At the APAMSA Conference 2011

Here are some of my insights:

You ever realize when data is collected for US health surveys, the “Asian” group is conspicuously absent. You have “White,” “Black,” “Hispanic/Latino,” “Native American,” but no “Asian” box. What is up with that? The Asian population is the forgotten population, as much data is usually absent or not collected. Perhaps there is decreased disclosure on the part of Asian patients? Perhaps there is a stigma to revealing too much information about personal health to doctors?

First up: “Truth Telling in the Chinese Culture.” Interestingly, the topic of this talk coincided with what I’ve been learning in Foundations. In class, we’ve been discussing medical ethics: informed consent, patient autonomy, communication, etc… Imagine, a patient comes in with particular pain and symptoms. The doctor runs tests and the patient has advanced cancer. However, the patient and/or the family wishes to not know about the diagnosis and receive subsequent treatment. In the US at least, we tend to value patient autonomy and truth-telling. However, conflict arises when patients’ rights clash with the doctor’s duty to beneficence and healing. During Dr. Lee’s talk on end-of-life care, I got the view from the other side, that is, how some cultures actually value non-disclosure of depressing news. In Asian cultures, there is a larger emphasis on family & community, non-maleficence, longevity, Confucian ideals like filial piety, and ancestor worship. In addition, Asian cultures tend to view death as a taboo, where certain words and concepts related to ‘death’ are commonly avoided. Death is kept under mums. The number 4 is considered unlucky because 四 (“si”) sounds eerily similar to 死 (‘death’). Chinese people practice to honor the elders and ancestors, because spirits are believed to roam the earth. Elders are honored ceremoniously with proper burials, burning of paper money to the heavens, and blessings for fortune and longevity. In Chinese homes, an elaborate shrine with Buddha and a framed photo of the relative are placed together with daily offerings of fruit and drinks.

Thus, understanding the background of a patient can open doors and allows you to be a more culturally competent physician. When it comes to communicating with the family members and the patient, it is important to take in their perspectives, build a trusting relationship, and take care of the patient to ensure quality living. You want to be able to give them the information, but allow them to decline more information or treatment.  I believe it is just as important to open their minds to a patient’s right to know about his or her sickness and live as it was for a good-willed doctor understand where the patient’s coming from. Even when the patient wishes to die without tubes in every orifice and peacefully surrounded by family at home, I strongly believe in hope and survival. There are studies showing better outcomes, pain management, and reduced stress when patients know about their diagnosis and prognosis. Even within the last 50 years, there has been a growing trend towards patient autonomy and truth disclosure. Back in the 1960s, US doctors equated revealing a cancer diagnosis to a ‘death sentence” and ‘getting hit with a baseball bat.” Beginning in the 1980s, there began an emphasis for truth and patient rights. In 1990, the Patient Self-Determination Act was in place, while similar positive changes eventually made way into Asian countries:  National Death Act (Taiwan) and Doctor’s Law-Republic of China.

Next, “Hepatitis B in Asian Americans.” It’s a silent disease among Asian Americans (also a major problem in Africa and South America). There is a stigma associated with Hepatitis B, and thus, it is rarely discussed and people are not educated about the disease. Basically, it is a viral infection affecting the liver. It is transmitted via body fluids, sexual contact, blood-blood contact, mother-baby, and contaminated needles/drug use, similar to HIV transmission. There is no cure and one effective treatment targeting adenosine only controls the viral replication. Over half of those affected in the United States are Asians. Most are affected due to mother-baby transmission, particular during the birthing process when the baby is covered in the mother’s blood (in contrast to sexual contact as the most common mode of transmission in non-Asians). Vaccines are an essential way to protect against the virus, though they do not protect for life as the antibodies wear away every 5-7 years. Thus, screenings, education, and resources need to be targeted toward the Asian populations, the forgotten population.

Last, a documentary coming out soon called “Can: Mental Illness in Asian Americans.” Mental illness is yet another stigma in Asian culture. For Asian families, dealing with mental illness is draining, depressing, embarrassing, and a sign of failure. This documentary looks into the life of Can, a young promising Asian American who deals with bipolar disorder and overcomes his many challenges. Again, it’s a true rarity to find an Asian family into their personal lives, especially when it comes to something as taboo as mental illness. To let strangers into Can’s life and hit a glimpse of his sufferings and obstacles is truly a positive experience for Can and his audience.

He comes from a typical Asian family, with family pressures to succeed (he is the only son in the family) and an arrogant and stringent father. And yet, he is fortunate to have a loving family to feed and care for him, even after leaving college and living at home without a job. It is both sad to see him have suicidal ideations, crying spells, and manic episodes and to think about his future. What will he do when his parents are gone? Who will take care of him? At the same time, he does not fall in face of his disability. He eventually went back to college and graduated. He speaks at lectures to educate people about his mental illness as an Asian. While at times he feels lonely and seeks to become more ‘white,’ he has grown and embraced who he really is. His story is unique and inspirational, and I would certainly encourage people to check it out when it premieres.

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