Clinical Medical Anthropology

As we learned in lecture, applied medical anthropologists do not just study health cross culturally but also here in the U.S. where they study domestic issues of health. I chose to focus on the intersection of Clinical Medical Anthropology because clinical anthropologists are the ones who work with medical professionals and patients in clinical settings on ways to improve health care and management. I currently work as an aide at a physical therapy outpatient clinic. I work side by side with two medical professionals who have earned a Doctorate in Physical Therapy. We interact with patients of different backgrounds on a daily basis. The field of Physical Therapy and especially Occupational Therapy greatly interest me and I plan on pursuing a career in Occupational Therapy. Whether I am working for an Occupational Therapist or I myself become one, taking a clinical medical anthropological approach is crucial in the field and can help in improving the healthcare given to patients. One of the main goals of a clinical medical anthropologist is to emphasize the cultural context of an illness experience. This becomes important when treating patients of other cultures who understand health through different ethnomedical systems. The clinical medical anthropologists consider the complete cultural, biological, psychological, and social circumstances. They act as a cultural mediator in order to develop the best strategies to achieve health for each individual patient. Non-compliance is a big issue they encounter and the clinical medical anthropologists must find out why patients do not follow a specific medical protocol. Like any other medical field, patients in need of occupational therapy come from different backgrounds and cultures. Therefore, the therapy techniques used might not suit everybody’s traditional beliefs on ways of treatment. By receiving anthropological medical training, or assistance from a clinical medical anthropologist, the clinician can provide the best possible care and alter the treatment methods to suit the specific patient in need of therapy. Anthropologists who studying cultural competency have found results that prove the misunderstanding that occurs among clinicians and patients. For example, a case of an HIV positive man, who has lost his wife to the infection, isn’t able to take his four year old child, who is also diagnosed as being HIV positive, to regular doctor check ups. Clinician’s comprehension of the reason for this was not accurate. Medical anthropologists had to study the case and found out that the man was working late night shifts as a low paying bus driver which enabled him to take his son to appointments to see a doctor. Therefore it was concluded that instead of the reason being cultural differences, the man’s socioeconomic situation and local world he lives and works in are the factors preventing the opportunities to get the best care available. The article I found is criticizing the way cultural competency is viewed and the way it works. Even though the actual reason for the father in the example is due to his status in society, the factors that led to this cause are related to the differences in culture and the fact that the man was an immigrant himself or second generation. I do not mean to imply that every immigrant in the United States struggles to be ranked higher socioeconomically. I do however, believe that many people who migrate to the states start out or end up living in areas that aren’t as fortunate as others. Providing the means and opportunities for everyone is only fair, even for the people that might not be as advantaged. Understanding other’s cultural beliefs, when it comes to illness and treatment, is important to provide the best care for all.

 

Kleinman, Arthur and Peter Benson. “Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It.” PLOS MEDICINE 3 (2006): 1673-1676.

 

http://anthropology.msu.edu/anp204-us13/files/2012/06/6.-Kleinman-and-Benson-Anthropology-in-the-clinic.pdf.

 

 

 

This Post Has 6 Comments

  1. Breanna Block says:

    I like your post, the article you found sounds very interesting. Though I think just asking patients the explanatory model approach correctly would ease most cultural tension, I see the benefit of having an anthropologist on staff- whether they are teaching coworkers how to use the approach correctly, or if they do some of the interviewing themselves. I think you covered the things an anthropologist contributes to the clinical intersection well. I found the story of the man you mentioned very interesting when I read it this week. It shows that a problem could have easily been solved if the clinician had tried to get to know their patient, instead of making an assumption that the problem was strictly cultural. In addition to what you have posted, I think another benefit an anthropologist could have is improving the reputation of their employer. The better the experience was for the patient, the more likely that patient is to recommend that clinic to their friends and family. The presence of an anthropologist in a clinical setting can also improve the workplace. The healthcare system is full of people from different cultures. There are a lot of foreign doctors, nurses, OTs etc. so a benefit of having an anthropologist on staff is that they are likely to ease any cultural misunderstandings between employee’s too.

  2. Francesca says:

    Dear Rei,

    I found your post to be very interesting and similar to the post I wrote. I agree that this intersection can contribute to the understanding and mediation between different perceptions of certain illnesses. Having an anthropologist present in certain clinics, especially if most of the physicians are practicing outside their native culture, should be necessary. Clinicians overlook often times out of the norm symptoms because they are not familiar with the culture. In addition, clinicians may not know how to classify symptoms into a certain illness because their native culture does not have a word for it. Often times ignorance can lead to false assumptions which can cause and lead to worse outcomes for patients. Many people believe that the way western society cures and heals illnesses is the way the whole world cures illnesses which is extremely far from the truth. Clinical medical anthropology allows people to open their minds to new treatments, illnesses and cultural expectations. I find that to work in the medical field you need to be extremely open minded and have to be able to think outside the “normative box.” This thinking outside the “normative box” is not innate but has to be learned and practiced overtime.

    Francesca Bignasci

  3. Alex Palffy says:

    I also wrote about the intersection of medical anthropology and clinical treatment and I agree with your post about how an anthropologist can enhance medical treatment and better the understanding of a patient. However, the more I read about this the more I see this “need” for medical anthropologists being created because of how doctors are forced to treat patients nowadays. If physicians had more time with a patient, they could acquire the same knowledge from the patient that a medical anthropologist can. In this day and age, it’s unfortunately not very cost-effective for a physician to see a patient for more than 15 minutes (and not all of that is necessarily spent with the patient one-on-one). I imagine that for physical therapists they would have an easier time filling that role of “medical anthropologist” since so much of their time is spent directly with a patient. The mentality of a medical anthropologist is one that all healthcare professionals should embrace. The motivation to find understand in a particular case is a byproduct of compassion and genuine interest in a patient’s wellbeing. Unfortunately, those of us who go into one of these fields with the best intentions (at least according to our personal statements) are falling into an environment that doesn’t lend itself well to compassionate care.

  4. Aaron Schmidt says:

    I think it is interesting that an anthropologist may find problems with a patient’s healthcare in things other than just cultural differences. I like the example of the HIV positive man who couldn’t bring his child to an appointment. Healthcare providers need to evaluate patients and speak to them individually to find their specific circumstances. They may have an ethnic background where one would assume they are of a certain culture, but they could just be having socioeconomic problems, as was the case for the HIV positive man. I think the explanatory model approach would be best in a clinical setting. The six steps of this interview would tell a healthcare provider how the person is dealing with an illness, and what the patient’s background and culture are. This will help the healthcare provider develop therapy that fits the individual person. Another thing to consider with all cultures, even our western culture, is religion. There are many religions, some that we might not understand or believe, that will change how we treat a patient. For example, a patient might believe that drugs are unnatural or that they are a sin. In this case, we can’t just see the patient, prescribe the drugs they need, and leave. An anthropological approach would allow us to find out what they believe in, and what their experience with their illness is. From that, we could develop a treatment without medication, such as diet and exercise. The thing we need to realize in healthcare is that everyone is unique. We can’t assume someone from one ethnic group is from a certain culture until we get to know their story and experience, and then we can deliver adequate healthcare.

  5. Danielle Gittleman says:

    I also wrote about the clinical approach, mostly because I would like to be a physician in a clinical setting. I, too, work in an office where I believe an anthropologist on staff could be of a lot of help. I work at an orthopedic office and because most of the doctors I work for are surgeons, they have to make an extra effort to make sure that our patients know that their practice isn’t all about the cut. I believe that this is actually because our world is starting to become less drastic in treatment for certain fields of medicine, orthopedics included. This is a cultural change that doctors these days have to take into consideration when finding the best possible treatment for their patients. The article that you found seems very interesting and the connection you made about doctors who travel to other countries to work is a valid one. It is an incredibly important trait to be able to work around the culture you are surrounded by. I think that that aspect of medicine is often overlooked and that it why it is so important to have anthropologists around to make sure others are aware of how the community sees medicine in the area these doctors practice.

  6. Thuy-Tien Giap says:

    Hi Rej,

    I agree that medical anthropologist’s work is important, as evidenced by your story of the HIV positive man. Without knowing the real reason for why the father couldn’t take his son to his checkups, the health care professionals deemed him as a non competence father. It was a good thing that through anthropologists, his real life story was unfolded. With his socioeconomic status revealed, and him being a single father who tried to support himself and his son, it was difficult for his to perform his fatherly duties. However, once we have understood his situation, we can arrange a social worker who could give this man a hand. I agree with you that its important to understand the father’s culture in order to provide him and his son the best medical treatment. I think that a medical anthropologist should help advocate on behalf of the man. The anthropologist could ask the doctor to grant him a rest permission from his employer, because being a victim of HIV, the man requires rest. In order to protect himself, and those around him, I think it’s important that he receives a personal nurse who would tend him since he’s in critical condition.

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