Substance misuse

The incident

I was supporting a Polish man in his 30’s trying to access substance misuse services.  He had clear alcohol problems, was homeless and unemployed.  I went with him to the Recovery Partnership to interpret for him during his registration session.

He was asked lots of questions regarding his lifestyle and drinking habits.  Eventually, he was asked “How do you want to reduce your drinking or to stop completely?”

It came to him as a cultural shock, as it seemed to him as a soft approach to drinking problems.  He probably want to hear “You need to stop drinking as you suffer from alcohol addiction.”  He expected the health professional to be less understanding and more authoritative.  He did not believe they were going to help him and said to me, “They are just smiling and chatting.”

1. Identities of the actors in the situation

Patient: Polish, Male, 30s, Single, Unemployed, has a number of health issues linked to substance misuse, has been living in the UK for 2 years. He did try and access help in Poland but this was the first time trying to access help in the UK.

Narrator: interpreter White British, Female, 30/40s, Recovery Partnership worker that deals with registration of new clients.

2. Context of the situation

A support service, that assists people to recover from substance misuse was approached for help and advice.  This incident took place during the registration process of this service.

3. Emotional reaction

The narrator felt surprised by the reaction and possible culture shock experience of the patient.  She felt somewhat uneasy and unsatisfied because helping the man was not entirely successful, his disappointment came through.

After the registration process they were told to carry on drinking and that someone would be in touch with an allocated support worker. He felt even more hopeless about the help he was likely to receive than before he went.

The incident left the person feeling hopeless and disappointed.

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

Empowerment of the clients / patients:  The organisation the narrator represents believes in supporting individuals to make the right decision for them and it is up to the individual to decide on what support they need.  From their point of view it is important that the patient is involved on the process with an active role and engagement.

This is in line with the respect of autonomy of the client and also the value of empowerment, taking responsibility in one’s own illness.

Differentiated Healing process: In the paradigm of the organization there is not only one path to recovery but several steps to achieve it, which should be identified together with the patient.

Relationship with hierarchy: the preferred communication style of the organization is of equality and symmetry.  Communication and decisions are not governed through hierarchy but reciprocal dialogue. The narrator is perplexed by the fact that this is not in line with the patient’s preferences.

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?

They thought the other person was nice and understanding but too soft and therefore had a negative experience.

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.

Healing from alcoholism implies complete abstinence, any solution falling short of that is partial or false. If the medical procedure does not allow the patient to reach this objective, it is useless.

Seeking for help: from the patient’s point of view when you go to see a professional for help, he should know how to treat you. The professional should resolve the problem and propose the better healing path.

Responsibility / autonomy: If the patient is being asked how he wants to be treated, in a way it’s been asked to assume his responsibility on the illness and to be active on the healing process.

Relationship to the authority: The patient expects that the professional will tell him how he will be cured and what he needs to do.  He does not want to figure that out himself, he wants to be told how to overcome his addiction and the steps he needs to take.  This approach reflects the asymmetrical medical relationship where the patients transfers decision-making and the power over his body to the doctor.

Direct communication and authority is a sing of professional reliability: it sends the message that the medical professional holds the knowledge necessary for the treatment. Indirect approaches may imply insecurity in medical knowledge, lack of professional confidence.

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

The tolerance or expectation of power distance and hierarchy is an important dimension of cultural differences, which intersects with the professional culture of health institutions.   Hospitals usually are organized hierarchically and doctors, nurses other medical assistants occupy different levels of the hierarchy.  The hierarchy appears also in doctor-patient interactions: doctors represent medical – scientific knowledge, which raises them to the position of making judgments for the patients, possibly instead of the patients.   The recent developments in modern European societies, characterized by a strong preference for individualism and autonomy invite a moderation of these power differences during interactions.  The communication style is adjusted to express mutual respect: not just for the doctor but also for the patients.  Indirect approaches are incorporated to ensure that sufficient autonomy and respect is offered for patients.  However not all societies put a similar weight on equality, in some cultural contexts power differences are more accepted, in particular in the medical context.  Clear instructions are considered a sing of professional security and reliability.