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How Cultural and Religious Differences Impact Caregiving

Ensure your loved one’s needs, beliefs and values are known to health care providers

A Muslim woman sits across from her female doctor as she talks with her about cervical cancer
Anchiy / getty images

June McKoy, M.D., had a request for the physicians who treated her aunt when she accompanied her older relative to medical visits: “Please don’t use the word ‘cancer’ to my aunt,” she recalls telling them.

McKoy grew up in England but was born in Jamaica and was intimately shaped by her birthplace and Jamaican heritage. “Your culture goes with you, wherever you go, it defines you,” says McKoy, who’s the program director of the geriatric medicine fellowship at Northwestern Medicine in Chicago. This cultural embodiment included the way her family approached medicine. “In terms of Jamaican culture, if you find something really bad, you wouldn’t put it in terms that would frighten the patient,” she says.

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Although doctors ultimately discovered that her aunt had colorectal cancer, McKoy asked them to use other words, like “tumor,” to describe her condition because “once you say ‘cancer,’ it really brings up a great deal of anxiety.”

McKoy emphasized that her aunt was educated; her request didn’t “mean that she was stupid,” but rather signaled a difference between the way her Jamaican family viewed medicine and the way it was practiced in the United States. She also asked medical providers not to urge her aunt to have surgical procedures because “it goes against her culture to [have an operation] because she’s not going to give in.”

It’s cultural nuances like these that McKoy says are essential for families to communicate to the physicians and medical providers of the older adults whose medical care they are shepherding.

She and other geriatricians and physicians have the following advice for families who want to ensure that their unique cultural and faith needs are being integrated into the medical care of their loved ones.

Communicate wishes clearly

Erika Hutz, an osteopathic physician and geriatrician with Swedish Medical Group in Chicago, says it’s impossible for families to over-communicate when it comes to the kind of medical care they want their loved ones to receive. She adds that it’s helpful when patients bring in lists with specific wishes for their care.

“Physicians need to take these courses that are now pretty much mandatory in hospitals to better communicate with patients,” says Hutz. “But the patient and families also have to advocate for themselves. And if something's very important to them, then they need to let their medical staff know about it.”

Hutz pointed to one situation in which she had an older adult patient from the Middle East who would come to appointments with her son. Hutz said her patient would always “get very, very sick around certain times of the year.”

What the patient and her son did not disclose to Hutz was that the mother was trying to fast during Ramadan.

“They assumed that I would know, or they didn’t want to share it with me for some reason,” Hutz says. “I felt that it was my fault not to delve deeper about, ‘Why is this patient having these issues during this time of year?’”

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Reflecting on that experience, Hutz says she wonders if the family didn’t tell her about the Ramadan fasting because they worried Hutz would forbid the mother from partaking in the religious observance that requires Muslims to abstain from food and drink from sunrise to sunset. Hutz emphasizes the doctor-patient relationship is no longer a paternalistic one like in previous decades. She would have started a conversation in which she would have given recommendations for fasting during Ramadan while avoiding the health issues she had been experiencing.

Ultimately, Hutz says, “if you have a health care provider that does not speak your language, that has a different ethnic background than yourself, or religious background, that communication is key. Because you do have to advocate for yourself or have the family advocate on your behalf because sometimes, a health care provider is very willing to learn but may not understand exactly what you're going through if they're of a different faith or a different culture.”

Use language resources

As the person in charge of her mother-in-law’s medical care, Hina Patel accompanies Shantaben J. Patel to all her appointments.

Dr. Hina Patel and her mother-in-law Shantaben J. Patel
Dr. Hina Patel and her mother-in-law Shantaben J. Patel
Courtesy of Dr. Hina Patel

Because both Hina and Shantaben speak Gujarati, with Shantaben speaking very little English, Hina acts as a translator during the visits. Hina says she’s critical to smoothing language obstacles and medical understanding for her mother-in-law.

“Because of the language barrier, I’m overseeing everything she needs care for,” Hina says of Shantaben, who’s 89 and deals with dementia and mobility issues. “I’m kind of a bridge between her and medical care.”

However, if the trusted go-between is not as familiar with certain terminology, physicians want patients and families to know there are other options so that health care-related information is clearly understood. “I definitely want all patients to know that it is their right to have someone [medically] translate for them,” Hutz says.

Hutz has experienced complicated situations, like when she has Rohingya patients from Myanmar, and “it’s extremely difficult to get a translator, so sometimes they're waiting, and it can be a pain on our end. But I cannot successfully give advice and treat a patient if I can't understand what their medical problem is.”

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Recently, she says, her clinic obtained an iPad with the possibility to tap into myriad real-time medical translation services. This not only gives patients and their families a palette of choices, but also enables her patients to see the faces of their translators, which Hutz calls “the second-best thing to having a live person in the room.”

Be clear about faith-based needs, dietary issues

Daily religious practices should be noted too.

If a Muslim and would like to pray five times a day while staying in the hospital, the staff will do their best to accommodate that person’s schedule, Hutz says.

“That's absolutely something that we would try to work around,” she notes. “We don't want to try to take you for radiology if we can avoid it during the brief five prayers a day.”

Or if someone is Orthodox Jewish and does not do certain things on the Sabbath, this is something patients should make clear to the staff so that needs and faith practices will be respected.

McKoy says that it’s incumbent on hospitals and providers to listen to those faith and culture needs, and in the situation of someone who would like to pray multiple times a day, not only to ensure the patient is not disturbed but also to go a step further and provide a mat and a quiet place to pray.

McKoy, who’s also assistant director of diversity, equity and inclusion at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, says that for medical providers, “it starts with listening to our patients, and being very aware of cultures from which patients come.”

Hutz suggests clarifying dietary needs and restrictions upfront, such as if a family member keeps kosher or halal.

“This is part of getting to know my patients,” she says. “It's not only health. It's the social situation, religious situation, philosophical situation; also, when it comes to advance care directives, that just goes toward the patient-physician relationship.”