Comparing The Doctor-Patient Relationship Between Cultures

Cam Bartlett

As we rounded the dirt corner, the motorbike gave way beneath us as we slid on the gravel, which burned our backs, feet and hands. I thought I was okay until someone held up my shoe, which was dripping with blood.

After the Auroboys helped to stop the bleeding, I found myself thankful it was over. But it wasn’t quite. For the next two weeks or so of the practicum, I found myself becoming very familiar with the local doctors and nurses. It seemed that everybody had helped patch me back up, from the local vet, our taxi driver, the Auroville Santé nurses, and, last but not least, the Health Center. It was at this health center that I got an unexpected brush with a part of the Tamil medical system. 

Halfway through my visit, I was led into a different room and, without my consent or knowledge they began to treat me. Without anesthetic and without me knowing beforehand, they began to extract the dead flesh from inside my foot and peeling off the  healing that had already begun. This was, needless to say, incredibly painful and highly shocking. I later limped out of the procedure room in much pain, hands shaking by my sides.

What this experience did lead me to understand, with the help of Sacha Elder, our Aurovillian friend and guide, was a fundamental difference in the understanding of the doctor-patient relationship in India versus the United States.

In the U.S., patient autonomy tends to be prioritized over all else. The doctor helps the patient to make decisions based on a plurality of potentially effective treatments and their potential benefits and downsides. This is consistent with the highly individualistic nature of U.S. culture. Individual freedom is valued above all.

In India, a more collectivistic culture, individual freedom isn’t placed on a pedestal. Often times, individuals will withhold their opinions in favor of group harmony. This effect of a collectivistic culture is apparent in their doctor-patient relationships. Sacha explained that it is very uncommon for patients to ask questions to their doctors. The doctors are treated as a near-absolute authority. After all, it is they who have so many years of medical experience, so they should have the knowledge to make the necessary decisions for their patients’ health. The doctors expect to make the choices for the wellbeing of the patient.

Indians’ relationships to figures of authority have been found to be different from similar relationships in the U.S.. However there may be some psychological mechanisms that help to explain this difference. A study performed by Savani, Morris & Naidu (2011) found that, in the presence of authority figures’ expectations, Indians are significantly more likely than Americans to defer to these expectations, whether this is clothing or education choices. Furthermore, those who made choices against the perceived expectations of authority felt higher levels of guilt.

The question of which of these systems is correct is, frankly, irrelevant. They both work within the context of their respective cultures. However, if you are from one culture and get injured in another, make sure you know how that system operates or you could be in for an unwelcome surprise.

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