I was admitted to hospital for a suspected heart attack. I was on the emergency ward on the first day and was transferred to another ward on the second day. As I had not chosen my meal option, I had to choose from what was left over. The Health Care Assistant (HCA) automatically assumed that I would want chicken curry for dinner.
When I told him that I don’t want the curry and asked for a different meal option, the HCA was shocked that an Asian man doesn’t like curry. I asked for a sandwich and I was told that the only sandwich left is ham. I said that the ham sandwich will be fine. The HCA then made the assumption that I do not eat pork, as we live in a heavily populated Muslim area. When I asked for the ham sandwich the HCA questioned whether I knew what ham was. I replied that “I have lived in this country since I was four and that I am well aware of what ham is. I am a non-practising Sikh and I do eat pork so I would prefer the ham sandwich.” I was shocked at how the HCA automatically made an assumption about what religion I am and whether I should or should not eat pork.
1. Identities of the actors in the situation
Patient: Male, 68 years old, British Indian, he has lived in the UK since he was 4 years old and has been educated in England. He is a retired engineer; he retired after 40 years in this field. He is married and lives with his wife. They have been married for 46 years. He is a non-practicing Sikh.
Health care assistant (HCA): Male, in his late 20’s, Filipino origin. He works at the hospital as a Health Care Assistant. English is not his first language
2. Context of the situation
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.
3. Emotional reaction
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.
4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.
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.
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?
Negative and stereotypical
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.
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.
7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?
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.