by Karen Peterson-Iyer
Leyla Ansari, 30, a recent immigrant from Afghanistan who is 22 weeks pregnant, is admitted to East Valley Hospital-a large, suburban, non-teaching hospital--with severe cramping. A preliminary ultrasound indicates brain abnormalities with her fetus. She is accompanied by her husband of eight years (also an immigrant) and her mother, who speaks no English and lives with the couple. Mrs. Ansari (Leyla) also speaks very little English, though she does understand some; her husband speaks English better, though somewhat haltingly. Their primary language is Dari.
Mrs. Ansari is stabilized, and further scans are conducted on the fetus. The physicians soon discern that the fetus is afflicted with a relatively severe encephalocele; its size and location make survival outside the womb extremely unlikely. The attending physician, Dr. Fox, is not previously acquainted with the patient, since any earlier prenatal care she obtained was inconsistent and not at this facility.
Dr. Fox enters Mrs. Ansari's hospital room, where she had been meeting with an Afghan female friend (who apparently also speaks English reasonably well) while waiting for news of the fetus with her husband and mother, all of whom appear agitated and anxious. Mrs. Ansari's other children (all girls, ages 2, 5, and 6) are in the outside waiting area, accompanied by an aunt. Before Dr. Fox begins to speak, Mr. Ansari, noticing a look of deep concern on the doctor's face, asserts that his wife is sick with fear and anxiety and that she herself would prefer that her husband handle any news of the situation. He requests that Dr. Fox meet separately with him first, outside of his wife's room. Moreover, it is the traditional time for Muslims to offer prayers, and, since he and his family are devout Muslims, they would prefer to do so before any difficult conversations are had with the doctor. Mrs. Ansari, obviously upset but remaining silent, makes no visible objection to her husband's wishes. The friend also is silent. Mr. Ansari repeats his request that the doctor meet separately with him.
Dr. Fox, unsure of how to proceed but not wanting to stress Mrs. Ansari further, agrees to meet the husband separately across the hall, in an empty office; but he also informs Mr. Ansari that they must talk now, for he does not have time to wait for him to complete his prayers. Mr. Ansari silently follows the doctor to the empty office, where Dr. Fox discloses the most recent scan results to Mr. Ansari. Dr. Fox recommends termination of the pregnancy. Stunned, Mr. Ansari sits in silence for several minutes.
After several moments, there is a knock on the door from Mrs. Ansari's mother. She immediately discerns from the husband's face that something is terribly wrong, and asserts (in Dari) that her daughter must not be told anything of the situation until she is in a better frame of mind. She converses for some time with Mr. Ansari, becoming increasingly agitated through the course of the conversation. Dr. Fox eventually interrupts and asks the husband to translate, which he does, relaying that Mrs. Ansari's mother insists that the medical information from the scans may be faulty, and it would be bad luck for her daughter to learn the scan results at this point. In fact, she asserts, her daughter may "lose the baby" from stress over the results. She wishes for the hospital to keep her stable and let the fetus continue to grow inside her uterus in order to see "what God intends." She herself firmly believes (though there has been no information in this regard) that this baby is the long-anticipated boy that the entire family has been hoping for, and that God would not visit such an unhappy result on such a devout family.
Mr. Ansari then turns back to Dr. Fox and insists that the doctor refrain from telling Mrs. Ansari the scan results, assuring him that he will tell his wife himself once she is emotionally ready for the news. The doctor, increasingly frustrated with the direction of the conversation, informs the husband that such a choice is not his to make. He gets up and proceeds back across the hall, where he walks in on Mrs. Ansari awkwardly performing her prayers. Dr. Fox interrupts her and asks the friend (who is still present) to help him translate his news for Mrs. Ansari. He then gently but firmly informs Mrs. Ansari of the scan results, as the friend awkwardly translates for her. Mr. Ansari has stayed across the hall, and Mrs. Ansari's mother retreats, wailing, to the waiting room. Mrs. Ansari struggles to keep her tears at bay as she listens to the doctor.
Found at: http://www.scu.edu/ethics/practicing/focusareas/medical/culturally-competent-care/fetal-abnormality.html
Leyla Ansari, 30, a recent immigrant from Afghanistan who is 22 weeks pregnant, is admitted to East Valley Hospital-a large, suburban, non-teaching hospital--with severe cramping. A preliminary ultrasound indicates brain abnormalities with her fetus. She is accompanied by her husband of eight years (also an immigrant) and her mother, who speaks no English and lives with the couple. Mrs. Ansari (Leyla) also speaks very little English, though she does understand some; her husband speaks English better, though somewhat haltingly. Their primary language is Dari.
Mrs. Ansari is stabilized, and further scans are conducted on the fetus. The physicians soon discern that the fetus is afflicted with a relatively severe encephalocele; its size and location make survival outside the womb extremely unlikely. The attending physician, Dr. Fox, is not previously acquainted with the patient, since any earlier prenatal care she obtained was inconsistent and not at this facility.
Dr. Fox enters Mrs. Ansari's hospital room, where she had been meeting with an Afghan female friend (who apparently also speaks English reasonably well) while waiting for news of the fetus with her husband and mother, all of whom appear agitated and anxious. Mrs. Ansari's other children (all girls, ages 2, 5, and 6) are in the outside waiting area, accompanied by an aunt. Before Dr. Fox begins to speak, Mr. Ansari, noticing a look of deep concern on the doctor's face, asserts that his wife is sick with fear and anxiety and that she herself would prefer that her husband handle any news of the situation. He requests that Dr. Fox meet separately with him first, outside of his wife's room. Moreover, it is the traditional time for Muslims to offer prayers, and, since he and his family are devout Muslims, they would prefer to do so before any difficult conversations are had with the doctor. Mrs. Ansari, obviously upset but remaining silent, makes no visible objection to her husband's wishes. The friend also is silent. Mr. Ansari repeats his request that the doctor meet separately with him.
Dr. Fox, unsure of how to proceed but not wanting to stress Mrs. Ansari further, agrees to meet the husband separately across the hall, in an empty office; but he also informs Mr. Ansari that they must talk now, for he does not have time to wait for him to complete his prayers. Mr. Ansari silently follows the doctor to the empty office, where Dr. Fox discloses the most recent scan results to Mr. Ansari. Dr. Fox recommends termination of the pregnancy. Stunned, Mr. Ansari sits in silence for several minutes.
After several moments, there is a knock on the door from Mrs. Ansari's mother. She immediately discerns from the husband's face that something is terribly wrong, and asserts (in Dari) that her daughter must not be told anything of the situation until she is in a better frame of mind. She converses for some time with Mr. Ansari, becoming increasingly agitated through the course of the conversation. Dr. Fox eventually interrupts and asks the husband to translate, which he does, relaying that Mrs. Ansari's mother insists that the medical information from the scans may be faulty, and it would be bad luck for her daughter to learn the scan results at this point. In fact, she asserts, her daughter may "lose the baby" from stress over the results. She wishes for the hospital to keep her stable and let the fetus continue to grow inside her uterus in order to see "what God intends." She herself firmly believes (though there has been no information in this regard) that this baby is the long-anticipated boy that the entire family has been hoping for, and that God would not visit such an unhappy result on such a devout family.
Mr. Ansari then turns back to Dr. Fox and insists that the doctor refrain from telling Mrs. Ansari the scan results, assuring him that he will tell his wife himself once she is emotionally ready for the news. The doctor, increasingly frustrated with the direction of the conversation, informs the husband that such a choice is not his to make. He gets up and proceeds back across the hall, where he walks in on Mrs. Ansari awkwardly performing her prayers. Dr. Fox interrupts her and asks the friend (who is still present) to help him translate his news for Mrs. Ansari. He then gently but firmly informs Mrs. Ansari of the scan results, as the friend awkwardly translates for her. Mr. Ansari has stayed across the hall, and Mrs. Ansari's mother retreats, wailing, to the waiting room. Mrs. Ansari struggles to keep her tears at bay as she listens to the doctor.
Found at: http://www.scu.edu/ethics/practicing/focusareas/medical/culturally-competent-care/fetal-abnormality.html
In this example Dr. Fox did not show any cultural competence or understanding and compliance with the family's wishes, he was very disrespectful of the whole thing. First when asked if they could wait to talk about the results after they were done praying he denied this saying he did not have time for this, which is not taking the patients wish into any consideration, and then two when asked not to tell Mrs. Ansari of the results because the stress would be to much for her and hurt the baby who they were hoping was still okay, he denied this two saying it wasn't his choice, which it was because he just has to let the family know which Mr. Ansari knew and said he would tell her once she is in a better emotional state. The Ansari's could report Dr. Fox on how he treated them with no respect and how he wouldn't listen to their wishes, because the choice of care is up to the patient overall, doctors can only suggest what to do not enforce what to do.
ReplyDeleteI think he showed some cultural competence at first, but as time went on he became more and more disrespectful as he became more and more frustrated. None of which is acceptable, but I do think that this is the one scenario where I see an actual attempt made at cultural competence, even though it ended in a total disaster. I think the first mistake was made when the Dr. Fox took the father aside and began speaking to him, without any actual discussion with the patient. It was all downhill from there.
DeleteI agree that the doctor could have shown a lot more compassion because prayers are very important in the Muslim culture. It is as long important to keep the patient calm as possible as well as keeping the family at ease and praying would help do that for this particular family.
DeleteA lack of cultural competence was shown in this situation. Dr. Fox knew his plan and how he wanted to go about it, but he did not take into consideration the culture and beliefs of this family. Dr. Fox should have been more sympathetic towards this family and known more about their history as a culture. He also could have talked to the translator about how to handle the situation because she was able to communicate with the family better. Dr. Fox showed frustration and irritation that made it seem like he had no respect for this family's culture and beliefs . It's important to attempt to understand the patient's perspective to create a comfortable and calming environment, especially for bad news such as this. The patient should always be put first by a medical professional, and Dr. Fox failed to have a good understanding of the background of their culture which led to inappropriate actions taken that caused distress.
ReplyDeleteI agree, Dr. Fox had one goal in mind and that was to tell the patient herself about the results, without consulting the family and making sure they were culturally excepting. Dr. Fox did not seem to care when it came to them praying, and didn't seem to care about the families wishes either. I also agree that he should've attempted to create a calm air for everyone in this scenario.
DeleteI agree the doctor should have taken other steps. It is important to always respect the patient's culture. I especially believe that the patient should always be put first in all circumstances.
DeleteDr. Fox failed to accommodate appropriately and providing patients with respect to their Muslim religion. He didn't let Mr. Ansari say a prayer and all he was focused on was Mrs. Ansari and the news about her baby, not the welfare of the entire family and their wishes and culture. NO matter if Dr. Fox was religious or not he was blatantly disrespectful to the family of the Ansaris and didn't show much cultural competency.
DeleteThere was definitely a lack of cultural competence and any sort of emotion behind Dr. Fox's actions. I do not believe that he made the right decision by informing the patient herself immediately. Understanding the situation was tough and frustrating, if their beliefs and wishes were such, the doctor should have better informed the family and took their wishes into consideration. there was nothing in here regarding life or death in this scenario so I do not feel it was right for him to rush into the room and tell the results when it appears that results could've waited until the family was ready to give them.
ReplyDeleteI agree that the for should have been better informed. I do not believe that he purposefully was uninformed. I think he was just ignorant. In this situation ignorance is not an excuse though. It is the attending's job to make sure that they are prepared for whatever their patients are going to throw at them.
DeleteI agree with what you are saying about how there was a huge lack of cultural competence, however when you were talking about life or death, it was in some sorts because he was talking about terminating the baby which is ending a life. That news seems pretty serious but then I agree with you that he didn't need to rush in and tell the mother, just telling the father was enough.
DeleteI agree, telling the patient outright and ignoring the husbands wishes was blatantly disrespectful. Understandably it may be difficult to accept someone else's beliefs, but showing utter disrespect towards the family by ignoring the wishes and walking in and interrupting prayer is not ok.
DeleteI agree that there was plenty of opportunity for the doctor to be culturally competent. As you said, this was not a life or death urgent situation, so the doctor could have put aside his frustration and follow the wishes of the family. The patient should always come first and their wishes should be respected. The doctor should have attempted to get a grip on their culture and how they feel about the situation rather than showing no sympathy and rushing into his own judgement.
ReplyDeleteI think that the language barrier and foreign beliefs/traditions led Dr. Fox to act in such a disrespectful manner. I understand his frustration and desire to tell the patient the news. When he first began talking with the family he seemed to be willing to follow their wishes. As the conversation(s) progressed Dr. Fox became less and less willing to follow those wishes. I feel like he could have asked for a real translator, he could have bothered to quickly brush up on Afghan culture, and/or NOT interrupt their prayers. Dr. Fox also failed to acquaint himself with his patient. Had he done this he could have been more prepared for the family's culture, wishes, and religion.
ReplyDeleteI like how you bring up the point that Dr. Fox never acquainted himself with the patient. I agree that this is very important. Like it said, Mrs. Ansari had been receiving care from other people at a different hospital, so they do not have the comfortability level with each other that they should. In what ways do you think that the doctor should have learned more about their culture? It seemed like this case was pretty time sensitive.
DeleteI think that you have a lot of good points that you made. I think that he did start off in a good manner at first but once the language barrier started to cause a "problem" I think that when it continued to get worse. I think that the doctor was thinking that the best thing to do was to try to find someone who understood to tell the wife when really he should have been understanding. Also, I agree that there should have been no inturruption of their prayers. Dr. Fox failing to get aquaintedwith the patient i think was due to the type of nes that was recieved from the scans and no consistency with the patients prenatal care. So maybe he was trying to get all the infromation he could for the patient so that he could give the best care. I do think in this case an extra person to help calm everyone down would have been helpful and someone who knew more about the cultural difference.
DeleteDr. Fox was very disrespectful to the patient and the family of the patients wishes. Dr. Fox did not make the correct decision when rushing Mr. Ansari out of the hospital room because the doctor felt he did not have time to wait for the family to finish praying with the patient. As a doctor, even if you are unfamiliar with someones religion you should still remain respectful and caring of how they practice and carry out their beliefs. When you see someone who appears to be praying or occupied in something that may be religious you should wait for them to finish their prayers and check back in a couple minutes rather than rush in and disrupt what is happening. It is extremely important that you use a translator if you are having trouble understanding the patient or other family members in the room in order to keep everyone involved in the situation on the same page.
ReplyDeleteAlly I totally agree with what you said. It is very wrong for someone to disrespect someone's religion especially when they're praying. Dr. Fox should've waited until they were completely done and he shouldn't be rushing them anyways in an emotional time that they were in.
DeleteIt seemed in the beginning that Dr. Fox was willing to cooperate with the families culture, however, later on he became frustrated and showed no sign of cultural competence. I think one of biggest issues is denying what the husband was trying to do, which, was to inform the pregnant wife of the scan results when she was more emotionally available to accept the news. This is directly disrespectful to the family and to the couple. What makes it even worse is that the doctor interrupts the prayer, which, is a major practice of the Muslim religion. Overall, the doctor could've been more patient with the family and followed the husbands wishes in a respectful manner.
ReplyDeleteIn this situation there was definitely a lack of cultural competence from the doctor to the hospital in general. It was already bad when the Doctor knew what he wanted and thought was best for the baby and the family. However it is not his choice on how one would take on this situation, it is the family's choice. Also Dr. Fox didn't respect their culture whatsoever when the family wanted to pray with with their loved one. There was a lack of respect for their culture and beliefs which should never happen because the patient and their family should always come first. The way Dr. Fox should've handle this situation was being more respectful and explain all of their options for the baby and the mom.
ReplyDeleteIn this situation again, East Valley Hospital does a good job of treating the patient but a terrible job with cultural competance. The family should be able to have their wishes kept if the way they do it in their culture is to keep information or have information be shared a certain way. Also, to not have the family take a few minutes of prayer quickly before the news is shared could have happened. Everyone was stable and not needing a decision right away. The doctor could have saved the family all these extra emotions if it was not for him being to busy being frustrated and think about the family and patient as a whole. This senerio could have been handled in a much more cultural compatent way if the doctor would have taken the time to understand.
ReplyDeleteDr. Fox was put in an uncomfortable situation, but that's not an excuse for being disrespectful to the families culture. An example of his disrespectfulness was when he interrupted their prayers. He also went against the families wishes to keep the news secret, but in his defense, I think he had to tell the patient. If he legally had to, then there was nothing he could do, but he shouldn't have interrupted her prayers to tell her. I think the situation would have been handled a little better had Dr. Fox been a little more competent to the family and their culture. I think the doctor should have presented them with the results and what he thinks the best treatment is, then he should listen to what the family has to say.
ReplyDeleteDr. Fox in the beginning tried to show cultural competence by allowing the Mr. Ansari to meet with him outside away from his wife's bedside and pray. He gave a courteous gesture to allow them to speak alone but he denied him the chance to pray which wasn't respectful to his religious and very disrespectful in the terms of cultural competence. As the mother came and talked to Mr. Ansari about the situation and the baby, Dr. Fox became more and more agitated and frustrated that he couldn't understand them and butted in on the family conversation. He did the correct thing however that he had to tell the mother of the child who indeed has the power in that situation whether or not to abort the fetus or keep the child and risk even further complications. Dr. Fox should have been more complaint with the Ansari families wishes and tried to think of alternative options to defuse to situation with the Mrs. Ansari's mother but he did try and tell Mrs. Asari directly and gently the seriousness of her situation as a doctor should.
ReplyDelete