How cultural differences influence your patients

Despite seeming agreement by the patient and his daughter, his surgery was cancelled and re-scheduled by the daughter three times with little explanation over a relatively prolonged period of time. The patient ultimately sustained a stroke. Only thereafter did his daughter mention that the patient was not comfortable having surgery performed by a female surgeon, that he was very upset that he could not participate in the initial discussions, and, as a result, felt that the power of decision making had been transferred to his young daughter. This was interpreted as a challenge to his authority as the head of his household. The daughter was too embarrassed to discuss this at the first visit or mention this regarding the subsequent cancellations. Eventually, the patient underwent his procedure by a male vascular surgeon, who also spoke his language. Although I could easily identify his vascular concern, I failed to recognize his cultural perceptions and sensitivities. If I had been more aware of these sensitivities during the first visit and had tried to address them with him or at least refer him from the beginning to one of my male partners, I might have prevented his stroke and rendered more effective care.

The patients we treat all have vascular disease that we made a commitment to treat, but the similarity often ends there. Our patient may be old or young, rich or poor, educated or not, from cultures all over the globe - evidenced by a plethora of varying beliefs and practices. It is our responsibility as physicians to understand these differences in core values and biases if we want to treat the patient and not just the disease.

Dr. Vouyouka is a member of the SVS Diversity and Inclusion Committee.