What beliefs or behaviors do you see that are different than your own?
Britain has a similar style of caring for the elderly as the United States apart from universal healthcare. I feel that the elderly in Britain are better cared for because they do not have the gaps in coverage that are left from Medicaid and private insurance policies. Universal health care ensures that chronic problems are identified and managed from an earlier stage of disease allowing elder British citizens to remain more independent for longer periods of time. In My Generation, Tim Samuels portrayed the feelings of an aging generation who felt left behind and forgotten (Samuels, 2017). I feel that American and British elders can mirror the sentiments regarding long term care plans.
The Grey’s Anatomy Hmong episode demonstrates the greatest differences between my personal individualistic culture and collectivist mindset of the Hmong people. In the episode the Hmong family feels that the patient has become ill due to a wandering soul (Eyerly, 2018 ). Initially McDreamy and Meredith do not understand the refusal of treatment and continue to insist on surgical treatment using Western reasoning. It is only when the family is separated do they feel comfortable enough to answer questioning about their cultural beliefs. Anna, the daughter, explains that she respects her elders more than her own autonomy. She trusts her Father’s assessment regarding a wandering soul and respects his decision to refuse surgery (Eyerly, 2018 ).
Derek questions Anna’s father in an attempt to understand the cultural beliefs of the Hmong people. Derek asserted his position as a caregiver and surgeon explaining that Anna could meet with the family shaman in the hospital. Derek showed cultural competence when he chose to collaborate Eastern beliefs with Western medicine.
• How would you feel if this person were your client, or how would you feel if you worked in this environment?
As an imaging professional in a hospital setting it is not uncommon to see patients who present with severe clinical symptoms whom refuse treatment. I understand Derek and Meredith’s frustration when a patient is willing to leave against medical advice or refuses treatment. It is easy to think, why come to the hospital if you don’t want our help? Most often, truly ill patients have a belief system that is preventing them from accepting the treatment they desire. It is important to take a step back and consider that the patient may not have the same beliefs or point of view (Drench, Cassidy Noonan , Sharby , & Hallenborg Ventura, 2012). Cultural competence can ease the tension in these situations through an open dialogue of questions.
All the drama of a typical Grey’s anatomy aside, Derek resorted to cultural competency after his standard bedside manner failed. His initial attempts to convince the family fell short because he was not considering Hmong beliefs. Derek changed course once he understood that the family respected his diagnosis but was refusing on religious grounds. Cultural competency training tells providers to forego assumptions and ask if there are any religious or cultural needs. My hospital does its best to provide the patients with a variety of on call religious services as well as a program that prevents patients from dying alone. Derek realized his mistaken assumptions that the family did not understand the severity of Anna’s condition and provided the family with the cultural considerations that were best for Anna’s care. In the end cultural competency won out and provided Anna with the care she needed which would have made me proud of the care team.
There is always room for improvement and I feel that if this situation were real it would be an important learning example for our regular Friday updates or quarterly meetings. I find that the best examples are relatable and create learning experiences through association.
• What questions could you ask to help this person to feel most comfortable in your clinical setting?
I believe that Derek and Meredith eventually asked the right questions. The most important question to ask is what the patient would like us, as caregivers, to know about their culture or health preferences (Drench, Cassidy Noonan , Sharby , & Hallenborg Ventura, 2012). In addition, providers who are met with refusals for care should ask the patient why they feel the need to refuse, and who typically makes health care decisions for them. A third important question to ask is what intentions the patient had, or what goals they expected to be met when they came to the hospital. Asking these questions is only the beginning to making the person feel comfortable. Providers should ask follow on questions to make sure they are clear about the expectations and goals of the client. Having the right answers gives the care team the ability to accommodate requests such as opening the window to let a soul out upon death, or restorative foods for yin and yang imbalances.
• Do you think the elderly are mistreated in our society? Our health care system?
I believe that the elderly are especially susceptible to mistreatment and abuse in society and in the health care system. Long term health systems were designed to support the needs of an aging population especially with the population explosion that came from the baby boomer generation. Social Security and Medicaid are the most common programs that aging Americans rely on. Unfortunately, many of these systems have been exploited through underfunding and government cut backs.
In addition to dwindling government resources American employers have stepped away from pension systems into self-funded retirement plans. Self-funded retirement plans are more flexible and reliable than pensions, however, they only recently became wide spread during the 1970’s. Modern medicine has increased the lifespan of the silent generation and baby boomers beyond the support of financial retirement preparation. The combination of scarce financial resources and extended life spans the elderly have become increasingly vulnerable to abuse and mistreatment.