Harmful cultural practices in medicine

[Glassdyr]

I was looking through MMI practice scenarios and came upon this one. If I had gotten this one, I would've started sweating.

"You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother. When should a physician step in to stop a cultural practice? Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine?"

I would've said something like: "I want to approach this mother nonjudgementally and with full respect and curiosity about her cultural practices while remaining aware of the impact to the child. Calling CPS without futher investigation would be harmful to both mother and child and I would prefer to get a full picture of information. If at all possible, I would like to ask the boy alone and, after establishing myself as a safe, neutral figure, if he feels safe at home and if he is being hurt at home. If he says yes, then I would consider having social services involved. I am especially aware that this practice involves 'rubbing', not striking, which should not cause bruising. I would compare the size and shape of the bruises to see if they match the practice the mother is describing to look for patterns of child abuse. If after further investigation, I believe that the mother truly has good intentions and is solely following a healing tradition, then I would calmly and gently point her towards more proven remedies with scientific backing and encourage her to investigate those instead. I would emphatically express our mutual interest in her child's wellbeing, establishing myself not as confrontational but simply as an observer and medical professional."

What would you say?

---

Members don't see this ad.

 

[jusc2917]

"In this scenario, the main considerations are the wellbeing of the child, the mother's autonomy on how to approach her child's healthcare, and respecting cultural practices which that I am not familiar with. As the physician my foremost focus is the health of the child so in order to provide the upmost quality care I would want to gather more information to craft an optimal approach. Remaining open and curious I would ask the mother about the cao gio procedure, when she preformed it, when the boys symptoms began, etc. I would also be curious to understand how frequently and in under what circumstances she preformed this procedure. I would also speak to the boy privately asking his thoughts about the procedure, if he felt he could chose to not do these practices, and if he felt safe and comfortable at home. I would want to gather this additional information before further considering calling child protective services. If the boy responded he felt safe and loved at home, but did not like cao gio, I would ask for his permission to have a discussion with him and his mother about if the boy could opt out of the procedure or if absolutely culturally necessary, if it could be done with very light and gentle rubbing, explain concerns about deep bruising and provide additional information around scientifically based remedies and care. I would not want to prematurely call child services without having a more comprehensive understanding of the situation and family dynamic, which could cause harm to the child by separation from his beloved family. It is important to try to gain a deeper understanding of cultural practices non-judgmentally, from the perspectives of all parties involved, to encourage an open, trusting and honest relationship between providers and patients. This has larger implications outside a single interaction as uninformed, negative interactions could distance a community from seeking necessary care in the future. However, if the boy felt he was not safe at home, felt he was being harmed and was not listened to when he protested these procedures, then I would consider calling child services appropriate. In cases where cultural treatments are non-consensually causing harm and involved patients feel they cannot speak up and protect themselves I believe it is warranted for physicians to step in to stop cultural procedures, emphasizing a central focus on the wishes of that patient and advocating in part of their best interests."

 

[LiudwigXIX]

You should contact law enforcement agencies in such situations, as far as I know. They have to call the children’s guardianship service accordingly. Such people should be deprived of parental rights. It’s hard to imagine what this poor guy went through. All information regarding this situation is available on Texas Medical Board Investigations: 3 FAQs and Defense Strategies. Btw, I have wanted to work in the children’s aid service for a long time. Unfortunately, the state does not pay a good salary there.

 

[jusc2917]

You should contact law enforcement agencies in such situations, as far as I know. They have to call the children’s guardianship service accordingly. Such people should be deprived of parental rights. It’s hard to imagine what this poor guy went through. All information regarding this situation is available on Texas Medical Board Investigations: 3 FAQs and Defense Strategies. Btw, I have wanted to work in the children’s aid service for a long time. Unfortunately, the state does not pay a good salary there.

That's jumping to conclusions pretty quickly and according to the UN Declaration on the Rights of Indigenous Peoples Article 24: Indigenous peoples have the right to their traditional medicines and to maintain their health practices. I actually talked about this practice with another applicant who's had this done to him when they grew up in Vietnam and stated it normally shouldn't harm anyone at all. I believe it's really important to ask more questions before calling child services, especially because of the possibility of alienating this community from western healthcare. Even if that's your opinion, I would suggest not diving right into that and not considering other sides of the case in an actual interview scenario.

 

[allentown]

This sounds like cupping, which is offered by many legitimate massage businesses in my area. I've never heard of anyone being harmed by it, but I just looked it up on Wikipedia and saw that there can be side effects.

 

[EArlyBirdGetsTheWorm]

This really depends on the state on whether you are obligated to call cps or not. Some states are more strict than others. I would go the route fo the first two responses unless there is a state law that I would have to follow.

 

[FutureInternist]

"In this scenario, the main considerations are the wellbeing of the child, the mother's autonomy on how to approach her child's healthcare, and respecting cultural practices which that I am not familiar with. As the physician my foremost focus is the health of the child so in order to provide the upmost quality care I would want to gather more information to craft an optimal approach. Remaining open and curious I would ask the mother about the cao gio procedure, when she preformed it, when the boys symptoms began, etc. I would also be curious to understand how frequently and in under what circumstances she preformed this procedure. I would also speak to the boy privately asking his thoughts about the procedure, if he felt he could chose to not do these practices, and if he felt safe and comfortable at home. I would want to gather this additional information before further considering calling child protective services. If the boy responded he felt safe and loved at home, but did not like cao gio, I would ask for his permission to have a discussion with him and his mother about if the boy could opt out of the procedure or if absolutely culturally necessary, if it could be done with very light and gentle rubbing, explain concerns about deep bruising and provide additional information around scientifically based remedies and care. I would not want to prematurely call child services without having a more comprehensive understanding of the situation and family dynamic, which could cause harm to the child by separation from his beloved family. It is important to try to gain a deeper understanding of cultural practices non-judgmentally, from the perspectives of all parties involved, to encourage an open, trusting and honest relationship between providers and patients. This has larger implications outside a single interaction as uninformed, negative interactions could distance a community from seeking necessary care in the future. However, if the boy felt he was not safe at home, felt he was being harmed and was not listened to when he protested these procedures, then I would consider calling child services appropriate. In cases where cultural treatments are non-consensually causing harm and involved patients feel they cannot speak up and protect themselves I believe it is warranted for physicians to step in to stop cultural procedures, emphasizing a central focus on the wishes of that patient and advocating in part of their best interests."

Pa-

Ra-

Graphs.