Suhana, who is from Malaysia, has had continuous headaches for some weeks and she decided to see a doctor.
Suhana: When I arrived I didn’t see a receptionist, so I sat in the waiting room quietly, like the other patients. When it was my turn, the doctor himself called me in. He offered me his hand. I told him about my headaches and the doctor felt my pulse and took my temperature. Then, he asked me what I thought could be the cause of the problem! How should I know? He is the doctor! He gave my some aspirins and told me to take some rest and come back if the pain would continue. I think my old doctor back home in Malaysia would laugh very hard if he heard that the Dutch doctor asked me what I think is the cure to my headaches! I think I will probably look for another doctor.
The Doctor:
I received the patient Suhana, asking her to come in and sit down. Her complaints did not raise any concern, as her pulse, blood pressure and temperature were good. I asked her what she thought could be the cause of the headache. She seemed puzzled and did not reply, even though she had explained her pain quite well. I expect to see her back if the pain continues.
What happened?
Suhana felt ill and was looking for comfort and a solution to her pain. There was no nurse and not even a reception desk. The clinic seemed very efficient, but Suhana did not feel comfortable and supported. How can a doctor work without a nurse? From Suhana’s culture in Malaysia, a doctor should only do what a doctor is trained to do, and not the tasks of a nurse or secretary. In her mind, the doctor loses authority. Suhana would expect the doctor to tell her what is wrong with her health and use his expertise to find a solution, not ask her what she thinks. As she said, she is not a doctor!
What are some possible solutions?
The doctor could explain better that based on her temperature and pulse, there is no critical issue and that fatigue and stress are common causes of headaches. He could be more precise in his prescription (for example: sleep two hours in the afternoon every day and come back in two weeks) and also more precise in his questioning. If the pain is severe, Suhana could try to insist on a medicine; in the Netherlands it is normal for a patient to speak up and make a request. As a consequence, the doctor could give her pills, and tell her to only take them when the pain is too severe. In two weeks she should tell him approximately when she felt the pain and when she took the pills.
Explanation
In Suhana’s experience, a doctor is an expert, definitely a person of authority and therefore to be respected (high PDI). In the Netherlands, being a doctor is just another profession, to help others with health problems (low PDI and low MAS). They usually save on receptionist costs and do their own administration during the consultation. They also include the patient in the analysis of the problem and try to find a treatment together. They don’t take on the role of acting like an expert, but rather assist the patient in identifying the problem and finding the right approach. They also hesitate to send patients to expensive check-ups, like a MRI, if there’s a chance that the problem might disappear by itself.
