Cultural Sensitivity and Respecting Muslim Patients’ Needs
By Tamar Abel-Halim Ghanem, MD, PhD Diversity Committee Henry Ford Medical Group Bloomfield Hills, MIAs an immigrant to the United States, what has impressed me most is the sense of democracy and respect for diversity, which is lacking in other places in the world. As a member of the Diversity Committee and as a practicing Muslim, I am priviledged to share my perspective on cultural sensitivity to caring for Muslim patients in medical practice. Cultural sensitivity in caring for the Muslim patient requires a basic understanding of Islam. Islam, which in Arabic, is derived from the word salam, or peace. It is the second largest world religion with 1.57 billion Muslims worldwide. There are approximately seven million Muslims in the United States. Islam is based on five pillars: • believing in Allah, Arabic for God, and Mohamed as his prophet (the last prophet in the lineage of prophets starting from Abraham); • performing five daily prayers; • fasting the holy month of Ramadan; • contributing to charity; • performing the haj or the pilgrimage to Mecca at least once. • Muslims follow both the teachings of the Prophet Mohamed and their holy book, the Quran. These teachings are parallel to the Ten Commandments and in congruence with Judeo-Christian teachings. Encountering and caring for Mulim patients requires knowledge of and respect for cultural observances. For example, Muslim women wear the hijab (head covering) which is worn by females volitionally in most instances and primarily for modesty. Just like other religions, Muslims vary in their interpretation and practice of their religious beliefs. Some Muslim women will request to be seen by only female practitioners, whereas the majority may be comfortable being treated by male practitioners. I recommend that the office staff or nurse first ask the patient if she is comfortable being seen by a male physician. If so, another way to make the patient more comfortable with a male physician is to include a female chaperone in the room, especially during a physical exam. Some female patients will not shake hands with a male practitioner, and therefore, it is important to ask before offering a handshake, “Do you feel comfortable shaking hands?” This advice also holds true for a female physician with a male Muslim patient. For the head and neck exam, ask if the female patient feels comfortable removing the hijab to facilitate the exam. If not, ask what can be done to make the patient feel comfortable during this part of the exam. The most important aspect is, do not make assumptions about the patient’s beliefs. By inquiring about what makes the patient feel comfortable, sensitivity to the patient’s needs is expressed. Another unique aspect about Muslim patients that the practicing otolaryngologist may encounter is sialadenitis or sialoliths during the month of Ramadan. The Muslim calendar is lunar-based with 12 months. The month of Ramadan is the ninth month of the Muslim calendar, and that month commemorates when the holy Quran was revealed to the Prophet Mohamed. Muslims are supposed to refrain from eating and drinking from dawn to sunset during Ramadan. If someone is sick or has a medical reason for not being able to tolerate fasting, they are permitted to feed instead of fasting. For a Muslim patient with sialadenitis or sialoliths, it would be useful to ask about recent fasting history. Alcohol is strictly forbidden in Islam. Nevertheless, a physician must inquire about alcohol use and other social history especially for a patient with a suspected head or neck malignancy. Even though alcohol is forbidden, it is wrong to assume that all Muslims do not drink. It is also important to be sensitive in asking the question, as patients may not readily admit it with family members around. Smoking is also not encouraged in Islam, yet smoking cigarettes or the hooka is common in Muslim countries. Many mistakenly believe that hooka smoking is safe because the smoke is passed through a water bath, but this form of smoking is just as dangerous, possibly even worse than cigarette smoking. Betel nut (Areca catechu) chewing is common in certain cultures such as Yemen or the Indian subcontinent. Therefore, it’s important to ask about chewing tobacco when discussing substance use history. In an ethnically diverse society such as the United States, many Muslim patients can come from a variety of backgrounds, such as from the Indian subcontinent to those born in the United States. It’s critical to not only understand some of the unique aspects of Islam, but also to avoid assumptions of stereotypes. Like anyone anywhere, Muslims can have varied backgrounds and variable adherence to certain beliefs.
Islam, which in Arabic, is derived from the word salam, or peace. It is the second largest world religion with 1.57 billion Muslims worldwide. There are approximately seven million Muslims in the United States. Islam is based on five pillars:
• | believing in Allah, Arabic for God, and Mohamed as his prophet (the last prophet in the lineage of prophets starting from Abraham); |
• | performing five daily prayers; |
• | fasting the holy month of Ramadan; |
• | contributing to charity; |
• | performing the haj or the pilgrimage to Mecca at least once. |
• | Muslims follow both the teachings of the Prophet Mohamed and their holy book, the Quran. These teachings are parallel to the Ten Commandments and in congruence with Judeo-Christian teachings. |
Encountering and caring for Mulim patients requires knowledge of and respect for cultural observances.
For example, Muslim women wear the hijab (head covering) which is worn by females volitionally in most instances and primarily for modesty. Just like other religions, Muslims vary in their interpretation and practice of their religious beliefs. Some Muslim women will request to be seen by only female practitioners, whereas the majority may be comfortable being treated by male practitioners. I recommend that the office staff or nurse first ask the patient if she is comfortable being seen by a male physician. If so, another way to make the patient more comfortable with a male physician is to include a female chaperone in the room, especially during a physical exam.
Some female patients will not shake hands with a male practitioner, and therefore, it is important to ask before offering a handshake, “Do you feel comfortable shaking hands?” This advice also holds true for a female physician with a male Muslim patient.
For the head and neck exam, ask if the female patient feels comfortable removing the hijab to facilitate the exam. If not, ask what can be done to make the patient feel comfortable during this part of the exam. The most important aspect is, do not make assumptions about the patient’s beliefs. By inquiring about what makes the patient feel comfortable, sensitivity to the patient’s needs is expressed.
Another unique aspect about Muslim patients that the practicing otolaryngologist may encounter is sialadenitis or sialoliths during the month of Ramadan. The Muslim calendar is lunar-based with 12 months. The month of Ramadan is the ninth month of the Muslim calendar, and that month commemorates when the holy Quran was revealed to the Prophet Mohamed. Muslims are supposed to refrain from eating and drinking from dawn to sunset during Ramadan. If someone is sick or has a medical reason for not being able to tolerate fasting, they are permitted to feed instead of fasting. For a Muslim patient with sialadenitis or sialoliths, it would be useful to ask about recent fasting history.
Alcohol is strictly forbidden in Islam. Nevertheless, a physician must inquire about alcohol use and other social history especially for a patient with a suspected head or neck malignancy. Even though alcohol is forbidden, it is wrong to assume that all Muslims do not drink. It is also important to be sensitive in asking the question, as patients may not readily admit it with family members around.
Smoking is also not encouraged in Islam, yet smoking cigarettes or the hooka is common in Muslim countries. Many mistakenly believe that hooka smoking is safe because the smoke is passed through a water bath, but this form of smoking is just as dangerous, possibly even worse than cigarette smoking. Betel nut (Areca catechu) chewing is common in certain cultures such as Yemen or the Indian subcontinent. Therefore, it’s important to ask about chewing tobacco when discussing substance use history.
In an ethnically diverse society such as the United States, many Muslim patients can come from a variety of backgrounds, such as from the Indian subcontinent to those born in the United States. It’s critical to not only understand some of the unique aspects of Islam, but also to avoid assumptions of stereotypes. Like anyone anywhere, Muslims can have varied backgrounds and variable adherence to certain beliefs.