Not long ago I cared for the child of a family from a distant country.  When I walked in, they stood up.  When I walked out, they stood up.  It was like The People’s Court.

They agreed with whatever I said.  Their obsequious nodding whenever I spoke made me feel brilliant.  They treated me as though I knew it all.

The problem was that the family’s insistence on appearing to please me made it such that I could barely tell what was happening with the child.  When it came to deciding on a plan, matters only got worse.  I had to work desperately to dig below the surface of their servile regard for my position.  It was exhausting.

To the provider with a healthy sense of self-importance, this kind of behavior is validating and comfortable.  For the thoughtful provider, this odd imbalance of power is unsettling and potentially dangerous.

Cultural differences between doctor and patient can represent serious challenges to care.  They can work against us and we have to push to insure that the decisions made represent the interests and wishes of the patient.

Sounds like the right thing to do.

But in this case, the encounter was strained.  I have to wonder if I would have been better off acquiescing to their culturally-imposed expectations of paternalism, sizing up the situation and making an authoritarian dictum.  At which point they would have happily nodded and said, ‘yes, doctor.’

The scenario described here has been altered/de-identified/fictionalized/fudged to protect the privacy/dignity of the parent and patient.