Chiropractic Principles: Cultural Competence, Special Populations and Diversities

Strict cultural guidelines are very common in Arabic cultures, especially among Muslims. Modesty is stressed for both sexes, spiritually and physically, however it is greatest for Muslim women. For instance, traditional custom dictates that women cover their hair, body, arms, and legs (1). This is a concern any time a Muslim woman might be seen by men who are not from her immediate family (1). Special provisions should therefore be made for female practitioners to examine Muslim women (1). Similarly, a female assistant should always be present if a male doctor is treating a female Muslim patient (1). Some Muslim women may resist uncovering parts of the body not being examined. Finally, many Muslims believe it is forbidden to touch a member of the opposite sex outside of their family and will resist shaking hands (1). Something someone raised in the western culture may find offensive. The increasing rate of the Muslim population in Canada suggests the need to gain a better understanding of the cultural influences of Islamic faith and health related perceptions (1). Egypt, a country with a Muslim dominated population is discussed below with respect to Hofstede’s 6 dimensions of national culture.

Egypt scores high with respect to power distance, indicating that people accept a hierarchical order in which everybody has a place and which needs no further justification (2). With a score of 25 in individualism, Egypt is considered a collectivistic society (2). Egypt scores 45 in the dimension of feminism and is thus considered a relatively feminine society (2). In feminine countries the focus is on “working in order to live” and quality in their working lives (2). With a high score in uncertainty avoidance, the country maintains strict beliefs and are intolerant to ill indented behaviours and ideas (2). Egypt was ranked as having a very low score in long term orientation indicating that its culture is very normative (2). People in such societies exhibit great respect for traditions. Lastly, Egypt scores very low in the dimension of indulgence, demonstrating to be a very restrained country (2). Societies with a low score in this dimension do not put much emphasis on leisure time (2).

In the past, males had primarily dominated the healthcare professions. With progression to modern society, the incidence of female practitioners has been consistently rising. This remains true for the chiropractic profession. Much of this transition is directly related to the dismissal of the ‘traditional’ roles that women were once so heavily placed (i.e. primary child caregivers). That being said, research still demonstrates male healthcare practitioners as remaining dominant in certain aspects (3). For example the literature has demonstrated that female physicians, especially those with children, ‘have lower rates of employment and show lower values in terms of career success and career support experiences than male physicians’ (3). In terms of work-life balance, ‘female doctors showed to be less career-oriented and are more inclined to consider part-time work or to continue their professional career following a break to bring up a family’ (3). Any negative impact on career path and advancement is exacerbated by parenthood, especially as far as women are concerned (3).

Gay, lesbian, bisexual and transgender (GLBT) patients have unique and different health care needs when compared to heterosexual patients (4). Although a significant proportion of the population is gay or lesbian, physicians receive little formal training about homosexuality, and the unique health care needs of these patients are often ignored (4). For instance, research has showed that GLBT patients have higher rates of depression, suicide attempts, alcoholism, and certain cancers, sexual transmitted and cardiovascular disease (4). Physicians can improve the health care of GBLT patients and their families by maintaining a non-homophobic attitude toward these patients, communicating with gender-neutral terms, and maintaining awareness of how their own attitude affects clinical judgment (4). These are few of many basic strategies that should be used in all healthcare professions, especially chiropractors, as treatment is primarily done with the hands.

References

1. Carteret M. Dimensions of culture [Internet]. Modesty in health care: A cross-cultural perspective; 2011. Available from http://www.dimensionsofculture.com/2010/11/modesty-in-health-care-a-cross-cultural-perspective/

2. Itim International [Internet]. Finland: The Hofstede centre, Egypt; 2015. Available from http://geert-hofstede.com/egypt.html

3. Fischer BB, Stamm M, Buddeberg C, Bauer G, Hämmig O, Knecht M, Klaghofer R.

The impact of gender and parenthood on physicians' careers professional and personal situation seven years after graduation. BMC Health Services Research 2010; 40:1-23.

4. Dahan R, Feldman R, Hermoni D. The importance of sexual orientation in the medical consultation. Harefuah 2007;146(8):626-630, 644.