Cultural-end of chapter Q's. Ch1-13
What group of women are least likely to perceive themselves as overweight?
African American women
Which groups are not required to fast during Ramadan, a major Muslim religious observance
Anyone who is sick
what question may help identify social factors that would impact a patient's adherence?
Aside from your health, what else in your life is worrying you
Asian Indian patients who use alternative medical treatments are most likely to subscribe to which flavor of alternative medicine
Ayurvedic medicine
How should the physician respond when encountering patients with misconceptions regarding insulin therapy
Clarify the role of insulin by highlighting cause and effect
what are holistic healers called in Hispanic/latino culture?
Curanderos
Many latino patients incorrectly associate diabetes with which symptom
Depression
what factors might lead the parents of a Muslim or Arab adolescent patient to initially delay or refuse chemotherapy
Desire to consult with extended family members and or Imam first
What is true about the nature of acculturation
Differing patterns within families may lead to intergenerational conflict
It is never appropriate to use pejorative phrases when describing patients.
Don't use pejorative phrases when describing patients.
What is the importance of addressing a patient's anger during an office visit?
Enhances the physician's alliance with the patient
What approach should physicians use in taking care of uncooperative, self-abusing, or disruptive patients from a low socioeconomic group?
Ensure that personal biases do not taint clinical judgement
ETHNIC acronym
Explanation Treatment they have tried Healers or alternative medicines Negotiate treatment Interventions they can take Collaboration with patient, family, or healers
among Latino patients with diabetes, what factor is the most important in determining adherence to medication and instilling self-confidence
Family support
which criteria can often determine rates of illiteracy
If you think there is criteria that can determine if your patient is illiterate, you have not reached cultural competency
From which ethnic background are patients most likely to change their diet after being diagnosed with a health problem
Latino/hispanic
LEARN acronym
Listen with sympathy and understanding Explain your medical perceptions of problem Acknowledge and discuss diff and similarities Recommend treatment Negotiate agreement
the prevalence of sleep apnea, and its association with obesity, is greater among which groups
Native Americans and Hispanics
What service would be especially helpful for terminally ill Muslim patients
Negotiating a plan for outside visitors, especially the Imam
When communicating with Muslim patient about end of life issues what statement best shows respect and mindfulness about Muslim beliefs?
No one knows when, where or how someone will die
When is it appropriate to ask a Muslim patient about their sexual activity?
Only in a sensitive manner when it is relevant to the care of the patient
How should physicians respond to working professionals in comparison to unemployed or low-income patients
Physicians should promote patients' health regardless of their socioeconomic status
when meeting an androgynous(male)-appearing patient for the first time, what is the best approach
Refer to patient by full name, rather than using an engendered prefix. Ms. or Mr.
When preparing to examine a Muslim woman or girl it is appropriate to request that she...
Remove her clothes, keeping on the hijab if she prefers, and put on a gown and drape
In Arab culture and Islam, the following parties may participate in medically related decisions for an adolescent patient.
Senior family members, father, and individual parent
Four domains of social context "review of systems"
Social stressors and support network recent change of environment-have they moved Life control- do they have perceived control literacy- their level of literacy
How should physicians and office staff respond to patients who chronically miss appointments?
Speak directly to the patient about the missed appointments.
What approach is most effective in helping patients' with type two diabetes to lose weight
Suggest substituting healthy ingredients for meals and snacks based on the patient's cultural heritage and personal preferences
How can physicians effectively take care of patients from divers backgrounds
They should emphasize good communication in combination with understanding a patient's cultural context
How should a health care professional approach a colleague about their culturally insensitive behavior or remarks?
They should speak honestly, but respectfully, to the colleague.
Moxibustion or moxa, through heat generated by the burning of mugwort (spongy herb) is used by traditional Chinese practitioners to treat many conditions. what Western treatment is most likely to be impacted by concurrent moxibustion?
Topical medications
a complete discussion of contraception should include...
Verbal explanation of pros/cons for each method verbal and written descriptions of methods an opportunity for questions about how each method works
when a patient expresses anger about a physician's colleague, what is an appropriate response?
What concerns do you have about how you were treated?
What question can initiate the process of "LEARNing"
What do you think your sickness does to you?
who should be considered at risk for HIV
all patients should be considered at risk for HIV
when questioning a male about sexual orientation, what question is most appropriate
are you sexually active with other men
what may be the most effective approach to ensure good communication with a large family of hospitalized patient
ask family to choose an individual to be the point of contact with the health care team
How should health professionals respond to the widened definitions of prediabetes and diabetes by the World Health Organization, and other organizations
assist patients in identifying evidence based health care resources
what is an effective way to address cultural issues about personal contact in a clinical setting
attempt to accommodate patient's requests whenever possible, while providing medically appropriate care
What is the best approach when referring a Mexican patient with type two diabetes to a dietitian for nutrition therapy
attempt to identify a bilingual dietitian familiar with the Mexican diet
what are the three components that determine sexual orientation
attraction, cognition and behavior
what groups makes up the majority of users of complementary and alternative medicine in the US?
caucasians
what mode of decision making is prevalent among families of Asian Indian origin
communal deliberation
Cultural and religious issues may impact which of the following issues related to end of life care
creating and advanced directive using a feeding tube using medication for pain control
how might the perspectives of financially secure patients with respect to end-of-life care differ from those of disadvantaged patients
disadvantaged patients may interpret end-of-life care as an attempt to deny essential treatments
if patient understands the nature of sleep apnea and knows how to operate CPAP machine what measure would be effective in improving low CPAP adherence
discuss barriers that the patient has encountered when using the device
how could you provide culturally sensitive care to both partners in an arranged marriage
discuss perceived family pressures with each person individually and then together
how should physicians treat patients who they suspect are incapable of keeping follow-up appointments
discuss the importance of personal responsibility before administering follow-up care
when diet is affected by cultural factor, which in turn significantly impact a patient's health care, what approach is appropriate
discuss the underlying cultural factors related to the usual diet and explore options within that paradigm that might be better suited to their health
what question is associated directly with domain of "life control" in social context review of systems
do you ever feel that you are treated unfairly by the healthcare system
how should you respond to another provider's complaints about a patient that might reflect ethnic insensitivity
emphasize the primary importance of compassion toward patients
Direct observed treatment ( someone watching to ensure treatment is followed) is appropriate for people with multidrug resistant tuberculosis what is the best approach for physicians to initially take when a patient requires DOT
ensure the patient understands the diagnosis, importance of treatment and how this will impact their life
when domestic violence is suspected in a relationship, you should take which approach to address the issue.
explore the patient's inner thoughts and feelings, or their partner's behavior that might indicate ongoing abuse
what possible influence may family and friends' have on a patient's medication choices
family and friends may offer medical advice that contradicts the healthcare provider's advice
what approach may aid a provider in understanding the factors that affect patient adherence
find out the significant sources of stress in patient's life
what is true about marriage in China
free-choice marriage is a right for women age 20+, but some still practice arranged marriages
what is most likely to improve a patient's adherence to taking medications
having continuity of health care providers during office visits
what approach may lead to increased levels of patient's understanding
having them restate in their words the directions that have been given
what barriers to health care may have created disparities for lesbians in the US
homophobia
when patient requires long term care, what issues must be addressed by the family and the health care providers
how the patient and family feel about nursing homes
If you believe there is a language barrier with patient over the phone, what is best course of action
if available, ask a bilingual staff member to join the conversation
what is an important benefit of exploring a patient's explanatory model of illness
improved patient adherence and increased understanding of patient's perspective
What physician barrier can affect a patient's adherence?
inadequate explanation of instructions
what is an indicator of low literacy level in patients
incomplete health questionnaires
what is low health literacy associated with
increased hospitalizations
Poor adherence results in what outcomes?
increased patient morbidities and mortalities
how should provider respond when requested to withhold info about a diagnosis from family members
initiate further discussion with patient and help patient identify a surrogate decision maker
what question is taken from the "Treatment" portion of the ETHNIC acronym
is there anything you eat, drink or do on a regular basis to stay healthy
what is an effective approach to prescribing medications for patient's from diverse cultural backgrounds
learn about culturally relevant medicinal practices of patients before prescribing medication
what group has been referred to as the invisible minority within healthcare
lesbians
What sort of health disparities do African American and Hispanic in regard to organ transplants?
lower rates of graft survival
what approach is effective in building patient trust
making eye contact with them during visit
patients who are very respectful of providers may respond in which way when prescribed medication
may avoid asking about side effects
what is the result of a patient feeling "judged"
may jeopardize the effectiveness of doctor-patient relationship
why might a patient be reluctant to reveal their sexual orientation to a provider
might not self identify as gay uncertainty about how provider will react fear of being stigmatized or stereotyped
what level of exercise affords the greatest health benefits among sedentary individuals
moderate-intensity exercise
where should medical interpreter sit relative to patient
next to and slightly behind patient and avoid eye contact with physician
what is true regarding the adjustment process during acculturation
older adults tend to experience greater difficulty adjusting to a new culture
how can providers prevent presuming a patient is heterosexual
openly discuss sexual history and relationship status
what might discourage a patient from taking their medication
prescribing complex treatments
during medical history, what is best way to develop a patient's trust and build rapport
provide a setting that is private and safe for disclosure
what is the role of the provider and patient in making health care decisions
provider's responsibility to instruct patient about their condition , but provider must ultimately respect the patient's personal health choices
when providing care for a Chinese patient struggling to become "xianqi liangmu"(good house wife) what approach is best
referral to a Chinese social worker
what is providers role when patient lacks decision making capacity and has someone other than family member designated as surrogate decision maker
serve as a mediator between parties and encourage all groups to work together in the best interest of the patient, consistent with patient's wishes
What factor may contribute to the higher mortality rates seen in the homeless population?
suboptimal access to health care
when motivating patients to quite smoking what approach is most effective
support each patient's small steps and develop a long term plan to quit
How should physicians approach patients with type 2 diabetes and also regularly visit holistic healers?
take a history of alternative medicines used by patients to avoid herb-drug interactions
what may make it more difficult for a lesbian woman to quite smoking
targeting of LGBT community members by tobacco companies- they would support or provide funds for LGBT movements and protests
why might an immigrant be reluctant to participate in direct observed treatment(someone watching to ensure treatment/medication if followed/taken)
the patient may be fearful because of the loss of privacy or cultural misunderstanding or may be undocumented or have undocumented family
when discussing sensitive and personal issues with a patient that may involve significant lifestyle changes, how should the patient's family be involved in the process?
the physician should always decide whether or not to include the family based on the patient's wishes
what factors play the largest role in determining a patient's explanatory model
their culture
What should physicians who provide pharmaceutical samples in their office be aware of?
there may be a significant price difference between samples and the generic version of the medication
Prior to the physical examination of a Muslim adolescent, what should be clarified to the patient and their parent/s
they can express concerns about any part of the exam at any time
What role do ad hoc (as needed) interpreters playin bridging the language barrier
they may be helpful but they lack the clinical foundation and experience of training and experience of trained medical interpreters.
when there is a language barrier what is benefit of using medical interpreter
they offer direct interpretation of the patient's responses
what skills do trained medical interpreters provide in clinical setting
they provide the social and spontaneous interactions with patients like small talk for developing rapport
what is the physician's primary objective when approaching patients about their use of complementary and alternative medicine?
to establish and open discussion about all aspects of the patient's health care
primary purpose of "transtheoretical Model"
to identify where patient is in their thinking
sleep apnea is most dangerous among people in which occupation
truck driving
assimilationists, separationists, and integrationists characterize what model of acculturation
unidimensional model of acculturation
victims of abuse who do not have access to contraception have high rates of...
unplanned pregnancies that result in abortions
what is an effective complement to motivational interviewing
using confidence and importance rating scales
what question is most effective in identifying a patient's ethnicity
what ethnic identity best describes you?
what question is an effective way to elicit a patient's explanatory model of illness regarding Tuberculosis symptoms
what is your understanding of tuberculosis
under what condition is direct observed treatments(someone watching to ensure treatment or medication is taken) most successful
when DOT is carried out in a way that is convenient for a patient
when is it appropriate to prescribe birth control pills for patients in an arranged marriage
when the patient expresses they don't have the desire to get pregnant
what statement is likely to convince a truck driver to change their diet to a healthier one
you should refuel your body just as you refuel your truck, with healthy foods