As providers, you have information that will help your patients be healthier. You hope to communicate it in a convincing way, so it will enter into patients’ thoughts and actions long after the patient encounter.
But what about when you have differences of opinion on what healthy means? When it becomes clear you don’t share the same understanding of living a healthy life, or being as healthy as possible?
Aside from dictionary definitions of the term ‘healthy,’ there are probably as many everyday meanings of the word as there are people using it. Today I’m diving into these differences. I’ll show you how to keep them from getting in the way, when they occur between you and your patient.
Health as a relative concept
Many health researchers have documented the health perspectives of marginalized or non-dominant groups. And some stress the importance, when conducting culturally relevant programs, to do more than switch the language from English to something else.
Much of the attention to cultural differences in health attitudes and beliefs focuses on food and diet. And that’s understandable. The ideas or values of a social group also can be reflected in their stories. This includes those stories told to children. I am involved in a project about different socio-cultural ideas toward health, as reflected in children’s literature from different world cultures.
Let me tell you, it’s interesting! There are different cultural attitudes toward nutrition, no surprise there. But one of the funniest for me to see (from my American perspective) has been the different cultural attitudes toward poop. (And since we’re on the subject, if you haven’t yet heard my podcast on ‘pee-pee’ versus ‘urine,’ here it is.)
Whose “healthy” is it anyway?
Our understandings of health are culturally mediated. We each draw on a range of ways of understanding the body, science, procedures, insurance, nutrition, and more. These understandings are shaped by our knowledge, and our experiences with (our) bodies and with the health care system. Importantly, we have learned how to process this knowledge and experience in our communities.
We all have ideas about their health and health care. It’s also important to remember that these ideas are not fixed or homogeneous, but flowing and shifting.
They are our conceptual basis as we read, write, talk about, think about, listen to, process, and act on what it means to be healthy in our communities. These ideas may or may not correspond to the latest medical knowledge, but they make sense to the those who hold them.
When differences get in the way
Differences in ideas can feel like barriers to communication.
Also, we sometimes focus on a person’s perceived weaknesses, based on what we think is or should be normal, basic, or fundamental. One medical educator made a particularly powerful analogy for me, as we were speaking about this very topic:
“Take parenting. We have these snapshots in our heads of who our child should be, how they should behave and respond to our questions. And then we have the reality of what’s in front of us. And when we get frustrated is when the disconnect is there. It’s not the child, it’s the disparity between the expectations [and the reality].”
It can be easy to think of the ways other people—specifically, patients–understand their bodies and act upon health information as problematic. Especially when it’s not what you think is or should be normal, basic, or fundamental.
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But these ways can be a valuable source of information and insight. I’ve written before about how patient misconceptions can be advantageous in the clinical encounter. What you don’t want are possible perceptions of difference to get in the way of a productive patient/provider relationship.
To be clear, I am keeping to those instances where someone is not in danger. Of course you have a professional obligation and an ethical imperative to help in every way you can. And this means doing no harm, as well as doing all you can to keep people from harming themselves or others.
But you’re well aware the lines are not always so clear. Cultural norms are, by nature, subjective. What seems healthy to one group may not to another. There are large overlapping circles of influence on our ideas of health, and researchers have included these as well (as in this study of women’s health in a Haitian community in Florida).
As a health care professional, making your expert information relevant to the patient starts with knowing what’s important to this person and her/his life, and what he/she is already doing in that realm. This involves about seeing others’ bodies and health as they see them.
And considering what “healthy” means to your patient.
Start where the patient is
You’ve heard this from me before: begin with what people already do, believe, have, and think, regarding their health. The points is for you to understand how people are making sense of their health and build on and enlarge their understanding.
The burden of being the expert includes seeing the sense in another person’s ideas about health, so you can begin building bridges between their ideas and yours.
But make no mistake: the purpose of building this bridge is not so your patient will cross over to you.
You are both on that bridge. Looking at patients’ knowledge and ideas as a ‘gap’ between you can normalize your position as the one to be reached. “Progress” then becomes a stand-in for how far patients can make it in your direction. This is not what we’re talking about here. (Nor does it sound very SDM.)
This is about talking across different ideas of health. This is for allowing different definitions of health, different ways of getting healthy, and different ideas about what it means to be healthy. It’s not about discounting or replacing their definition but acknowledging and valuing it and working with it.
Attempting a cultural “fit”
This involves understanding what your patient values about their lifestyle and their health. Including what they are already doing to maintain their health, to strengthen their health, and to improve the health of their families.
I’m not saying to go stereotyping or lumping together patients in a certain social or cultural group. Nor do I mean you’re somehow supposed to custom fit everyone differently.
What makes more sense is for you to bring to your practice an awareness of diverse cultural possibilities that might relate to your patients, and then allowing yourself to get to know the patients themselves. And some places they might fit, in terms of how you work with other patients in your practice.
What you can do today
How do you start where your patients is, and begin to build the bridge?
- Don’t assume. Find out what healthy means to your patient.
- “What is important to you when it comes to being healthy?”
- “We all can have different ideas about being healthy, and I want to know what matters to you.”
- Consider the cultural values implied in your words, examples, and explanations. And be ready to make small changes. For instance:
- “I’ve explained this in the past by comparing it to x or y. Does either of those sound good to you?”
- If you switched even just a few words, or one single example, who would be included that’s now excluded? Who would you be reaching, that’s missing out now?
By meeting people where they are, you go far toward giving them appropriate support and actionable advice.
I won’t be the first to encourage you to place patients’ complaints in the larger context of their personhood and their lives. This includes what ‘healthy’ means to them. Especially when this is not what ‘healthy’ means to you, nor what you wished ‘healthy’ meant to them.
