Cultural barriers in medicine: lessons from Debjani Mukherjee

How does cultural context influence medical decisions and how can doctors be prepared to engage with patients in unfamiliar environments?

Debjani Mukherjee encountered these questions while researching traumatic brain injury in Kolkata, India in 2007.

After researching traumatic brain injury in India as a Fulbright Scholar, Mukherjee continues to study the relationship between culture and medical decisions.

She continues to study the relationship between culture and medicine in her current roles as director of the Donnelley Ethics Program at the Rehabilitation Institute of Chicago and as an assistant professor of physical medicine and rehabilitations and of medical humanities and bioethics at Feinberg.

Mukherjee discusses how doctors and students alike can prepare to understand structural differences and better engage with patients in different socioeconomic and cultural circumstances.

What surprises did you encounter in your research in India?

I really wanted to look at long-term outcomes for my study and the neurosurgeon who I was working with had a database of patients. But once I got there, it was hard to find people. There isn’t a phonebook. There isn’t a centralized way to locate people. The continuity was missing, and that’s something that we take for granted here when we work with patients – they have accurate contact information. The infrastructure is just so different.

How does working in the medical system in India differ from your experiences in the United States?

When you think about traumatic brain injury and working in India, the number one ethical issue is resource allocation. There aren’t the same levels of services available for everyone. For people who can afford it, there is world-class medical care, and for people who are indigent, there is medical care but it’s really not as good. We have that in the U.S. to an extent – it’s the difference between maybe a publicly funded clinic versus a very privately funded, lush clinic. But we still have a safety net here.

As a country that just gained independence in the 1940s and has a tremendous population India is still trying to figure some of these things out. Even the concept of health insurance is relatively new – it came about in the last 20 years or so. Before that, if you had a catastrophic illness, your family would figure out a way to pay for it.  And that’s very, very different from most of the developed world.

How do attitudes toward medical professionals differ across the two countries?

As far as attitudes, I found that the doctor to patient relationship is fundamentally different. Here we are much more skeptical of the medical establishment. We’ll do our own research, get second opinions and go in armed with information.

In India, one of my medical students and I found that people literally use the word ‘God’ to describe their physician. “He’s like God to me,” or “God brought me to this medical provider and I’m so thankful.” They were much less skeptical. Having worked with patients in the U.S., people just don’t say that here.

Do you have any recommendations for students who will participate in rotations or research abroad?

First, be open and don’t have preconceived notions. Things might be really different, or they might be similar. Either way, we have the tendency to overanalyze. It’s also important to know yourself – your biases, your privileges and your limitations – so when you’re put in an ambiguous situation you can focus on what’s going on and how you should respond.

Students have extremely good intentions, but trips abroad are often about enhancing professional development. We need to remember that it’s not just a one-way street. Understand the academics and develop your depth of knowledge so that you can really engage with people wherever you go and the experience can be mutually beneficial.

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