As someone who has long worked on health equity issues and with patients who look, speak and think differently from me I have always held that the impacts of cultural concordance between caregivers and their patients are perhaps over-exaggerated. Time, compassion, a willingness to learn, and sufficient empathy could in my mind allow a physician to afford equal care to almost any patient. Now, after having my first experience seeing how a person who looks like the patient can affect the course of treatment, a belief in intrinsic intangibles has started to emerge.
The circumstances of this change in mind frame occurred on my acting elective. While on this service a young woman was admitted to our service following a potential overdose while under the influence of alcohol. While hearing news of this would be distressing for any parent it is all the harder when one is 8,000 miles away from your child. Fortunately for this family though not actively on my mind was the fact that a small piece of home was already by the patient’s side. My father was by coincidence from the same state of India as the patient and my last name speaks strongly to this origin. Consequently, so introducing myself as Student Doctor Menon I was also introducing an unspoken affinity. When she arrived to pick up the patient immediately from the airport and she shared this feeling with me along with the gratitude which radiated even through her mask it really struck me.
At the same time factors beyond my active control or consciousness improved my rapport with the patient’s parents. They also made me and the team uniquely deft in managing the patient’s fears and attempts at manipulation. Whenever treatment did not go the patient’s way she immediately asserted our inability as non-Indians to understand her situation and the full consequences of our decision (per her initial request) to release her to her parents. Simply through my lived experience, I was able to discuss these possibilities with the rest of the team and provide a more realistic perspective on the patient’s grim visions. At the same time sharing with the patient that I did understand her situation while carefully avoiding counter-transference did allow her to gradually lean into treatment at least a bit more. She was able to shift from panicking to building an effective approach to discuss her concerns with her parents and carving out her own identity and recovery independent of them.
I have often joked about being born to be a doctor but this represented the first time that physical and cultural features with which I was born helped me to do so.