* * Anonymous Doc

Tuesday, April 12, 2011

"They do not want you to take any more blood," said the translator. "They are saying they gave enough blood last time, and if you cannot figure out what is wrong from that blood, they will go home because they have had enough and no one can have any more blood."

"Tell them we really need to run more tests, and I apologize, but the tests we ran were inconclusive and I still don't have a diagnosis. I want to help, but I need to run more tests."

"Don't you know that in Chinese culture, some people are reluctant to give blood?" asked the translator.

"No. I don't know that. They don't teach us that in medical school. Tell them, I don't know that. I don't mean to offend, I am not trying to hurt them. I'm just doing what I think is best for them."

"They are asking how anyone can not know that. How you can call yourself a doctor without knowing about that."

"I don't have an answer for them. But I don't have any way to make a diagnosis without more blood. I'm sorry."

Cultural expectations and beliefs are interesting. We deal with people from all over the world, who have all sorts of superstitions, religious beliefs, habits, ideas, customs.... I've had patients who refuse transfusions, I've had patients who refuse any medication, patients whose families demand every treatment no matter how futile, patients whose families demand no treatment at all. There's no coursework in this. There are no manuals. It's just surprises, day after day, when we learn something new. People from this country think x, people who speak this language think y. New languages I've never heard of and we can't find translators for. New herbal medications I've never heard of and neither has Google. New treatments-- well, old treatments-- that they don't explain to us. Someone has probably written a book about this.


  1. the spirit catches you and you fall down by anne fadiman

  2. Oh, I hate that book. It's a quick, light read, but it always gets suggested for this. Unless anondoc is treating an exclusively Hmong population, it's not going to have a lot of answers.

    Anondoc sounds like they already know that many different cultures bring their own approach to medicine. That's more valuable then any rote stereotypes you could memorize in med school. Even if they knew that some Eastern cultures believe that giving blood is giving up life energy, how would that change the fact that the patient needs a repeated blood draw?

  3. To me it's simple: tell the patient what the new tests would test for and stress that these are different tests from the tests they did on the other blood. Then let the patient decide whether she'd rather find out what the new tests say or give the blood. Let her balance her dislike of giving blood with her desire to know what's wrong with her. Maybe you have some kind of Hippocratic desire to give her the lifesaving test regardless of what she wants, but I'd let her decide.