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The Differential

Learning to Distinguish Cultural Practices From Child Abuse

Stephanie Nguyen, Medical Student, 10:48PM Jan 21, 2018

Temple University School of Medicine, Philadelphia, PA

A great physician strives to become more aware of cultural practices that are different than his or her own. Understanding the lifestyle decisions and religious practices of a myriad of cultural groups allows you to identify potential health concerns while building rapport and trust with your patients. It is incredibly important to have some level of cultural understanding with your patients, as this affects how you can effectively communicate with them.

I'm sure we've all experienced a time when we've talked to someone that shares no common ground. Their eyes glazed over and our words fell onto deaf ears. We must cater the way we communicate to best suit our audience. A provider that puts effort into acknowledging a patient's beliefs will also likely experience a higher degree of receptiveness to the professional recommendations that are provided. I try my best to learn about my patients' customs. Usually, if you simply ask them to elaborate on a specific cultural practice, they are more than happy to share this information with you. I recently just learned that in the surrounding Philadelphia area, it's common to serve gravy over rice for several meals per week. This may not seem like particularly important point, but it came into play when I was discussing nutrition and healthy meal decisions with a patient last week.

As providers we must also be aware that there is some distrust of healthcare professionals due to misunderstanding of certain customs. For example, there is a practice called "coining," also referred to as gua sha in China or cao gio (translated to "catching wind") in Vietnam. This practice involves using a lubricant on the skin and a blunt object, usually a spoon or coin, to apply repeated strokes that causes linear red marks on the skin. This is a traditional folk remedy that is thought to relieve blood stagnation and used to commonly treat the common cold, flu, and musculoskeletal pain. There are differing reports from controlled clinical trials on the effectiveness of this practice due to its nonspecific effects. One controlled clinical trial did state that it reduced musculoskeletal pain in cervical spondylosis. Although the current evidence is not sufficient to show its effectiveness, it is still widely practiced. Case reports have misidentified some instances as child abuse, thus causing mistrust among populations that practice coining.

At first glance for those not familiar with the practice, the linear red streaks on the skin may appear concerning for abuse. Although it is important to report injuries, it is equally important for any healthcare professional to collect more information about the situation before jumping to conclusions. My parents still use coining as a therapy for mild ailments; when I was younger, they expressed concern taking their children to the doctor while these marks were still visible due to the cultural differences and how it appeared to unfamiliar eyes. I could potentially see an issue with delaying appropriate medical intervention for families that fear that they will be accused of abuse when bringing their children in with these skin abrasions.

My intent is to reiterate the need for practicing medicine with an open mind and to be accepting of other cultures. It will make us better practitioners and will improve the outcomes for our patients.

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Medical school and residency can be a stressful, demanding time. These medical students share their insights and experiences, good and bad, in order to create a community of support and understanding for medical students everywhere.

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