The Ethnomedical Cultural Model

Every encounter between a patient and a physician is a cross-cultural transaction. Each person brings to the physician-patient relationship a unique mix of culturally embedded attitudes, knowledge, and beliefs. Ethnicity, gender, religion, language, education, and personal history shape expectations and behavior on both sides of the relationship. A physician's cultural proficiency is instrumental in establishing rapport and gathering information for accurate and comprehensive diagnosis and treatment (Carrillo et al., 1999). The patient's acculturation status and cultural background are important to understand, and physicians should become familiar with the dominant cultural groups they serve.

The ethnomedical cultural model emphasizes cultural concepts relevant to health and illness (Kleinman et al., 1978), including patient beliefs and expectations about the body, illness, and treatment. Berlin and Fowkes (1983) operation-alize this model in clinical encounters with their LEARN acronym, exhorting physicians to do the following:

• Listen with empathy and understanding to a patient's perception of the problem by eliciting the patient's explanatory model for the illness.

• Explain your perceptions or explanatory model in language the patient can understand.

• Acknowledge the differences and similarities between your explanatory model and that of the patient, and discuss any significant discrepancies.

• .Recommend treatment that you decide is optimal within your explanatory model.

• Negotiate treatment with the patient, seeking a compromise that is acceptable to the patient, is consistent with your ethical standards, and uses the patient's social network when necessary.

The ethnomedical cultural model highlights cross-cultural elements in all physician-patient interactions.

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