el razon vs las emociones

Ok, this is my last quasi-philosophical post, te prometo. Maybe.

So to wrap up our cultural competency lectures last week (which I’m not going to lie, started to drag a bit at the end) we talked a little bit about how people from different cultures order their thoughts/try to explain things. Our lecturer Ronnie said that all cultures use these things to try to explain life: reason, emotion, their senses, memory and intuition. The thing is that different cultures call upon these tools in different orders- for example, northamerican/European cultures prioritize reason, while Latino cultures prioritize emotion, Asian cultures memory, etc.

Obviously this is a generalization of huge swaths of people, but it struck me as having some importance to the doctor-patient relationship. During our MPH last year, Jamie, the other students and I talked a lot about how to communicate with patients about the decision to pursue or not pursue a certain treatment, including the risks and benefits of the choices they had. We also looked a fair bit at ‘decision-aids’: for example, an ‘outcomes table’ for breast cancer screening that tries to visually represent the different possible outcomes of the screening and their relative prevalence. The idea being in part that one responsibility of a doctor is to inform their patients as fully as possible, so the patient can make an informed choice.

The interesting thing is that this strategy of course is based on the idea that patients are using reason first to make decisions. I think it’s evidence of my having been steeped so well in western culture that the idea of trying to help patients make decisions by informing their emotions seems manipulative. Indeed, thinking of a person as being guided by emotion first instead of reason makes them seem weak, and is almost an insult- but of course, that’s not true in all cultures!

So the question is how to implement this idea into providing excellent care to people from other cultures? For example, when I’m trying to tell a Latina woman about the relative harms and benefits of breast cancer screening, should I bring up stories of past patients who had one outcome or another, to give my patient an idea that she can emotionally connect with? That definitely sounds a little manipulative to me…but maybe it’s just culturally competent.

And on further reflection, after seeing the markedly different reactions to an NYT narrative by a woman who was ‘saved’ by her mammogram and a story detailing the prevalence of overdiagnosis in cancer screening programs- maybe our culture isn’t so guided by reason as we’d like to think.



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