How to practise medicine in a multicultural society
BMJ 2001; 323 doi: https://doi.org/10.1136/sbmj.0110380 (Published 01 October 2001) Cite this as: BMJ 2001;323:0110380
- Sabina Dosani, senior house officer in psychiatry1
- 1St Thomas's Hospital, London
Begum
You may know a typical Begum. She is an Asian woman suffering from non-specific pains and weakness. When questioned, pains change places. On examination, nothing is apparently wrong. Investigations are normal. Begum comes to casualty with her large extended family who interpret for her, insisting that this is sorted out once and for all. Gynaecologists see Begum and diagnose functional dyspareunia. Perhaps you observed her endoscopy result and were taught about functional dyspepsia. Or perhaps you met her in the professor's neurology outpatient teaching clinic where her numbness disobeyed dermatomes. She visits many different departments and gets increasingly nervous. Doctors become irritated. Students are perplexed. Twenty years ago, someone wrote her up: “The Begum syndrome.”1
Stereotypes
It is not just Begum. Alcoholic Paddy turns up in almost every department with a plethora of alcohol related illnesses. Well, he's Irish, isn't he? What do you expect? Or the tired looking African man who must have HIV. Where do stereotypical patterns of illness in ethnic minorities come from?
Ethnocentrism
Ethnocentrism--believing your culture is superior to others--leads to stereotyping. We tend, both socially and clinically, to look at other cultures through our own culture tinted spectacles.
Expressing distress
A man from Haiti has chest pain. You might ask him questions about the position of the pain, its quality, radiation, severity, and timing. In response, he says a voodoo spell has been put on him. When you present your history, the consultant feels irritated. The patient is baffled. Nobody seems to be listening to him. He is treated for his myocardial infarction and referred …
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