Reshaping Bedside Manner in a Diverse World

Even for those on the receiving end of routine encounters, the experiences can be unsettling. Lubaba Mohammed, a young Ethiopian woman who lives in Prince George's County, was taken aback by the information she was asked during medical appointments. The doctors' manner seemed so forward, she said.

"You are surprised when they ask you questions, especially [about] a woman thing," Mohammed recounted, her toddler daughter balanced on one hip. "You are afraid to speak, to explain. You never used to back home. You are shy."

But she has since become Americanized: "If I have a problem, I have to talk. If I don't talk, it gets worse. That's what I learned."

Teaching doctors a more sensitive approach often falls to organizations such as the Delmarva Foundation, which is based on the Eastern Shore but focuses on health care quality nationally. The foundation recently launched a cultural education project that offers tutorials and other resources to physicians in Maryland and the District.

"It is not a peripheral or marginal or sometimes issue," said Michael Tooke, the foundation's chief medical officer. Yet in the project's first three months, only three groups signed on.

More progress is occurring at the public and nonprofit clinics that provide primary care to low-income communities.

At the Community of Hope clinic in Northwest Washington, what started as a trickle of patients several years ago now numbers hundreds of Ethiopians and Eritreans, not just younger ones like Mohammed, but elderly men and women who uniformly list their birthday as "1/1" -- because they do not know for sure when they were born.

The clinic's staff continues to adapt to patients' health needs, whether figuring out diet and nutrition counts for such traditional foods as the sponge bread injera or focusing on concerns linked to past tragedies. Medical Director Kate Sugarman can identify the signs of torture in those native lands. Back pains hint of brutal beatings. The lattice pattern on patients' knees reveals that they were forced to crawl for hours at a time across rough sand and gravel.

"You see those scars, the tiny dots," Sugarman said. She always aims for an empathetic response.

And at the Pregnancy Aid Center in College Park, which three decades ago opened its doors as a counseling service for university students, patients now come from countries where female circumcision is a rite of passage. Such radical anatomical refiguring precludes the usual pelvic exam and greatly complicates childbirth.

In Montgomery County, where a quarter of residents are foreign by birth, a network of ethnic-specific clinics continues to expand. There is a church-based clinic for residents from Haiti and French-speaking Africa, another designed to serve Latino day laborers. The newest program, opened in a Gaithersburg market, targets Koreans. Each is a collaboration of a community group and the nonprofit Mobile Medical Care Inc., whose executive director considers cultural understanding as essential to health care as a stethoscope or X-ray.

How else, Robert Spector asked, might a doctor discern which patients can be touched and which cannot? In certain cultures, only the husband or eldest son is permitted to make medical decisions. In others, "it's the whole family."