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“An elderly Hindu in a British hospital was found lying on the floor, so, thinking that he had fallen out of bed, the nurses placed him back. Shortly afterwards he was found on the floor again. He could not speak English to explain that he thought he was dying and wanted to die on the floor where he would be near Mother Earth, so that his soul could leave more freely than in a bed. Like many Hindus, he had a clear model of how he should die, yet he died alone, before his family could be summoned to perform the final rituals.”

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Shirley Firth, Dying, Death and Bereavement in a British Hindu Community

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The probability of any two random persons in America being of the same ethnicity is 0.49; 58% of medical critical care fellows are graduates of foreign medical schools. These two facts are enough to explain why a discussion of cross-cultural medicine should be placed at the front of a critical care text. Diversity and cultural sensitivity are concepts which are much in the forefront of recent conversations regarding medicine. However, much of what is done with these concepts and realties is simplistic, and many of the tools purporting to help cultural sensitivity do little more than reinforce prejudgment and stereotypes.

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Practitioners struggling to deal with the bewildering array of ethnicities, religions and cultures with which they are confronted and must interact could be forgiven for being overwhelmed. Learning the nuances of even one culture takes years of study. When that culture is confronted with an entrenched biomedical culture the complications multiply. It is therefore not possible to state in detail the proper way to approach any particular type of patient or family. The best that can be done is to learn what some of the fundamental issues are, and how to sensibly and practically approach them in the daily care of patients in the intensive care unit. Although there is some evidence of higher satisfaction when the patient and provider are similar in demographics, matching patients and physicians by demographics is neither reasonable nor desirable.

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A look at the basic language and terms involved can illustrate the complexity of the situation and begin a process of coming to terms with this challenge. Culture has been described in many ways, but for purposes of simplicity can be defined as a system of beliefs and a learned and ingrained worldview that goes beyond surface belief to patterns of core values and meaning.

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Culture should not be confused with either ethnicity or race. Race is a term which has no biological validity. The concept of race as a valid biological categorization has been refuted by the American Anthropological Association, and in general the term has no scientific meaning. Ethnicity refers to the ethnic background into which a person was born. It is generally similar to culture but can be very different ...

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