Chapter 10: Cultural Considerations during Care Transitions

BACKGROUND

In healthcare, we often encounter patients from various cultural and religious backgrounds. It is important for pharmacists to understand how cultural and religious beliefs influence how patients manage their health. For many patients, religion, culture, and ethnicity play a major role in the decisions they make about their health.¹ People of some cultural and religious backgrounds may not understand the importance of taking potentially life-saving Western medications, going to see their doctor, or value the advice of others. Furthermore, patients with different belief systems may have varying opinions of the efficacy of Western medications and medical practices. By respecting the culture of our patients and asking them about their beliefs, healthcare providers can build a bond with patients and gain their trust.¹

Many patients who are of Chinese descent focus on the concept of yin and yang, a balance of physical health and mind, also called qi or chi.² They believe that their mental health is most important and determines their overall physical health.² If patient believes that a medication is not working or causes a side effect, they will reduce the dose on their own or discontinue a medication rather than offend their doctor and voice their opinion.²

In this case, the pharmacist encounters a patient who practices traditional Chinese medicine and has medication adherence issues.

PATIENT PRESENTATION

Chief Complaint

My PCP retired, and I saw my new PCP 2 weeks ago to establish care. She said I might need some extra help with my medications.

History of Present Illness

FP is a 66-year-old female patient of Chinese descent. She immigrated to the United States 6 years ago with her husband to live with her daughter, son-in-law, and three grandchildren. Although she speaks some broken English, FP greatly relies on her daughter and son-in-law as translators at all of her appointments. She has an upcoming home visit scheduled with the clinic pharmacist following a transfer to a new primary care provider. FP’s previous PCP stated that he has a hard time controlling FP’s blood pressure because of medication adherence issues, mostly because of her profound beliefs in Chinese herbal medicines. He also states that FP has had multiple issues with her stomach, and this is a point of contention with this patient.

Past Medical History

Hypertension

GERD

Osteoarthritis

Peptic ulcer disease

Surgical History

Unknown; patient’s daughter does not think that she had any surgical procedures

Family History

Mother: died at age 82 of “bad heart”

Father: died at age 77 of “bad brain”

Social History