I recently read two books that dealt with the issue of culture and how it plays into medicine. The first book, “The Scalpel and the Silver Bear” is by a physician named Lori Arviso Alvord. She is the first Navajo woman surgeon, and her book discusses the struggles of combining her western medical training with the beliefs of her tribe. The second book I read is called “Medicine & Culture” by Lynn Payer. In this book Payer discusses the differences between how medicine is practiced in Germany, France, England, and the United States.
Both of these books have really opened my eyes to the fact that medicine is not a science. It truly is an art. What you are diagnosed with and how you are treated when you go to the doctor is largely influenced by where you live and the beliefs of your culture. Although the countries discussed in Payer’s book all practice “Western Medicine,” they have many different beliefs about the body. Payer noted that in France, many maladies are attributed to the liver, even such things as headaches. Germans visit the doctor 12 times a year on average, compared to 4.7 times in the U.S. Doctors are more likely to prescribe things such as spa treatments in both Germany and France. British doctors are more likely to do nothing than something. And, antibiotics are prescribed way, way more in the U.S. than in many other countries. (And this is just an abbreviated list!)
One thing that really stuck out to me was Payer’s discussion of hysterectomies. In the U.S., hysterectomies are the treatment of choice for things such as fibroids found in women. However, in France, where there is a greater emphasis placed on child bearing, hysterectomies are performed only 1/3 as much. The French prefer to do myomectomies, that just remove the fibroids, thus allowing women to keep their reproductive organs. Myomectomies are rarely even discussed as an option for women in the U.S.
Payer discusses one of the major cultural biases among doctors, which is to belittle studies done in other countries. Few doctors even read (or can name) medical journals produced in countries other than their own. And, if they do read studies from other countries, they oftentimes draw different conclusions. For instance, if a study done on chemotherapy in England shows a 20% increase in survival rates, it will be considered a success by doctors in the U.S. However, British doctors are more likely to look at declining quality of life as evidence of failure in that particular treatment.
Alvord brings up a lot of interesting issues in her book as well. She believes that Western Medicine could learn a lot from the practices and teachings of her Navajo people. The Navajo people have a practice called “Walking in Beauty,” which essentially means having all parts of the body in harmony (very similar to one of the Osteopathic Philosophies). They believe strongly that if a person is in disharmony, they will probably get sick, and that most illnesses can be attributed to factors affecting the person’s harmony. I believe this is largely true for everyone. It has been scientifically proven that stress can negatively affect one’s health.
Payer noted that U.S. medicine attracts a lot of Type-A personalities because of the money and prestige often associated with being a physician. This is not true of physicians in other countries, such as Germany. In part because of the large amount of Type-A personalities in health care, there is more pressure in our country to do everything possible. This is why U.S. physicians focus on survival rates, and not necessarily quality of life.
I think that our system of health care is without a doubt one of the best in the world. But, there is still so much we could learn from other cultures. Both books stressed how quick allopathic medicine is to dismiss “fringe” medicine (i.e. alternative medicine). While I am usually first in line to discount any benefits attributed to alternative medicine, we shouldn’t fall into the trap of believing that we have all the answers. I still believe that most cures attributed to alternative medicine can largely be explained by the placebo effect, but I definitely wouldn’t mind if my doctor would prescribe some spa treatments the next time I visit! Even if a patient feels better because of a placebo effect, they are still feeling better. Sometimes doctors, such as Alvord, have to make concessions and allow their patients to seek out alternative treatments (in addition to standard western medicine practices) such as visiting a medicine man. Alvord believes, as do I, that patients who are less stressed will respond better to treatment, such as surgery.
Medicine will never be an exact science. Every person is different, and there is always going to be some finesse associated with diagnosis and treatment. I hope that when I am a physician I am able to remember that just because something hasn’t been scientifically proven to be true, it doesn’t mean that it doesn’t work. There is room in medicine for much improvement, and I think the first step to improving medicine is the U.S. is to recognize that there IS room for improvement. We are wont to believe that we are the best in everything. It’s just our biased opinion as Americans. But, in order to really be the best, we have to learn from others.