RCC and Patient Well-Being

RCC & Determinants of Patient's Well-Being

In order to develop and maintain caring, healing relationships with patients, the practitioner requires capacities and abilities in several areas.

The patient's dignity, uniqueness, and integrity;

Appreciating the patient's experience of health and illness and his or her need for and right to care and respect creates the conditions for preserving the dignity and integrity of the patient within the practitioner-patient relationship.

Along with technical knowledge and skills related to biomedicine, the practitioner must be able to attend fully to the patient, establish and sustain respect for the patient's dignity, integrity, and uniqueness, and accept and respond compassionately to his or her own distress and the patient's pain. The practitioner must also be prepared to respond to the moral and ethical challenges that arise in the relationship and must understand threats to the integrity of the relationship and the potential for conflict. The presence of power and its potential for abuse as well as its ethical and responsible use must be recognized.

Additional resources that can contribute to healing;

Relationship-centered care acknowledges the many resources that can contribute to healing: traditional and nontraditional approaches to care, relationships with practitioners, family members, patients, friends, and one's community.

Social, political, cultural, and environmental determinants of health.

Indicators of health status and healthcare utilization provide evidence that minorities, the poor, the unemployed, and the undereducated are at greatest risk for poor health (Council on Graduate Medical Education, 1992.) Cultural differences create challenges for both healthcare practitioners and patients. Rapid and dramatic changes in communities resulting from migration, immigration, and demographic changes have made it difficult for practitioners to adjust to and learn about effective ways to care for patients from other cultures. Culture also determines our approaches to health, beginning with symptom interpretation and initial entry into the formal healthcare system.

For example, Dr. Mo describes an elderly unmarried Asian woman who complained for several years of pain in her hip and lower back (Mo, B, "Modesty, sexuality, and breast health in Chinese-American women," Western Journal of Medicine, 157, 260-64, 1992). She was not taken to the doctor because back pains are a common complaint and not considered serious. Finally, when the pain became too great, she was taken to the hospital, where she was diagnosed with metastatic breast cancer. Because she had never married, she had never had a breast exam or Pap smear. To do so would have been an acknowledgment of her sexuality, the idea of which was not only immodest but repugnant to her as a single woman.

Cultural norms can affect care after entry into the system as well. In some cultures, taking medication when one does not feel or appear sick is considered pointless. In a family with tuberculosis, the parents may not think it appropriate for a child to take prophylactic medication when the child does not seem to be ill, resulting in further illness and disability. Language barriers and legal issues (e.g., fear of having one's illegal alien status discovered) can compound the problems involved in cross-cultural healthcare.

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