CULTURAL PERCEPTIONS AND MISCONCEPTIONS – THE PRACTITIONER’S ATTITUDE (PRACTICE AND COMFORT)
After a time practitioners may feel comfortable with their attitudes in theory, but maintaining them in practice is not so easy. It would be simpler if consultations were clearly confined to one subject such as contraception, but this is rarely so. The social concerns of recent immigrants overlap with their medical needs. The doctor/patient relationship is often conducted in the context of the doctor/family relationships. Doctors may be distracted by the need to look for opportunistic surveillance of young children who attend with their parents, as well as trying to support the families’ social needs, especially housing. The problems of overcrowding will lead naturally to a discussion of contraceptive needs, but it is important not to let one’s anxiety about uncontrolled fertility undermine the relationship of trust by appearing to blame the patient for her fertility. Dealing with so many issues and patients in one consultation can be very wearing, and it would be surprising if the practitioner never felt under strain, with a sense of burning out, when dealing with such needy families. Poor coping mechanisms lead to doctors using the issue of culture as a reason for not being effective, and lowering their standards. The support of colleagues is essential both emotionally and as a context for looking at ways of making practical changes that can help.
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