Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research

Major health care problems such as patient dissatisfaction, inequity of access to care, and spiraling costs no longer seem amenable to traditional biomedical solutions. Concepts derived from anthropologic and cross-cultural research may provide an alternative framework for identifying issues that require resolution. A limited set of such con- cepts is described and illustrated, including a fundamental distinction between disease and illness, and the notion of the cultural construction of clinical reality. These social science concepts can be developed into clinical strategies with direct application in practice and teaching. One such strategy is outlined as an example of a clinical social science capa- ble of translating concepts from cultural anthropology into clinical language for practical application. The implemen- tation of this approach in medical teaching and practice requires more support, both curricular and financial.

[1]  D. Mechanic.  Social psychologic factors affecting the presentation of bodily complaints. , 1972, The New England journal of medicine.

[2]  A. Kleinman.  Medicine's symbolic reality , 1973 .

[3]  H. Waitzkin,et al.  The Communication of Information about Illness , 1972 .

[4]  C. Aring.  The Customer Approach to Patienthood , 1975 .

[5]  W. Tseng,et al.  The nature of somatic complaints among psychiatric patients: the Chinese case. , 1975, Comprehensive psychiatry.

[6]  M S Davis,et al.  Variations in patients' compliance with doctors' advice: an empirical analysis of patterns o communication. , 1968, American journal of public health and the nation's health.

[7]  Z. J. Lipowski.  Psychosocial aspects of disease. , 1969, Annals of internal medicine.

[8]  K. White.  Life and death and medicine. , 1973, Scientific American.

[9]  B. Korsch,et al.  Gaps in doctor-patient communication. Patients' response to medical advice. , 1969, The New England journal of medicine.

[10]  A. Young.  why Amhara get kureynya: sickness and possession in an Ethiopian zar cult1 , 1975 .

[11]  H. Fabrega,,et al.  The study of disease in relation to culture. , 1972, Behavioral science.

[12]  I. K. Zola.  Studying the Decision to See a Doctor , 1972 .

[13]  D. Haefner,et al.  Motivational and behavioral effects of modifying health beliefs. , 1970, Public health reports.

[14]  T. Litman.  The family as a basic unit in health and medical care: a social-behavioral overview. , 1974, Social science & medicine.

[15]  R. Elder.  Social class and lay explanations of the etiology of arthritis. , 1973, Journal of health and social behavior.

[16]  I. K. Zola,et al.  THE QUANTITY AND SIGNIFICANCE OF PSYCHOLOGICAL DISTRESS IN MEDICAL PATIENTS. SOME PRELIMINARY OBSERVATIONS ABOUT THE DECISION TO SEEK MEDICAL AID. , 1964, Journal of chronic diseases.

[17]  Saxon Graham,et al.  PATIENTS' VIEWS OF MEDICAL PRACTICE , 1962 .

[18]  J. Mckinlay.  Social Networks, Lay Consultation and Help-Seeking Behavior , 1973 .

[19]  A. Kleinman,et al.  Why do indigenous practitioners successfully heal? , 1979, Social science & medicine. Medical anthropology.

[20]  L. Kupper,et al.  Determinants of physician utilization , 1973 .

[21]  I. K. Zola.  Culture and symptoms--an analysis of patients' presenting complaints. , 1966, American sociological review.

[22]  R. Kane,et al.  Manipulating the patient. A comparison of the effectiveness of physician and chiropractor care. , 1974, Lancet.

[23]  D. Apple.  How Laymen Define Illness , 1960 .

[24]  J. Mabry.  LAY CONCEPTS OF ETIOLOGY. , 1964, Journal of chronic diseases.

[25]  William P. Lebra.  Culture-bound syndromes, ethnopsychiatry, and alternate therapies , 1976 .

[26]  M. A. Henderson,et al.  PATIENT'S ASSESSMENT OF THE RESULT OF SURGERY FOR PEPTIC ULCER , 1975, The Lancet.

[27]  G. Stimson.  Obeying doctor's orders: a view from the other side. , 1974, Social science & medicine.

[28]  N. Waxler.  CULTURE AND MENTAL ILLNESS: A Social Labeling Perspective , 1974, The Journal of nervous and mental disease.

[29]  A. Kleinman.  Medical and Psychiatric Anthropology and the Study of Traditional Forms of Medicine in Modern Chinese Culture , 1975 .

[30]  L. Eisenberg.  Psychiatry and Society. , 1977, British medical journal.

[31]  D. V. Shaver.  Opticianry, Optometry, and Ophthalmology: An Overview , 1974, Medical care.

[32]  G. L. Engel.  The need for a new medical model: a challenge for biomedicine , 1977 .

[33]  E. Suchman,et al.  SOCIAL PATTERNS OF ILLNESS AND MEDICAL CARE. , 1969, Journal of health and human behavior.

[34]  Eliot Freidson,et al.  Client Control and Medical Practice , 1960, American Journal of Sociology.

[35]  A. Harwood.  The hot-cold theory of disease. Implications for treatment of Puerto Rican patients. , 1971, JAMA.

[36]  L. Eisenberg.  The search for care. , 1977, Daedalus.

[37]  P. Manning,et al.  An integrated theory of disease: Ladino-Mestizo views of disease in the Chiapas Highlands. , 1973 .

[38]  H. Beecher.  Relationship of significance of wound to pain experienced. , 1956, Journal of the American Medical Association.

[39]  A. Lazare,et al.  The customer approach to patienthood. Attending to patient requests in a walk-in clinic. , 1975, Archives of general psychiatry.

[40]  L. Kupper,et al.  Determinants of Physician Utilization: Approach to a Service-oriented Classification of Symptoms , 1972, Medical care.

[41]  W. Mcdermott.  General medical care identification and analysis of alternative approaches. , 1974, The Johns Hopkins medical journal.

[42]  G. Jansen.  The doctor-patient relationship in an African tribal society , 1973 .

[43]  R. Horton,et al.  African Traditional Thought and Western Science , 1967, Africa.

[44]  L. F. Snow.  Folk medical beliefs and their implications for care of patients. A review bases on studies among black Americans. , 1974, Annals of internal medicine.

[45]  I. K. Zola.  The concept of trouble and sources of medical assistance-to whom one can turn, with what and why. , 1972, Social science & medicine.

[46]  Kleinman Am.  Toward a comparative study of medical systems: an integrated approach to the study of the relationship of medicine and culture. , 1973 .