Visiting the doctor with Mum

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bad-celiac-doctors

Over the summer break our family were in the process of supporting our darling matriarch thru the decision of having to undergo radiation therapy. The meeting with the doctor had been set up for two o’clock one afternoon and I had to be there – because I supposedly speak good English. En route to the hospital Mum rings me at 1.27pm to say that the doctor has called for her and wants to meet her now to go over the procedure and explain any after effects of the treatment. Doing my best to sound firm, but not disrespectful over the phone I tell her to tell the doctor that the appointment is for 2pm and they should wait; taking all of me not to use words that my God-fearing, (very) Samoan mother would find unbecoming. Picking up the pace I walk into the consultation room at 1.48pm.

In the intervening 20 minutes between our telephone conversation the doctor went out to my mother and said that she needs to outline the procedure now and can’t wait for me to arrive. Later, mum tells me in Samoan that she didn’t want to be disrespectful to the doctor so she agreed to go in and begin the consultation. My blood boiling but aware that I shouldn’t do or say anything to upset Mum during this time, I ask the doctor a series of questions. Looking at her watch constantly and breathing that breath where you know she’s irritated at having to go over the information again, we talk for a good 45 minutes. Throughout the entire conversation she answers my questions by looking at my mother and only rarely glancing at me. Out of respect for my mother I just handle what I regard as extremely rude behaviour. Mum and I are in and out of Samoan so that we’re both sure that we’ve both understood the conversation, even though there are medical terms used that we have to turn into sentences and phrases because neither of us can find a Samoan equivalent. I think created some new Samoan medical terms that afternoon because we had to transliterate words at times.

Durie (2001) says that Doctors bring a scientific ethos to their work and can improve their treatment of patients significantly by being culturally competent. He adds that the best way to broach this divide is through language, by being aware that there are subtleties in language that need to be delicately explained and understood. Each time I asked the doctor a question she would turn to my mother and begin by saying “it’s your body and you can do what you decide is best for your body Mrs Collins” then briefly glance over at me. Mum would look somewhat confused towards me each time she started her reply with that answer; all the while my frustration growing at the obvious assumptions that she’s making of me. After I politely asked all the questions we had, we requested some time alone so that Mum could think about what the next step would be for her, for us.

Our family had met on a number of times to discuss this treatment with Mum; numerous telephone calls to Australia, prayer meetings, getting advice from our church Minister and calls back home to Samoa. The doctor had no idea of how we prepared for that meeting when she went about starting it half an hour early. To pressure my mum to have the meeting 30 minutes before I could be there to both offer moral and linguistic support was culturally insensitive at best. She had no idea of the cultural power that existed because as a doctor, she’s seen as holding authority and knowledge; the type that we’d been raised to respect. This meeting was about more than “mum’s body” and how she chose to have her body treated. This meeting was about Mum as the matriarch of our family being able to express her values, leadership, wisdom, faith, hopes, anxiety and tradition.  The respect that we had shown to the doctor wasn’t reciprocated and it made us feel belittled and undervalued. Eventually the doctor returned and Mum told her exactly what she was thinking and feeling in relation to the discussion and treatment – in true Samoan strength, faith and beauty.

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14 COMMENTS

  1. I disagree that many doctors are culturally insensitive – I think a lot of them are just plain insensitive full stop.

    As a white middle class male I’ve experienced this sort of behaviour as well – although in the interests of accuracy, I do get a more watered down version of it.

    Having gone to a university that trained doctors it is no surprise however. By far the majority of the med students that I met were doing medicine because of the high social status that it would bring them. Not all were like this, but certainly the vast majority.

    • I have to agree. I’ve taught science courses to Med students and about half of them think their shit could be used for toothpaste. Needless to say, this had no relationship with their intellect, but seemed to be something bred into them. The ones who were human and showed empathy were a real treasure, and I did my best to encourage them. I could really understand why we need doctors from different cultures, and I get quite short with any pakeha claiming that students on quotas are keeping them out of their desired profession.

  2. Indeed, Aaron: this doctor was rude and insensitive, no matter the culture she was dealing with. I suspect that you’re right about the motivations of many medical students.

    I am fortunate to have a GP whose approach is the antithesis of Efeso Collins’ experience: lucky me! However, I’ve also experienced consults with other health sector professionals, where their behaviour has been more like that described above. It’s regrettable that such situations still occur, given the emphasis on quality assurance in the health sector nowadays. Or so the sector claims…

  3. The cultural insensitivity subject of your blog aside, Im challenged by the underlying topic in your story. I am Maori and a matriarch but if and when the time comes to make the types of decisions your Mum had to make, something tells me I dont want my decisions to have to take into account my matriarch status or even what my children/grandchildren want. I imagine they will want to keep me alive for as long as possible whereas I have other ideas… maybe Im not Maori enough lol?

  4. What a horrible experience for you and your mum at such a serious meeting.
    When I was 25 I went to the G.P who treated me like a hypochondriac when I asked very timidly that I had been advised when I was 14 if lumps came up to be sure to get biopsies done. Well she treated me like I was telling her what to do and wasting her time… Six weeks later after the specialist and all the test had been done I was rushed straight into chemotherapy as Hodgkin’s disease was in my bone marrow this is the last stage of cancer. If I hadn’t insisted on the specialist (as the G.P had told me if the lumps hadn’t gone down in three months to see her again that was her advice). I would be dead!
    My point is I still haven’t found a good G.P, 15 years later…but I am still alive.

  5. Oi talofae! Having gone through the same process with my mum, I know exactly what you’re talking about. No doubt about the doctor being rude inconsiderate and insensitive. What others need to understand is that Pacific families have a huge extended fanau. It never stops with the immediate family or the nucleus family.

    Your mun will know exactly what she wants. During my mums ordeal with cancer, we her children thought we knew what she wanted. But we didn’t take the time out to listen to what she wanted. We became obsessed with what the medical professions were wanting and we assumed that is the right path to take.

    Blessings to your mum and your family. My thoughts and prayers are with you and your mum. Alofa tele atu.

  6. “Durie (2001) says that Doctors bring a scientific ethos to their work and can improve their treatment of patients significantly by being culturally competent.”

    Yes, it is disturbing me, what I observe happening within the medical profession in New Zealand (and apparently also elsewhere). Doctors are now part of systems that have been “reformed” all over again and again, and pressures exist for them to deliver services within tight time-frames and set schedules. There is anyway a shortage of some medical staff in hospitals, hence we have about half of all medical staff being of migrant origin.

    Cultural sensitivity and awareness are one of the things that suffer under the pressure systems doctors and nurses often have to work under. Hence we have such worrying incidents as described here.

    The patient is for them often nothing more than one other “number”, no matter how much individual medical professionals may try to still dedicate the time needed for consultations and giving advice. I experience this with my own GP, who always seems to be under time pressures, having persons wait, and some needing more time than others.

    And there is more happening, with an ageing population, more prone to illness and accidents, the demand for medical care is increasing, which leads to some considering “savings” even on elderly now. It is called “Advance Care Planning”:

    http://sciblogs.co.nz/publichealthexpert/index.php/advance-care-planning-good-for-patient-care-and-better-use-of-health-dollars/

    While that may make a lot of sense, there is a careful balancing act necessary, as some system administrators, like the Ministry if Health and the various Health Boards may be tempted to put cost saving before care, which could compromise ethics.

    And then we also have increased efforts by government and commercial interests, to interfere in the way the medical profession handles certain groups of clients or patients, such as those suffering from sickness and disability and depending on welfare benefits. The drive in the UK to get sick and disabled disentitled to benefit claims, and to usher more of them into work, has led to scandalous developments.

    http://blacktrianglecampaign.org/2013/08/28/atos-fit-to-work-assessments-branded-farcical-as-nearly-half-of-people-with-progressive-diseases-like-parkinsons-told-theyll-recover/

    And then we have persons of the calibre of a Professor Mansel Aylward travel around the Anglo Saxon countries, also Australia and New Zealand, and preach of the “health benefits of work”, which has unbelievably influenced the medical fraternity and their professional organisations, to release policy statements like the following:

    http://www.racp.org.nz/page/afoem-health-benefits-of-work

    So we have such “experts’ that were financed to prepare selective “research” by rather corrupt and in the US convicted insurance corporations like “UNUM”, advise them and influence them, to apply policies that ultimately suit insurers and governments, to redesign their policies, tightening up and putting also more pressures on the medical professionals, leading to issues with their codes of ethics:
    http://www.racp.org.nz/index.cfm?objectid=E1D5428F-B1BF-2C2F-7A247F80DC4F363C

    At best, after making adjustments to explain what “good work” is, they come up with this:
    http://www.racp.org.nz/page/racp-faculties/australasian-faculty-of-occupational-and-environmental-medicine/realising-the-health-benefits-of-work/latest-news/

    It has in NZ led to the appalling welfare reforms, where a Principal Health Advisor (also a GP) Dr Bratt, for WINZ, gets away with likening “benefit dependence” to “drug dependence”:
    http://www.gpcme.co.nz/pdf/GP%20CME/Friday/C1%201515%20Bratt-Hawker.pdf
    (see pages 13, 20, 21 and 35)

    Paula Bennett and her welfare and now also medical “mercenaries”, all gradually being indoctrinated by the “research results” of Aylward, Waddell and others, propagated by former ATOS staffer Dr David Beaumont (GP, also running ‘Pathways to Work’ as a reintegration business for disabled and sick), and selected doctors, have brought it this far, to basically tell us, that “work will set you free”:

    http://accforum.org/forums/index.php?/topic/15264-welfare-reform-the-health-and-disability-panel-msd-the-truth-behind-the-agenda/

    http://en.wikipedia.org/wiki/Arbeit_macht_frei

    Yes, doctors and other medical staff are not necessarily what they used to be, and cultural consideration is part of the wider ethical considerations they must give towards patients and caring for them.

    It seems we are going to have more issues with Code of Ethics of the NZ Medical Profession coming up in the near and not so distant future.

  7. Same thing happened to us in 1986
    end result
    mum died

    next times were in 2009, 2010, 2011 with my dad
    end result
    dad died.

    the difference in bedside manner was minimal…

    heres the rub…we have soooo many maori, pacific , ethnic, advisory groups in the hospital system…all saying the same thing …all advising on the same cultural,hospital and patient issues…and yet for some practitioners the message is not getting through…

    • See my comments above, sadly, no time, pressures, more deadlines, results and career on their minds, than the actual person they are dealing with. It is perhaps not quite as bad as in some other countries here, but the trend is clear. Hope to not get sick and dependent on doctors, that is the best “advice” I can give.

      I dread the day I am in such a situation, where I have little say and input, to be heard, and get dealt with as they see fit. I think I would rather swallow some pills and rid myself off them.

  8. I think you really have a chip on your shoulders, having read most of the things you have to say. This has nothing to do with culture. Sure, she shouldn’t have started the consultation early.

    NOTHING is free these days, and nor should anything be. You paid NOTHING for the services of the doctor, so if anything, you should be grateful your mother has a chance to live longer, to be with your family as the matriarch of your family.

    • Alo,
      So If I don’t pay for a doctor directly (but do via my taxes) I don’t deserve respect? Is this what you really think?
      I hope a parent or child of yours gets cancer and you get to see first hand how dismissive the medical industry can be of family support members.
      Sure, doctors deal with death everyday but the have to remember that us normal punters get terrified when told a someone we know may have a terminal illness.
      In my line of work I take care to explain what I’m doing when up and personal with clients as I understand what I’m doing is totally foreign to them. (Non medical but still get to see people in various states of undress)
      That’s all we ask, to not be a number but a person that has fears regardless of weather or not our doc charged $10 or $100 a consult.

      I’ve been with my dad to his doc regarding his cancer and saw that the poor old fella had no idea what was being said to him. After interupting several times to relay the message he soon got it, took a while though. Sadly it seems every appointment was like that, he was talked at, not too.

      Now I do know he may be an extreme case and there are good docs out there, hopefully this article will remind them we are people too.

  9. So, the doctor treating your mother was culturally inappropriate because she kept making it clear to your mother that her treatment is her decision, with the implication that the extended family might attempt to influence her to accept treatment she wasn’t happy about.

    But the doctors treating commenter Litea Ah Hoi’s mother were culturally inappropriate because they didn’t go to enough trouble to find out what the mother wanted and let the extended family influence her into treatment she may not have wanted.

    And the doctors treating comenter Faavae’s parents were culturally inappropriate because the parents both died. (You do know that death is the end result for all of us, right?)

    Who’d be a doctor, you have to wonder.

    • Well, you said it – ‘kept making it clear’. I wonder, because I was not there, whether at any time She the Doc ever stopped to listen to her client? Ever put her doctor culture and ethics before the client so Mrs Collins could understand why she was being spoken to in a certain way? Why the doctor person was insisting that Mrs Collins take her own decision, please hurry up?

      The culture of medical establishments is often completely weird to those of us who are outside their funny little ways. And they seem to think we must ‘get it’ because we all watch ‘Shortland Street’ (Not.)

      As others have already pointed out, it has nothing to do with country of origin or ethnicity or language. It’s more that ‘insiders and outsiders thing’ – and it’s about time our ticket clipping time-wasting medical practitioners realised that they are the ones who need ‘patience’.

      (The sooner that stupid term, ‘patient’ is eradicated from their vocab the better. They might stop leaving their clients waiting for literally hours for attention, before handing out the not so accurate opinions and taking the rather plump fees.)

      And, if the medical industry – particularly in the US – wasn’t so persistent about self-promotion and advertising its wares and services – perhaps the general public wouldn’t be asking for ‘miracle treatments’, or holding unrealistic expectations. Perhaps?

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