Building a culture of trust in partnerships
by Jill Shah on January 20, 2012
About the author
Anne Jaconette is a student staff member on the globalhealthU team at the GlobeMed National Office.
Over the past month, our network has engaged in discussion around the novel, The Spirit Catches You and You Fall Down by Anne Fadiman. We have discussed what elements create effective communication, and how we bring these lessons to the partnerships between GlobeMed chapters and their partner organizations.
The novel makes the argument that treating culturally diverse patients requires a different perspective. Western medicine is often a one-sided practice: Doctors give treatment, and patients receive it. It makes sense to us because our culture values science and trusts its findings. However, this one-sided relationship fails to benefit the patients when ethnic beliefs differ, and there is no culture of trust.
Lia Lee is mistreated in The Spirit Catches You and You Fall Down because no culture of trust existed that allowed the doctors and patients to reconcile their differences. One-sided medicine only works when there is acceptance of the practice.
In order to create acceptance and understanding throughout treatment, Arthur Kleinman developed eight questions to enable doctors to see the discrepancies between their perspective of a problem and the perspective of the patient. They are:
By asking these questions, doctors begin to approach not only an understanding, but also a culture of trust. The most important result of these eight questions is that doctors relinquish power to the patient by considering new causes of diseases and methods of treatment.
In Western medicine, doctors diagnose problems by attributing them to specific reactions in the body. Because this is so common in North America, the cultural reasons for diseases can frequently be forgotten. Thus Arthur Kleinman questions, “If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?”
Too often, we think of our biases as “correct.” In medicine, doctors must learn to hear concerns of the patients and communicate a culture of understanding and trust. Similarly, in GlobeMed, we learn to consider appropriate solutions through the lens of our partners. We communicate with partner organizations across the world to understand their goals, culture, and allow ourselves to be guided by our partner’s beliefs and needs.
The Spirit Catches You and You Fall Down ultimately offers solutions to reaching understanding when cultural conflict occurs. In the book, Sukey Waller offers advice to author, Anne Fadiman: to disregard what we see as “truth” and replace it with “consensual facts,” the understanding of the “truth” that two distinct cultures agree upon. Through this, we look at the same problem, and can begin to truly hear the voices around us.
Thank you for your participation in the GlobeMed Winter Break Book Club! E-mail us at if you have any questions, comments, or feedback.
More from Winter Break Book Club:
http://www.globemed.org/blog/posts/solidarity-through-empathy/
http://www.globemed.org/blog/posts/by-lipstick-or-tradition/
http://www.globemed.org/blog/posts/learning-to-make-fish-soup/
http://www.globemed.org/blog/posts/kicking-off-the-ghu-winter-break-book-club/
http://www.globemed.org/blog/posts/winter-book-club-selection-the-spirit-catches-you-and-you-fall-down/
Anne Jaconette is a student staff member on the globalhealthU team at the GlobeMed National Office.
Over the past month, our network has engaged in discussion around the novel, The Spirit Catches You and You Fall Down by Anne Fadiman. We have discussed what elements create effective communication, and how we bring these lessons to the partnerships between GlobeMed chapters and their partner organizations.
The novel makes the argument that treating culturally diverse patients requires a different perspective. Western medicine is often a one-sided practice: Doctors give treatment, and patients receive it. It makes sense to us because our culture values science and trusts its findings. However, this one-sided relationship fails to benefit the patients when ethnic beliefs differ, and there is no culture of trust.
Lia Lee is mistreated in The Spirit Catches You and You Fall Down because no culture of trust existed that allowed the doctors and patients to reconcile their differences. One-sided medicine only works when there is acceptance of the practice.
In order to create acceptance and understanding throughout treatment, Arthur Kleinman developed eight questions to enable doctors to see the discrepancies between their perspective of a problem and the perspective of the patient. They are:
What do you call the problem?
What do you think has caused the problem?
Why do you think it started when it did?
What do you think the sickness does?
How does it work?
How severe is the sickness?
Do you think it will have a short or long course?
What kind of treatment do you think the patient should receive?
What are the most important results you hope she receives from this treatment?
What are the chief problems the sickness has caused?
What do you fear most about the sickness?
By asking these questions, doctors begin to approach not only an understanding, but also a culture of trust. The most important result of these eight questions is that doctors relinquish power to the patient by considering new causes of diseases and methods of treatment.
In Western medicine, doctors diagnose problems by attributing them to specific reactions in the body. Because this is so common in North America, the cultural reasons for diseases can frequently be forgotten. Thus Arthur Kleinman questions, “If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?”
Too often, we think of our biases as “correct.” In medicine, doctors must learn to hear concerns of the patients and communicate a culture of understanding and trust. Similarly, in GlobeMed, we learn to consider appropriate solutions through the lens of our partners. We communicate with partner organizations across the world to understand their goals, culture, and allow ourselves to be guided by our partner’s beliefs and needs.
The Spirit Catches You and You Fall Down ultimately offers solutions to reaching understanding when cultural conflict occurs. In the book, Sukey Waller offers advice to author, Anne Fadiman: to disregard what we see as “truth” and replace it with “consensual facts,” the understanding of the “truth” that two distinct cultures agree upon. Through this, we look at the same problem, and can begin to truly hear the voices around us.
Thank you for your participation in the GlobeMed Winter Break Book Club! E-mail us at if you have any questions, comments, or feedback.
More from Winter Break Book Club:
http://www.globemed.org/blog/posts/solidarity-through-empathy/
http://www.globemed.org/blog/posts/by-lipstick-or-tradition/
http://www.globemed.org/blog/posts/learning-to-make-fish-soup/
http://www.globemed.org/blog/posts/kicking-off-the-ghu-winter-break-book-club/
http://www.globemed.org/blog/posts/winter-book-club-selection-the-spirit-catches-you-and-you-fall-down/
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