Diversity is important to healthcare delivery
- Increasing diversity of populations (patients and workforce)
- Increasing albeit limited evidence that taking a patient-centred approach improves outcomes
- Huge disparities in care accessed
- Disparities beyond the point of access
- Differential outcomes
- Legislative frameworks (changed Oct 2010)
[*] Problems that may arise
- Lack of knowledge – resulting in an inability to recognise the differences
- Self-protection/denial – leading to an attitude that these differences are not significant or that our common humanity transcends our differences
- Fear of the unknown or the new – because this is challenging and perhaps intimidating to understand something new that does not fit into one’s worldview
- Feeling of pressure due to time constraints which can lead to feeling rushed and unable to look in depth at an individual patient’s needs
[*] In turn may lead to:
- Patient-provider relationships are affected when understanding of each other’s expectations is missing
- Miscommunication
- Non-compliance and not understanding patient perspective
- Rejection of the healthcare provider
- Conflict or isolation within staff groups
Explain why terminology around sexual behaviour can be a problem in talking to patients, and identify the implications for practice
[*] Sexual behaviour is a major determinant of sexual and reproductive health. Doctors need to be able to provide answers to queries about sex related to medical conditions (e.g. sex after a heart attack). Patients tend to consult their GP first about sexual problems
[*] Doctors have an important role in promoting sexual health (e.g. STIs, contraception)
[*] Doctors need to understand sexual behaviours and reflect on their own views on the diversity of sexual behaviours, in order to fulfil GMC requirements
[*] Understanding of what counts as ‘sex’ can vary. This could lead to difficulties getting accurate information from patients (e.g. a sexual history) or discussing sexual behaviour with them.
[*] It’s important that as doctors you:
- Use specific terms for sexual behaviours
- Check that the patient understands them in the same way that you do.
[*] Major sex studies in the US
- Kinsey, 1948, 1953, based on personal interviews, findings highlighted the diversity of sexual behaviour
- Masters and John in 60’s and 70’s: laboratory observation of 100s of volunteers having sex. Described the sexual response cycle; debunked myths about female orgasms; informed the development of ‘behavioural’ sex therapy. But subject to criticism for their methods and interpretations.
Describe the NATSAL survey – the main source of information in the UK about sexual behaviour.
[*] Little reliable information on sexual behaviour in Britain prior to 1990s
[*] National Survey of Sexual Attitudes and Lifestyles (Natsal) has been conducted on 3 occasions in Great Britian: Natsal-1 in 1990-1991, Natsal-2 in 1999-2001 and NAtsal-3 in 2010-2012
[*] Natsal-3 included a representative sample of 15,162 men and women aged 16-74
[*] People were asked questions about their sexual behaviour by an interviewer in their own homes, using a standard set of questions on a computer screen
[*] The main changes in sexual behaviour reported via Natsal since the 1990s are:
- Increased average numbers of heterosexual partners
- More people reporting oral and anal sex
- Decrease in how often people say they have sex
- More people reporting same-sex experience
- More acceptance of same-sex relationships
- Higher incidence of consistent condom use in the past 4 weeks
- More HIV tests and visits to STD clinics
Explain why it is difficult to get accurate information about sexual behaviour
[*] People may be embarrassed / reluctant to report their sexual behaviours to an interviewer
[*] People may not be able to recall all their sexual encounters
[*] Sampling problems (who takes part).
- People under 16 and over 75 are not included
- We don’t know about the behaviour of people who declined to take part
Explain the implications of diversity in sexual behaviour
[*] There is no such thing as ‘normal’ sexual behaviour
- Problems of gathering reliable data means we can’t say what is ‘normal’ statistically
- ‘Normal’ can sound judgemental and implies that we see some sexual behaviour as ‘abnormal’ or ‘unacceptable’
- What may be thought of by many as not ‘normal’ sexual behaviour may nonetheless be quite common ((e.g. anal sex is relatively common in heterosexual couples).
- What is ‘normal’ or usual sexual behaviour for one person might not be for another
- It can reflect stereotypes and overlook diversity (e.g. ‘older people don’t have sex’).
- Behaviours and social norms around sexual behaviour change across time, cultures, age groups, sexual orientation, social context etc.
[*] Patients may seek help from doctors about: having a fulfilling sex-life, sexual problems in relation to their physical illness, sexual health, fertility
[*] Terminology is important – use clear language and check patient understanding
[*] Sexual behaviour is diverse. As a doctor you need to be informed about and comfortable with, discussing all forms of sexual behaviour with your patients.
