A Tale of Culture and Health Care (i.e. My Big Fat Scary ER Experience)

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About a month ago, I went for a run and had chest pains. I assumed I’d pulled a muscle in my chest, something I had done once before. I took some ibuprofen, slathered Ben Gay on myself, and figured it would heal. The chest pains continued for several weeks to the point that I couldn’t sleep and couldn’t lie on my left side. As the weeks went on, my abdomen started hurting as well. I convinced myself it was totally normal and I probably just had indigestion and took some Tums. Then my stomach became severely distended, I couldn’t breathe without coughing, and I started vomiting. I finally argued myself into admitting this was not normal and went to urgent care.

Urgent care sent me to the emergency room. I still figured they would just find I had some weird indigestion and a pulled chest muscle and send me home.

In the ER, they did an EKG and within minutes the medical assistant grabbed me and rushed me back to see the doctor, saying, “Don’t worry. You got to us just in time.”  I immediately started crying, wondering if I was dying.

The ER doctor came in and said, “I’ve never seen an EKG like this on a person your age. We’re not sure what’s going on but you may be having a heart attack. Oh, also, your abdominal pains are most likely coming from your gall bladder, so we’ll probably have to take that out, too.” I stared at him in silence and disbelief, unable to even ask any questions as my mind went blank.

Then someone yelled, “hey, this dude’s toe is falling off,” (yes, this is a literal quote from ER medical assistant!) and the doctor pulled the curtain aside and rushed off without another word.

Granted, a toe separated from a foot is definitely a big deal and requires immediate attention, but I was left with no insight of what was coming next, other than possible heart and/or gall bladder surgery. I sat shaking, thinking about how I’d just gone on a five mile run the week before, and how could I suddenly have the health of an 80-year old smoker diabetic who eats Arby’s five days a week? I started tallying up all the people in my family with heart conditions and wondering if my life was forever going to be altered or shortened.

Enter Dr. Kumkumian, cardiologist and fellow Armenian.

I’ve done a lot of diversity and cultural sensitivity training for hospitals and health care centers. I have talked with medical professionals about the importance of establishing culturally competent relationships and communication with patients, who often are at a heightened level of anxiety when they encounter medical staff and may need different approaches. I’ve spoken with these health professionals about how important it can be for culturally diverse patients to talk to someone who shares their culture.

It never dawned on me that I would be that patient. I’m American-born, and a pretty typical member of the more privileged element of our society: Caucasian, native English-speaker, upper middle-class, well-educated, etc.

Yet in a moment of great fear and distress, I felt a flood of relief simply by seeing the last three letters of this man’s surname sewn onto his medical coat.

Our shared ethnicity immediately established trust and camaraderie, even before he opened his mouth. I could find no logical explanation in that moment for my immediate trust in this man. He had yet to show any significant difference in behavior from any other medical professionals I had encountered to that point. Yet, there it was. I felt better and more hopeful just because I assumed we shared a cultural history.

My trust was further reinforced by Dr. Kumkumian’s warm demeanor and compassion. He asked questions, and reassured me I was going to be ok. He smiled. He talked with me, asked questions, and ordered some tests.

Every time the first ER doctor entered to talk with me, he also asked questions and listened to my responses. He may have been a bit more rushed (again, ER doctor, racing to sew appendages back on), but generally he was friendly and focused on me. However,  I felt a twinge of fear and mistrust, and found myself not fully believing his prognoses. When Dr. Kumkumian would enter and essentially share the same information, my mind immediately afforded him more credibility.

Again, I teach this stuff for a living. I know how implicit bias works. I know the research that shows that doctors who demonstrate higher levels of empathy with patients are less likely to be sued for malpractice, even if they commit the same number of mistakes as their less emotionally intelligent peers.

Yet, here I was, in the midst of a personal medical situation, and my own emotional reaction was so stark. Two doctors, equally qualified and talented, sharing essentially the same information with me…but I assigned credibility and trust to one mainly because his name automatically implied to me a shared history, culture, and set of values.

Several learning points for me out of this experience:

  1. Implicit preferences and biases related to cultural identity are truly powerful and must be acknowledged when it comes to medical care.
  2. First impressions with medical practitioners and their bedside manner can create or destroy trust and credibility, directly impacting both patient and provider.
  3. In today’s hospitals, when so much is driven by patient feedback, medical providers must demonstrate superb communication skills and cultural sensitivity.
  4. When your chest hurts, go to the damn doctor. Immediately.

P.S. For all of you out there concerned about my physical well-being, after a battery of tests and two days in the hospital on a clear liquid diet, I was told I had contracted a virus, probably from my germ-farm children, and sent home with anti-inflammatories and a warning to take it easy for a month. No surgeries required.

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2 comments

  1. You are amazing to have the fortitude to see the learning in the moment Maria! So glad you were not rushed to gallbladder surgery!

  2. You are amazing to have the fortitude to see this in the moment has a learning opportunity Maria! So glad you didn’t have gallbladder surgery!

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