Prairie Doc® Perspectives for week of July 26, 2020
By Debra Johnston, M.D.
Sometimes, life has lessons for us that we don’t truly appreciate until much later.
Many years ago, when I was a very wet behind the ears new doctor, I had the privilege of being part of the care team for an elderly Native American woman. She had been transferred from somewhere in rural South Dakota to our hospital in the city in hopes of identifying her disease and ascertaining how best to help her. Her daughter accompanied her. The medical team was convinced we knew “best,” while her daughter was determined that we were not going to take a single step that might conflict with her mother’s values. The stage was set for conflict.
As an intern on one of my first rotations, I just could not understand why someone would come to us for help, and then not be willing to follow our recommendations for testing and procedures that we felt would give us information we needed. We were frustrated. I didn’t recognize it at the time, but I learned a lot from that fierce patient advocate.
In retrospect, the most obvious lesson was the importance of acknowledging that people have different values, and those values are shaped by many things, including culture and religion. While it may be true that some values are shared across cultures, it is a mistake to assume that we can understand another person’s values and priorities through the prism of our own, or based upon what we think we know about them.
Healthcare providers can best help their patients by taking time to discuss cultural values, sacred traditions, and priorities with patients. This is especially true when it comes to end of life care, but it also applies to situations such as acceptance of medical testing, preferences regarding prescription drugs versus non-pharmaceutical alternatives and culture-based healing practices.
Another lesson was the importance of an advocate for the sick and vulnerable. It is extremely valuable for both the patient and the care team to have someone else present with the patient. This is a person the patient trusts to help clarify their concerns, to remember information, and to pass that information along to the patient’s loved ones. Prior to the covid-19 pandemic, few patients utilized an advocate, except in the gravest of circumstances. Now, procedures in place to protect patients, staff, and family from this dreadful virus, limit the opportunity for patients to have an advocate physically present. However, most facilities support connection to patient advocates via phone call or video call.
In the end, a wise chaplain arranged for a traditional healer to visit our patient in her hospital room. I was not present for the ceremony, but the senior physicians and the daughter agreed on a plan of action. We didn’t cure the patient, but we were able to offer her physical comfort in her final days, and I believe that by blending her culture and traditions with our medical ethos, we helped both the patient and her daughter find spiritual comfort as well.
Debra Johnston, MD is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.