Hairy patient

The incident

I was an assistant at a dermatology, there was a patient that I remember very well.

He was a foreigner, in his 30s, short and appeared seemingly very well off. He arrived at the consultation.  He was confused and barely understood the procedure of the consultation.  To my instruction, he got undressed but he did not come out until a male doctor came in the consultation room.  His underwear was not “European” and his behaviour either.  His body hygiene was not “conventional” either.  He had been together with a prostitute, his hairy body was full of louse. His expectations and ours were really different. His attitude to the treatment was not really understood by us (doctor, nurse, assistant).

1. Identities of the actors in the situation

Medical assistant: Female, Hungarian citizen, in her early twenties, living in Budapest. Belonging to lower middle class. Her mother tongue is Hungarian but has English as second language. She is Christian but not practicing.

Patient : a male migrant in his early thirties, his official status is unknown. Origin: Syria. He speaks Arabic, his religionand profession are unknown. He appears to belong to an upper middle class.

Almost everything in their social identity creates distance between the actors. The only thing that brings them close is their age.  However, this can also cause problem because it shifts a professional situation towards a potentially uncomfortable personal situation.  Besides the distance the implicit hierarchy might cause tension, too.  The professional situation puts the assistant in a dominant position, added to it the local-foreigner hierarchy, which may not correspond to the class hierarchy. If the man considers himself as belonging to a higher position he might feel an increased humiliation.

2. Context of the situation

The situation occurs in the examination room of a health institution. In the beginning she is alone with another female nurse, then she calls a doctor.  There is a space covered by a curtain where the patient can change.  The patient is initially behind the curtain.  He demands a male doctor, but the assistant asks him repeatedly to come out and discuss the situation with her. She is very upset because he refuses to cooperate. At this point the assistant already has a negative opinion of the patient, whose body is covered by thick hair and this hair is full of louse.

The case happened before migration caused a moral panic in Hungary but the Hungarian public was not very open to migrants even at that time, especially with visible difference.

3. Emotional reaction

First thought: he is not normal. shocked, disgusted, anger, unsure, frustrated.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.
  • Health system, professional roles: The patient should cooperate. Everybody deserves the same treatment, with no exceptional treatment. The language of communication should be Hungarian.  The patient should know the process and comply to it.
  • The situation: This is a professional situation. I am a young professional. I have to comply with the expectations of the doctor. This is a professional problem to be solved. The process of the consultation: taken for granted, everybody should be aware. If a patient fails to comply, it is a wilful challenge (meaning disrespectful, non-cooperating behaviour)
  • Body, shame: this would be a routine case if the man was not creating problems. If a patient undresses, this is just normal. Shame is not a feeling that a professional should have to deal with.
  • Gender roles: she recognises the patient as a Muslim man – meaning: he probably has negative attitudes towards women. She might wonder if he is disrespectful to her because she is a woman.
  • Thick body hair: there is something animal-like in him. The lice adds to this impression.
  • Visiting a prostitute is morally reproachable, unclean. She might think that the lice is some kind of just punishment. (Consequently, he deserves it)
  • The image of the other as not clean: marked by strong wording: “Non conventional hygiene”, “non-European underwear”, these are just substitutes for other qualifiers, for example. bizarre, “primitive”, dirty, “uncivilized”.
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?

Very negative, unrealistic.

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.

Context:  this is a highly exceptional situation, a problem that has to be resolved, even at the cost of transgressing some personal norms.

Situation: feeling insecure, no clear scenario for the consultation.

Expectations: a male doctor is the only competent actor in such a situation.

Getting undressed in front of a woman: shame.

Showing the lice: shame.

Speaking about a prostitute: shame.

The assistant: represents the institution, represents the norms of the host country, she is in a dominant position. A young woman, a junior professional, not sure if she is competent?  Does she have prejudices against foreigners?

The assistant insisting on him coming out from  behind the curtain, not calling a male doctor: a challenge (“disrespectful”).

The patient only coming out when the doctor comes out: cooperating.

“Long underwear”: possibly a protection because of the lice.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?
  • We are inclined to draw conclusions from a non-expected behaviour concerning the intentions of the Other. If he does not obey: he is not cooperative.
  • We are also inclined to draw cultural conclusions from a perceived strangeness: if he wears long underwear, Is because of his culture?
  • Both assumptions might be questioned.
  • Medicalisation does not forbid sensitivity to human reactions like shyness, uncertainty, etc. If the rules can be changed without hurting the purpose, they might be changed in the interest of all.
  • If we have the impression that our professional identity is endangered, we might react in a challenging way without realizing it.
  • Asking for help from a colleague is not shameful. This is what happened. To realize: this is a resource used.
  • Asking the patient instead of giving instructions might help to overcome a difficult situation.