Friday appointments

The incident

I was treating a patient who needed regular 2-3 times a week appointments, clinics ran on Monday, Wednesdays and Fridays for ulcer dressings.  The client was on the end of life pathway.  When his appointments landed on a Friday the client would either cancel or not turn up.  When I started arranging the home visits, he would often have his religious prayers on in the background, this made me feel as though I was intruding on his religious time and it was awkward for me. After a while I asked him why he didn’t want appointments on Fridays and he said it was his religious day when he would pray. His appointments were then moved to Tuesdays and Thursdays.

1. Identities of the actors in the situation

Narrator: Female Podiatrist in her 30s, white British, married with 2 children, member of church of England but not very religious, sociable, union representative, university qualified, lives in house with average cleanliness online shopper, mentally stable, reserved, modest.

Patient: Male, Muslim, late 70s, lived in Nuneaton UK, with his son and his family, in a heavily populated Muslim area with their local mosque down the road, religious, diabetic, was approaching the end of his life, has limited command of English.

2. Context of the situation

The situation takes place during a home visit for dressing a wound.  There were lots of religious praying via a CD or television in the background, which was very distracting.

3. Emotional reaction

Initially narrator was frustrated, at the client for cancelling or not showing up for appointments and then for not realising or asking why he had a problem with some of his appointment days.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

Priorities: health is more importance than religion – the narrator places more importance on health and wellbeing than religion and thinks it is irresponsible to cancel medical appointments.

Respect for professionals – The professional felt as though she was just fitting in with his routine and that he did not place much importance on her care.

Behaviour when having a home visit – The narrator also felt that when a professional visits your home you switch off CD players and the television and give your undivided attention to the professional.

The place of religion: there are specific spaces and moments for religion, such as places of worship and rituals, but religion does not need to interfere with everyday activities, there should be a boundary between the spiritual / religious and other activities.

Respect of cultural values: despite not being very well informed at the beginning about the religion of the patient it was important for the narrator to respect the religious / cultural practices of the patient. This motivation helped her to understand what was the problem with Friday appointments and to make the necessary adjustments.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

The narrator was surprised about the behaviour and at first saw this shock as negative.  More importance should be placed on health rather than religion.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

The priority of religion – spiritual concerns seem to be more important than the concerns about physical / biological health.  The patient was happy to talk about religion and where his family were from i.e. Pakistan but showed little interest when talking about health, diet etc.

End of life: facing death it is common for people to turn towards their religion. Possibly this could have happened to the patient also. He was also getting ready for his next journey of which his faith played a crucial role.

Friday prayers in Islam: Friday is the day when men are expected to go pray in the Mosque. Because of his illness the patient could not attend the prayers in the Mosque, but this made it all the more important to remain connected with the rituals via the television or the radio.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

The situation highlighted the need to adapt to different cultural calendars the professional medical calendar or agenda.

The question or priorities is one of the most interesting one in intercultural contexts. Indeed it is very difficult to understand and accept a different priority system. Many professionals in the health or social sector in Europe take the priorities of Maslow’s hierarchy to be an objective and universal set of hierarchies, but the model only reflects modern Western values.  A different priority system can often seem strange or even irrational from a different cultural perspective, in particular when the wellbeing, health or even survival of a person is threatened by other social or spiritual priorities.

Asking the patient about his religion and culture proved to be an important resource in this incident. Nevertheless rarely do professionals allow themselves to ask such questions, partly by fear of invading the other’s privacy and partly by fear of showing their lack of knowledge. The art of being curious and asking questions should be part of communication trainings for health professionals.