Table 9.

Examples of key issues identified during patient cultural assessment and main recommendations issued

Brief case description	Issues identified during cultural assessment	Main recommendations
A. Young recent immigrant female patient treated for sarcoidosis with major side effects, isolated and depressed.	• Language barrier: the patient’s younger sister usually translated. The patient was somewhat reluctant to talk openly in front of her sister for fear she would tell others, and the sister did not effectively translate all that was said. • Cultural meaning of the illness: the patient and her mother (the only other family member who was aware of her disease) feared that knowledge of her disease would ruin her opportunities to marry. In addition, she was physically unable to fulfill the important role of oldest daughter, which caused tensions at home.	• Use a professional interpreter to allow the patient to freely express her feelings and concerns. • Discuss and distinguish between the side effects of treatment and the symptoms of illness. • Try to destigmatize her illness by reassuring the patient that she can live a normal life even with sarcoidosis.
B. Female visible minority patient in her late twenties, hospitalized for an acute abdominal infection refusing care.	• Language barrier: No local interpreter was available that spoke the patient’s language. Communication with her doctors and nurses was in English, but neither the patient nor many of her health care providers spoke it fluently. • Mistrust: The patient mistrusted the hospital because she developed an abdominal infection after an initial laparoscopy. • Beliefs about the body: The patient believes the blood draws and antibiotics are “drying her out” and making her weak. Lack of knowledge about the internal workings of the body and medicine in general make it difficult for the patient to understand the doctors’ explanations of her disease and its treatment.	• Information was provided on a telephone interpreting service that had interpreters for the patient’s language. • Make time to meet with the patient, answer her questions and concerns, restore trust and find common ground. • Use simple language and drawings to address the origins of her infection, the reason for frequent blood tests, how the body replaces blood, the anatomy of the stomach and purpose of the drain. • Address the concerns of the patient and her family about the proposed surgery.
C. Middle aged ex-refugee male patient with obsessive-compulsive disorder and chronic pain	• Multiple losses and trauma: the patients’ narrative reveals a succession of social and economical losses, traumatic experiences and a strong feeling of shame and injustice that was left unrecognized by public services (law, disability pension). • Precarious situation: lack of financial means, unemployment, inadequate housing and lack of access to social services • Explanatory model: his karmic explanation of misfortune was culturally congruent, but his compulsive thoughts of wrong-doing seemed more likely to be a manifestation of psychiatric illness. He firmly believed traditional medicine from his homeland could help him, as it had done so in the past.	• Refer patient to social-legal services to help with workplace accident compensation • Maintain a combination of cognitive behavioral therapy and physical therapy sessions • Encourage counseling with the Buddhist monk (who had served as cultural informant) • Explore feasibility of prolonged visit to home country for traditional treatment.