The art as well as the science of medical care has always involved the possibility of adapting care to fit the belief systems of the patient, group of patients, or category of patients. A geriatric primary care doctor is better served by understanding that elderly patients have different concepts about doctors, drugs, medicines, authority and courtesy. When global medicine initiatives are developed, there needs to be consideration of the cultural, regional, religious, and other differences in acceptance or rejection of modern medicine.
There are political belief systems which include ways in which rumors and conspiracy theories are spread, making for a surprising reaction to an arriving team who last heard that a regional people were very enthusiastic about having an innoculation program. One rumor that the innoculations are actually part of a secret genocide program, and the best laid plans will go awry.
One problem with applying Western medicine, as practiced by Western medical teams is in the assumption that, because some populations are not formally educated, they are stupid. The inability is of Western medical teams to understand that, first, the individuals would not be alive if they were congenitally stupid. Most of the people in the world have developed medicines and medical treatments that have served them for millennium.
Second, individuals in other countries have different ideas about the normal life cycle and when it is perfectly fine to die. Many in the world do not have the desire to undergo indefinite life support or to live in a state of physical helplessness. Many prefer to die rather than to be an unbearable burden on their families or communities.
Third, of the belief systems, religions are the philosophy of most of the world’s humans. Whether the religion is ancient or modern, religious belief and faith can counteract any medical program or advancement. Jehovah’s witnesses are serious about refusing certain forms of life saving medical care, regardless of the suffering involved or the possibility that they will recover to live full and healthy lives. In many countries (not all on the African continent), witchcraft, shamanism, and other religions give the priests, practitioners, and wise ones an equal, if not over riding say in the acceptance of Western medicine.
In the case of Western patients, the age groups are an important consideration. As the example of elderly patients describes a generation that has a different understanding about medicine, about how their parents and others handled illness and died, and about how they expect to die and handle illness. The baby boom generation may be all for the best and newest that medicine has to offer, but is developing an adamant posture toward not extending life without quality, having seen their peers as well as their parents undergo prolonged, but poor quality life extension.
The “Generation X” will have seen two to four generations of the life and death process, as their grandparents and parents are living longer, their own age group lives and dies, and as their children live and die. They are coming to their own conclusions and exploring alternative medicines during a time of both enormous technological and scientific change and in education about alternative and natural medicine. One growing area of adamancy concerns the refusal or inability of an increasing number of parents to inoculate their children or to have seasonal flu vaccines.
The poor and the marginalized will have a disconnect or a distrust of medical care, based on the biases and attitudes that they receive when they require attention. There are cultures of religion, faith, natural medicine, and even acceptance of the death process that may be easier for the poor to process than for the wealthy. The wealthy will demand medical care that may be more life threatening than of any help, as with the boom in plastic surgery procedures.
As a result, the standard Western protocols of preventive care, innoculations, social engineering programs that encourage healthy diets and habits, appropriate cancer screenings, and blood pressure , insulin and cholosterol management have been the biggest causes of extended life expectancy, yet the social and belief factors of the population remain a major roadblock to universal acceptance of these protocols.