How Cultural and Religious Differences Impact Caregiving

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?’”

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

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.”

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.”