Socio-cultural Issues in Primary Care and Hyperlipidemia
Introduction
It is clear that therapeutic lifestyle changes are paramount in clinical management of hyperlipidemia. Increasing patient and public awareness about the effects of high cholesterol on the cardiovascular health of individuals and communities is also important. Teaching patients about cholesterol regimens and their risks and benefits can lead to better adherence to treatment. Physicians are in a unique role to educate and support patients, their families, and communities. Improved outcomes can be achieved with specific counseling that addresses the patient’s needs (ex. individualized diet counseling incorporating culturally appropriate foods; specific ways to integrate exercise into the patient’s lifestyle; provide targeted advice to the patient’s knowledge base on tobacco dangers).
In order to provide specific and tailored education and support, a physician must assess and understand the patient’s socio-cultural background and how it affects their health beliefs and individual behaviors. Patients come to their doctor’s office with certain beliefs, concerns, and expectations about their illness, which may be influenced by culture, socioeconomic status, education level, and previous experiences with the medical system. Doctors are trained to understand the medical disease process and its treatment. A competent physician will take time to assess the patient’s understanding of their illness as a method of collaborating with the patient on their care (Kleinman, et. al Ann Intern Med 1978). This can improve clinical diagnosis and management, promote culturally responsive health education, avoid unnecessary medical testing, and lead to better understanding between you and your patients.
“The physician serves as the expert on disease, whereas the patient experiences a unique illness. Even when the patient’s and the physician’s socio-cultural backgrounds are similar, substantial differences may exist because of these separate perspectives.” (Ann Intern Med 1999)”
Socio-cultural Assessment Exercise of A Patient with Hyperlipidemia
SOCIOCULTURAL ASSESSMENT EXERCISE:
THE PATIENT’S UNDERSTANDING OF HEALTH, ILLNESS, AND HYPERLIPIDEMIA
COLUMBIA UNIVERSITY COLLEGE OF P&S / PRIMARY CARE CLERKSHIP
Credits: This exercise is based on Arthur Kleinman’s cultural interview questions (Ann Int Med 1978) and further expanded work by J. Emilio Carrillo, MD, MPH; Alexander R. Green, MD; and Joseph R. Betancourt, MD, MPH (Ann Int Med 1999).
Instructions: Print out the pdf document of the socio-cultural exercise. Select one patient this week that has hyperlipidemia as a diagnosis or a potential diagnosis. With the patient’s permission, conduct an interview using the questionnaire. The information is to be used to understand your patient’s views of their illness and health BEFORE you engage them in patient education. After the interview, you can proceed with your routine history, physical and presentation. You can also ask your clinical supervisor if you can interview a patient who is waiting to be seen. The survey is to remain completely anonymous and no identifiers are to be used. You should share your findings with your patient’s primary provider. You will post your findings on this website for review by your CP3 Small Group Cyberteacher – and you will receive electronic feedback. For part one of the exercise, there is a 300 character limit (one or two sentences) for each of your answers so be brief. Feel free to write in N/A if the question is not applicable to the patient you interviewed. You are required to turn in this worksheet to the Clerkship Directors at the end of your rotation. For part two of the exercise, there is a 2000 character limit (one or two paragraphs) for your answers. This exercise is due in ONE WEEK. You will submit this portion of the exercise through the website by the assigned date. If you are unable to locate a patient with hyperlipidemia then feel free to use another chronic medical condition that comes up.
IMPORTANT: EACH STUDENT IN THE CLERKSHIP MUST LOCATE ONE INDIVIDUAL PATIENT TO INTERVIEW AS PART OF THIS ASSIGNMENT. ONE SUBMISSION FROM A GROUP OF STUDENTS AT ONE CLERKSHIP SITE WILL NOT BE ACCEPTED.
STOP AT THE END OF PART 1 AND DISCUSS YOUR FINDINGS BRIEFLY WITH THE PATIENT’S PHYSICIAN. COMPLETE PART 2 ON YOUR OWN AFTER THE ENCOUNTER IS COMPLETE. AN ELECTRONIC “SHARING” SESSION WILL FOLLOW WITH YOUR CP3 SMALL GROUP CYBERTEACHER.
Use this link to submit both parts of this exercise to your cyberteacher.