Family Medicine

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World Book of Family Medicine – European Edition 2015 all drugs employed should be kosher. The family physician must also consider that the need to perform religious rites and duties can lead to physical torture and psychological disorders, including depression (4). Some religious rituals can contribute to the development of certain syndromes and diseases, and lead to the spread of infections. Ignorance of them causes difficulties in diagnosis, false diagnosis and ineffective treatment. For example, eating traditional dishes from certain kinds of raw or insufficiently processed meats or fish, offal or animal brain can lead to the development of prion, helminthic diseases and different infections. Such lifestyle habits are transmitted from generation to generation without suspicion that it may cause harm to health. On the other hand, the violation of religious and cultural features can lead to extremely negative consequences not only to patient, but also to doctor, leading to criminal liability. For example, blood transfusion without consent of the patient or his relatives is a crime in some Muslims countries and African states. In Muslim countries, male doctors, especially non-Muslim, may examine women and deliver babies in the absence of her family. Nevertheless, the family doctor should remain patient, observe human ethics, compassion and empathy, do no harm and try to find a way to provide the necessary medical care as outlined in the Hippocratic Oath (1-3, 7). It is clear that the education of family doctors should pay attention to the development of religious and culturally sensitive care to avoid mistakes and problems such as misdiagnosis, misunderstanding, non-adherence, and recidivism (1-3). In 1996, the Society of Teachers of Family Medicine published curriculum guidelines for teaching culturally sensitive and culturally competent health care to family medicine residents and other health professions students. Cultural Sensitivity permits us to respond with respect and empathy to people of all nationalities, classes, ethnicities, religions, ethnic backgrounds and other groups in a manner that recognizes, affirms, and values their worth (4-7). As a result, it is necessary to form culture competence in the family doctor, which is measurable as an important quality indicator of care. Quality indicators must incorporate principles and measures of cultural competence focusing on the policies, procedures, and resources needed to provide linguistically appropriate and culturally relevant services at all points of client contact within a system (1-3, 8). Several existing quality improvement tools have the potential to incorporate dimensions of cultural competence and can be used to define and track outcomes of interest for populations at risk (3). Take home messages The patient's religion, their cultural and personal features need to be taken into account in health care as much as possible. This will avoid confusion, medical errors, misdiagnosis, misunderstanding, non-adherence and recidivism. The family doctor should be aware of cultural religious characteristics of his population, know manners, rituals and norms of behaviour, and consider them when providing medical care, observing human ethics and compassionate empathy. Cultural competence training should focus on empathic listening and development of communication skills that work across cultures and have to be monitored with special tools. Original abstract http://www.woncaeurope.org/content/43-developing-culturally-sensitive-services-primary-care References 1. Colliver JA, Conlee MJ, Verhulst SJ, Dorsery JK. Reports of the decline of empathy during medical education are greatly exaggerated: A reexamination of the research. Acad Med. 2010; 85(4) : 588–93. 2. Helen Riess, John M. Kelley, Robert W. Bailey, Emily J. Dunn & Margot Phillips. Empathy Training for Resident Physicians: A Randomized Controlled Trial of a Neuroscience-Informed Curriculum. JGIM, Published online 02 may 2012. 3. Jean Lau Chin. Culturally Competent Health Care. Public Health Reports, January /February 2000, Vоlume 1, 15, p 25-33 4. Karina Lovell, Jonathan Lamb, Linda Gask, Pete Bower, Waquas Waheed et al. Development and evaluation of culturally sensitive psychosocial interventions for under-served people in primary care. BMC Psychiatry 2014; 14 : 217 http://www.biomedcentral.com/1471-244X/14/217 5. Michael S. Krasner, Ronald M. Epstein, Howard Beckman, Anthony L. Suchman, Benjamin Chapman, Christopher J. Mooney, Timothy E. Quill. Association of an Educational Program in Mindful Communication With Burnout, Empathy, and 250
World Book of Family Medicine – European Edition 2015 Attitudes Among Primary Care Physicians. JAMA. 2009; 302(12):1284-1293 6. National health service corps educational program for clinical and community issues in primary care. Developed by Robert T. Trotter II, Northern Arizona University, October 1, 1994, Revised by National center for cultural healing, Reston, Virginia, June 30, 1999, 67 p 7. Neumann M, Edelhäuser F, Tauschel D, et al. Empathy decline and its reasons: A systematic review of studies with medical students and residents. Acad Med. 2011; 86(8) : 996–1009. 8. Stephanie Marshal A Cultural Competence Guide for Primary Health Care Professionals in Nova Scotia, 2005, 50 p. 251
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