In your practice, you may have had the experience that patients explain their illness differently from your medical understanding and explanation. These explanations can base on or involve the following (See for instance: Kleinman 1978, Kleinman and Benson 2006, Godoy-Izquierdo et al. 2007, Henderson and Maguire 2000, Maroney, Potter, and Thacore 2014):
- Lay models of disease
- Religious believes
- Diverse supernatural forces
- Gender
- Upbringing
- Personal experience
Usually such explanatory models are overlapping and are taken for granted. Therefore, when patients talk about their illness, they might expect that you as a family physician/ primary health care provider/X understand what they are referring to and what treatment they expect and accept – even if their understanding is divergent to your medical opinion or to common explanatory models of your own culture.
Lay models of disease have been found to determine the emotional and behavioural responses of both patients and health professionals in regard to coping mechanisms and health related goals (Lobban, Barrowclough, and Jones 2003). There are key themes across cultures concerning a suffering person’s need for an explanation, the way of experience, and the giving of meaning to an illness, as well as the aim to find a cure (Kleinman 1988).
For most people, there is no contradiction in consulting different health care providers. Especially in countries with resource shortages, people make strategic decisions about visits to a range of possible practitioners both in the biomedical health care system and among traditional healers (cf. Brodwin 1996). Medical pluralism equally exists in Europe; people use homeopathy or consult TCM practitioners and at the same time seek treatment in your practice.
Wunn and Klein (2011) suggest that elites and educated people usually accept medical compromises whether they are religious or not. Less educated people and people from remote areas, however, tend to hold on stronger to religious believes and country specific models of disease and healing than the former.
Your patients may have different explanatory models and to show them that you take them seriously, and that you respect their beliefs may even support the healing process (Wunn and Klein 2011).
For example:
| Physiological illnesses can impact a person’s cognitive abilities. The other way around, there are physiological problems, which, from a medical perspective, are often regarded as having psychological causes, such as irritable bowel syndrome or chronic fatigue syndrome. Patients nevertheless have symptoms and their suffering is real and has to be acknowledged (Godoy-Izquierdo et al. 2007). Similarly, in several African countries, witchcraft is taken very seriously and is considered dangerous (see for example: Moore and Sanders 2003, Geschiere 1998, Comaroff and Comaroff 1993). A fear of witchcraft or the persuasion to be bewitched can have manifest mental and physical expressions or can even lead to death. You may offer alternative explanations and take care of the symptoms explained by your patient. |