ABU DHABI // Doctors need to change their bedside manner when dealing with Arab patients, or risk missing details that could be crucial to treating them.
Training on how to communicate with patients has been developed mostly in western, English-speaking settings, and often does not translate well for doctors working in the UAE and the region, experts told a conference yesterday.
Dr Deen Mirza, the assistant professor at the faculty of medicine and health sciences at United Arab Emirates University in Al Ain, compared the doctor-patient consultation to a map. The Dubai Metro and the London Tube are similar in many ways, he said, but a map of one is no help in navigating the other.
"There are many aspects that affect the dynamics of a consultation," said Dr Mirza, speaking yesterday on the second day of the Abu Dhabi Medical Congress.
"Cultural aspects, such as the tribal culture of the Arab world, will mean that there are implications of tribal tradition with men in Arab society as breadwinners and protectors, whereas women are the ones to raise the family."
This mindset, he said, means that men who have been unemployed for six months have exaggerated feelings of inadequacy and low self esteem.
A patient with erectile dysfunction, for example, would not be open about his problem with his doctor, and instead insist on his wife undergoing unnecessary investigation for infertility. “In this case, open questions will get you nowhere,” Dr Mirza said. “Sometimes, direct questioning is helpful. Adapt your style, show that you are understanding of the feelings of guilt or depression, say that this is normal and show the patient that he is allowed to have these symptoms.” Attributing symptoms to jinn (spirit) possession or the evil eye is common in the Arab world; doctors have to be careful not to dismiss this religious belief as superstition. “As a doctor, you may or may not share the same beliefs as the patients, but if you dismiss something that the patient believes in so wholeheartedly, it may lead to discordance between doctor and patient,” Dr Mirza said. Even the contents of a doctor’s office can affect a patient’s trust. A prayer mat in the corner, or a lot of religious paraphernalia, may make a patient unwilling to discuss alcohol or drug abuse, or admit to having sex outside marriage. “Patients are intimidated by doctors, and need to feel that they will not be judged,” Dr Mirza said. “Sometimes the doctor is also shy and does not ask direct questions, which does not help.” Dr Cother Hajat, section head of public health programmes at the Health Authority-Abu Dhabi, said part of the problem is the lack of resources for doctors to help them to learn how to communicate with Gulf Arab patients. “Adapting to local needs does not just involve translating,” she said. “There is so much more to gaining the trust of the patient.” Some guides do exist, but they are not enough, she said. She suggested that one solution could be for doctors with expertise in the region to work together on drafting a relevant resource. Dr Laeth Nasir, professor and chair of the family medicine department at UAEU, co-wrote a guide in 2008 with his wife Dr Arwa Abdul-Haq, a paediatrician at Al Ain Hospital. In Caring for Arab Patients, A Biopsychosocial Approach, based on studies in 22 Arab countries, they set out the key aspects of treating Arab patients, including the effects of gender on health, death and dying and family dynamics. “Many of the physicians practising in Arab countries have received their training in Europe or America, which then translates into how they practise medicine,” Dr Nasir said. “The technology of medicine can be transferred directly from one culture to another but many psychosocial aspects of medicine cannot.” This is echoed by Dr Mirza, who said doctors are learning in one language – English – but practising and communicating with patients in their native language – Arabic. Explaining a diagnosis to a patient, or describing how treatment should be administered, might not come as naturally in Arabic as it does in English. A gap remains, he said. “Doctors need to sit down together, throw ideas back and forth, and come up with phrases that make sense and can be used from experience in the field, so that when we see our patients, we are able to connect with them,” he said. firstname.lastname@example.org