Culture And Health (2) SOC 162 PDF

10/10/2023 CULTURE AND HEALTH (2) SOC 162 10/10/2023 1  Last time we talked about….  Cultures of biomedicine: Doctors and hospitals have their own interests, emotions, biases, etc.    E.g., They value rational thinking, efficiency, strong professional hierarchy. Gaps between cultures of...

10/10/2023 CULTURE AND HEALTH (2) SOC 162 10/10/2023 1  Last time we talked about….  Cultures of biomedicine: Doctors and hospitals have their own interests, emotions, biases, etc.    E.g., They value rational thinking, efficiency, strong professional hierarchy. Gaps between cultures of biomedicine and Hmong or Muslim immigrants. Is there a cultural gap between biomedicine and the general population? 2 1 10/10/2023 CULTURAL GAP BETWEEN BIOMEDICINE AND EVERYDAY LIFE  Cultural ideals of biomedicine [“voice of medicine”]:    Focus on abstract rules/guidelines, define reality in technical terms, oriented towards goal completion. Promote patient compliance. Cultural ideals of everyday life [“voice of lifeworld]:   Sensitive to context, value mutual understanding, oriented towards consensus and compromise. Promote partnership.  Clinical communications are a mixture of the two. But voice of medicine tends to dominate. 3 EXAMPLES: EXCERPTS FROM “DARK SIDE OF THE FULL MOON” (1) Watch this story about Jennifer’s experience of postpartum depression....  What is her husband saying?     In what ways is he being “sensitive to context, desiring mutual understanding, oriented towards consensus and compromise”? In what way is he promoting “partnership” between the two of them? An example of “voice of the lifeworld.” 4 2 10/10/2023 EXAMPLES: EXCERPTS FROM “DARK SIDE OF THE FULL MOON” (2) Watch this clip about how the healthcare system responds....  What explains the healthcare system’s lack of response to this problem?    In what ways is the healthcare system focusing on abstract rules/guidelines, technical descriptions, or goal completion?” An example of “voice of medicine.” 5 SIDEBAR: WHY IS PPD OFTEN UNDIAGNOSED AND/OR UNTREATED IN THE US?    1 in 9 new mothers has PPD (2019 CDC study). Insufficient training and awareness among healthcare professionals. A professional culture that focuses  more  more  on prenatal than postpartum care; on physical than mental illnesses. In the US:      There is universal coverage for prenatal care, but not postnatal care. New moms typically are not seen by doctors for 6 weeks. PPD screening NOT part of routine postpartum visit. Gestational diabetes (~10%), preterm labor (~12%), low birth weight (~8%), pre-eclampsia (~5%). Increasing awareness recently, but still work-in-progress. 6 3 10/10/2023 EXAMPLES: EXCERPTS FROM “DARK SIDE OF THE FULL MOON” (3)  What is the social context for Mary Rose’s illness experience?    What kind of social support did she need? Why couldn’t she receive it? Why did the hospital detain Mary? What policies/values did this case reflect? Biomedical culture and health policies are connected to larger systems.    E.g., market society, changing family structure, the regulatory state. These systems value: efficiency, profit, individual solution; state control. “Privatization of motherhood.” 7 VOICES OF LIFEWORLD AND MEDICINE Gap between the two sets of sense-making schemas;  The gap experienced by all patients, not just minorities;  Understanding cultural brokerage for minority patients may help closing the gap for the general population.  8 4 10/10/2023 CULTURAL BROKERAGE: BRIDGING LIFEWORLD AND MEDICINE [From Lo 2010]  Biomedical culture/voice of medicine: the sensemaking schema informed by biomedicine, hospital rules, professional hierarchy.  Patient culture/lifeworld voices: Patients’ sensemaking schema, informed by multiple structural forces, e.g., ethnicity, gender, class, sexual orientation, etc.  How to bridge or blend the two? Cultural brokerage through mutual inclusion.  9 MECHANISMS OF CULTURAL BROKERAGE [From Lo 2010]  ‘Translating between health systems’    ‘Bridging divergent images of medicine’   E.g., “I won’t go back to the eye doctor.” ‘Establishing long-term relationships’   E.g., “Physical therapy here doesn’t do anything.” E.g., “My Peruvian patient was leaving out her ‘bad’ blood sugar records.” “Working with patients’ relational networks.  E.g., “For Khmu patients, learning new information from an office is not their thing.” 10 5 10/10/2023 DISCUSSION Which mechanism resonates with you the most? Why? Personal experience with any?  Which example (from the reading) did you find most interesting? Most disturbing?  Which mechanism might best address the problems faced by the moms in “Dark Side of the Full Moon?”  Which mechanism might best address the vaccine hesitancy we face today?  11 CULTURAL BROKERAGE: A FORM OF LABOR  Shared ethnicity doesn’t guarantee that cultural brokerage will happen.  Unwillingness to engage in mutual inclusion?  Resource constraints  Pressure to act “extra professional”? Lack of resources (time, $) as a challenge for the doctors’ cultural brokerage in Lo’s (2010) study.  Widespread physician burnout in post-COVID contexts.   What types of resources are required for doctors and nurses to address vaccine hesitancy today? 12 6 10/10/2023 CONCLUSION  Cultural barriers in clinical communications: tensions between voices of medicine & lifeworld.  Two different sets of sense-making schema. These cultural barriers can exist for all, though more pronounced for minority patients.  Cultural brokerage:     Mutual inclusion of different schemas; “blending” How? Four mechanisms. Cultural brokerage is a form of labor, and requires resources. 13 7