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Caregivers need to understand how patients think (2/10/98)

How people behave as patients is influenced by circumstances in their daily lives, according to Linda M. Hunt, PhD, assistant professor and medical anthropologist with the department of acute nursing care at The University of Texas Health Science Center at San Antonio.

"As a medical anthropologist, I try to understand why patients make the choices they do rather than ask why they don't conform to medical instructions," said Dr. Hunt. "I've found that most patients try their best to comply, given the limits and demands of their everyday lives, but often react to habits established in childhood. Sometimes health care professionals are unaware of this, since it is natural for a clinician to assume that theirs is a complete vision of reality. Translating medical advice into everyday actions is a much more complicated task than most people realize."

There are several major sub-fields in anthropology, according to Dr. Hunt. Physical anthropologists study human evolution and human variation within and between different populations, and sometimes their medical problems. For instance, they may study the impact on population growth and development when nutritional habits change. Linguistic anthropologists study human language to determine how it affects perception and behavior. Archeology, another sub-field of anthropology, is the study of the material remains and the cultures of populations.

"Most medical anthropologists train as cultural anthropologists, as I did," said Dr. Hunt. We look at the way people perceive their bodies, how they interpret and apply information given to them and how, in turn, they make choices that affect their health.

"We also look at phenomenology, or experience," said Dr. Hunt. "We are interested in learning how certain groups - given their upbringing, identity, socio-economic status and so forth - differ from other groups in experience and view of the world, taking into account their obligations, the tasks they must perform, their technical knowledge, health care options and other information."

Dr. Hunt has been involved mainly in the study of self-care for diabetic patients and cancer screening behavior since she joined the Health Science Center in July, 1993. "I was with the department of medicine initially, and took part in a diabetes study using Mexican-American subjects from San Antonio and Laredo. We found that diabetes management is especially difficult for this population, primarily due to socio-economic factors that impact their choices."

Most people try to take care of themselves and follow their doctor's orders but sometimes have problems doing so because of limited resources, Dr. Hunt said.

"Health care decisions are difficult for everybody but when you are poor and have little social power, it becomes even more difficult to carry through," she said. "Add to that the language difficulty, and limited instructions from the clinicians because they may not realize the help patients need to enable them to understand and adapt to proper treatment."

In addition, some of the clinics where these patients go for health care are under-funded, according to Dr. Hunt, and the staff may have very limited time to explain instructions to each patient. Also, many times patients can't keep up with normal follow-up care if they are asked to be seen every few months or they are referred to a specialist.

"What happens then?" asked Dr. Hunt. "Its almost impossible for some people to take time off. They don't want their bosses to know they are sick; they are afraid they'll lose their jobs. Maybe they need to eat at regular intervals or take medication, but their circumstances make it very difficult to comply."

Unless we have had such problems ourselves, we simply don't consider the difficulty some patients have in complying with their doctor's orders, according to Dr. Hunt. "They may not have the money for bus fare to get to the clinic," she said, "and even minimal charges may be too costly. Perhaps paying for medication is also difficult."

Dr. Hunt, who received her PhD from Harvard in 1992, hopes to be able to help both health care professionals and the lay public to understand the seriousness of these problems. "We have to realize this is a cultural situation. It isn't that patients need to be convinced or frightened into complying; many times it's that what they are being told to do simply isn't possible."

Contact: Jan Elkins, (210) 567-3570