Hospital meal

The incident occurred in a Foundation Trust Hospital in Yorkshire.  It was during a hospital stay when the patient was experiencing chest pain (he had had a heart attack a couple of months before this).  He was admitted to hospital for observation.

The narrator was shocked that firstly, the HCA assumed his identity without asking him and questioned his choice. He assumed that as he was Indian he would prefer the chicken curry. Would he have done that if the patient was White British?

Again when the patient asked for a ham sandwich, the HCA questioned this choice and reminded the patient that ham was pork.  The patient felt belittled and undermined, as he was well aware what ham is.  Again the HCA made assumptions without asking the patient, which made him feel angry.

Identity is not derived from skin color  – As a British Indian the narrator felt angry that the HCA made assumptions about his identity, undermined his choice of food and assumed his religion. They just assumed that as he was Asian he was Muslim (and could not eat pork) which was just a stereotype due to the colour of his skin.

Respect for autonomy – The HCA should have told the narrator what other meal choices there were instead of choosing for him.  The HCA assumed that the narrator liked curry when actually he did not as the hospital curry was far too spicy. Not offering the chance to make one’s own choice is a threat to autonomy or sense of control, which can be a sensitive issue at the hospital where patients have relatively lower capacity of controlling what happens to them.

Acculturation / British identity – The narrator felt frustrated and that his cultural expertise was undermined: after living in England for 64 years the narrator felt that he knew what ham is and that it is derived from pork. He felt it was patronizing for the HCA to assume he didn’t know what ham was made from. Furthermore the HCA should  tell from his accent (that was a very Northern British accent) that he had lived here for a very long time. Ignoring this can amount to a threat of the British cultural identity of the narrator.

Negative and stereotypical

Preconceptions: cultural identity is connected to skin colour – The HCA makes inference on the culinary preferences of the patient based on preconceptions concerning the skin colour of the patient.

Generalisation – People categorise others based on gender, age, ethnicity automatically. Once the categorization is done, we apply information we know (or think to know) about given social groups, i.e. we are using stereotypes. The HCA proceeded with this same logic, not reflecting on his generalisations and stereotypes.

Conception of acculturation: original culture prevails over the dominant host culture. For the HCA the recognition of the original cultural identities is more important than the recognition of the British identity of the patient.  Several hypothesis could apply: maybe he’s a more recent migrant, and in his migration path the Filipino identity is still stronger, more meaningful than the British. He expects the same from the patient.

Tension between care and respect of autonomy: The HCA could have thought he was being helpful by anticipating the patient’s needs and preferences and pointing out that he was about to eat pork. However by doing this he was seriously underestimating the need for autonomy and control of the patient.

Health professionals often have to walk the delicate line between sufficient recognition of the cultural identities of the patients and too much or forced recognition. Too little recognition often characterizes universalist or “colour-blind” approaches which put the emphasis on what is common, often extending the values or practices of the majority society to the others.  The opposite tendency of forced recognition implies the recognition of the difference of the other even when the other does not think that relevant or even accurate.  This is particularly frequent in the case of migrants who have been settled in the country for longer period and who have acculturated to the host society’s models.  For them, the identification to the culture of origin can imply the denial to appear as a member of the dominant society, as such it is a type of identity threat. If such an attribution is made based on skin color, we can also talk about a form of racism.

Attributing different cultural identities to a person – which are not connected to the person’s own identities is yet another form of identity threat. This is in particular resented when the confusion is made with an identity that from the person’s point of view holds less status than his identities.

Another register: people in situations where they have less autonomy, such as hospitals, retirement homes etc. have a stronger need for a sense of control.  Even taking small decisions can help improve this need for control and should be used to this effect.