There is nothing about this world, or even this country, that is homogenous. From schools to hospitals, depending on where in the world a body is located, common culture, societal values, and popular beliefs influence how a system is run. In particular, medical systems are very much influenced by factors specific to certain locations. Many different influences shape medical systems; as said by Leslie, “because they are embedded in local communities medical systems vary from one part of the world to another according to the family structures, religious, economic and political institutions of the regional and national societies in which they are located.”
In many countries, there currently is a push to manufacture an entire medical system, from schooling to how hospitals are run, to be the most effective model. The ultimate goal, what is considered to be the most effective, is to transform to a more business-like way the means by which medical institutes within a country, and medical institutes across countries, communicate; “the generic conception of a medical system is thus based on a single, historically recent system: a bureaucratically ordered set of schools, hospitals, clinics, professional associations, companies and regulatory agencies that train practitioners and maintain facilities to conduct biomedical research, to prevent or cure illness and to care for or rehabilitate the chronically ill” (Leslie). To truly maximize efficiency, eventually the goal would be for all medical systems around the world to be identically bureaucratically ordered and connected (Leslie).
While there are many conceivable benefits to a homogenized medical system, it is not feasible for many reasons. A significant issue is that, “quality of medical care is variable, and access to it differs among rural and urban populations, members of different social strata and ethnic groups” (Leslie). Meaning, even if hospitals across the world looked the same, they still wouldn’t be reaching populations that need care. Also, it is not feasible to organize a medical system like a business because, “the normative bureaucratic perspective involves an enormous simplification of the ways that medical systems are organized” (Leslie); people don’t work like a business, medicine is too intertwined with emotion and spirituality. Finally, another reason that bureaucratically organized medical systems is an unobtainable goal is that many regions of the world do not practice medicine in the way “we” (the west) do. Similarly, homogenizing systems, or labeling them as homogenized and strictly scientific, “simplifies the west and reduces it to only one of its traditions-which, by declaring it to be dominant, is made to be so ever more. This frustrates good care, contributes to the marginalization of patients, and makes it difficult to think about, let alone attend to, the body and its diseases” (Mol).
In homogenization, medical pluralism, or the employment of more than one type of medical system to treat illness, would not be able to exist. In countries like the United States, where medicine is very bureaucratic, the difficulties of medical pluralism can be seen. While more than one type of way to treat a disease isn’t inherently a bad idea, the interaction of culturally and ideologically different systems can often make treatment difficult. This can be seen in the episode of Grey’s Anatomy entitled “Bring the Pain.”
In The Spirit Catches You and You Fall Down by Ann Fadiman, Kleinman proposes three ideas to help make interaction between cultures in medicine easier, “First, get rid of the term ‘compliance.” It’s a lousy term. It implies moral hegemony. You don’t want a command from a general, you want a colloquy. Second, instead of looking at a model of coercion, look at a model of mediation. Go find a member of the Hmong community, or go find a medical anthropologist, who can help you negotiate. Remember that a stance of mediation, like a divorce proceeding, requires compromise on both sides. Decide what’s critical and be willing to compromise on everything else. Third, you need to understand that as powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful. 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?” (Fadiman 261). In “Bring the Pain”, an interaction between cultures that ultimately successfully follows all three of these suggestions can be seen.
Sometimes, the wishes of a patient don’t correlate with the route doctors who practice biomedicine want to take (Mol). In this case, the patient’s family holds a different view on medicine and curing than the doctors working at the hospital, which leads to tension as a treatment plan is decided upon. Initially, the conversation doesn’t go smoothly. The doctor, Meredith, is very condescending; when the patient initially refuses the proposed treatment due to conflicts with her cultural beliefs, Meredith says, “you know that you’ll have to sign an AMA form stating that you’re leaving against medical advice” (“Bring the Pain”), rather than working with the patient to come up with an alternative solution. This slightly threatening response was what came naturally to the American-trained doctor; her very bureaucratic and scientific medical training hadn’t taught her about Hmong culture and shaman, or even simply how to embrace a different culture that is maybe less empirically scientific in the way they treat disease. As said by Leslie, “it is difficult for them to realize that along the way they implicitly acquired an ideological view to medical sociology.”
It’s also difficult for some Hmong to adapt to and trust western medicine, which can be seen by the patient’s response to why she must refuse surgery, “our religion has got rules that are way old and way set in stone and way spiritual and you don’t mess with them; you don’t anger the ancestors” (“Bring the Pain”). This idea can also be seen in Fadiman’s book, in which she explains that the Hmong are deeply distrustful of Western medicine, and would rather treat illness with their own solutions. However, in Grey’s Anatomy, after the initial hiccup, the doctor asks about the Hmong rules and what the family needed in order to treat the patient, Anna.
After speaking with Anna about Hmong medicine, she sends Derek, a male doctor, to talk to the father about possible solutions because “having testicles is a requirement” (“Bring the Pain”). In their conversation, Derek asks why the father wouldn’t just say they needed a shaman in the first place, and the father says “why, so you could call me a fool?” (“Bring the Pain”). Derek says he respects their tradition, even if he is unable to understand it. This successfully follows Kleinman’s first and second recommendations; Derek is not asking the father to be submissive and just do what he says, instead they’ve reached a compromise with which both cultures can treat the disease how they see fit. However, the doctors still feel pressed for time while anxiously waiting the shaman’s arrival, which shows that even though they’re letting them do their ritual, they don’t believe it’s actually healing her; only the surgery will.
Despite not necessarily believing in the powers of the Hmong medicine, the doctor’s in this episode adhered to Kleinman’s suggestions. His first suggestion is to abolish the idea of compliance. The doctors struggle with this in the beginning when they pseudo-threaten the family with social services and AMA forms, however, by the end, they abolish the idea of compliance when they don’t make the family comply to their biomedicine regimen without letting them treat Anna how they want to. This also adheres to the second suggestion. They are able to mediate with the family to ensure the health and safety of Anna, and the mediation ends with satisfaction in both parties. They do this by flying the shaman in on a helicopter to find Anna’s lost soul, and it is done within the window of time allowed before the surgery has to be competed according to biomedicine. Finally, they are able to understand that both of the cultures, Hmong and biomedicine, are very powerful. This can be seen in the conversation between Derek and the father, when Derek tells him that he doesn’t understand their culture, but shows that he understands its importance in healing Anna by flying the shaman in on a helicopter. Both parties in this case agree that biomedicine (the surgery) and the shaman (to find Anna’s missing soul) must be performed together in order to heal her successfully.
The way the doctors in the fictional Seatle Grace Mercy West hospital handled a Hmong patient is very different than the real life example of Lia Lee from Fadiman’s book. In the television show, the doctors were very willing (after an initial adjustment period) to allow Anna’s family to practice their medicine, even if they felt it was quackery. This contrasts sharply with how the doctors interacted with the Lees; they only allowed the family to perform traditional Hmong treatments on Lia in the hospital because they thought she was going to die anyway. In Grey’s Anatomy, the patient lived and was not paralyzed because the cultural differences between the doctors and Anna’s family didn’t create too large of a barrier. This could be due to the fact that unlike with the Lee family, there was no language barrier. On top of culturual differences, inability to communicate makes compromise incredibly difficult. Also, Anna grew up in America and was old enough to advocate for herself, while Lia’s parents did all of the coordinating with the doctors. While Anna’s father was largely in charge of her treatment, the family was much more Americanized than the Lees. In Grey’s Anatomy, arguably the doctors and the family both had the goal of getting Anna into surgery, so they were able to compromise, following Kleinman’s third suggestion, in order to heal her. In contrast, Lia’s doctors were not as willing to compromise, because they were hardly on the same page as the Lees due to the fact that they didn’t believe in their Hmong medicine, “because the exemplars of cosmopolitan medicine make disease the central domain of their competence, they shun the symbolic, political and economic functions of clinical transactions” (Leslie). Medical pluralism wound up ending Lia’s life because the biomedicine and Hmong medicine couldn’t be mixed in a way that pleased both parties and kept Lia healthy; the doctors’ failure to see past their own biases ultimately led to the breakdown of communication between the two sides. Again, a big difference is the existence of the language barrier, and the fact that the Lees had not assimilated in the way the family in Grey’s Anatomy did.
The greys anatomy episode was a gross oversimplification of what medical pluralism really is and how complex it can be. While paralysis is a severe outcome, this case was much simpler than Lia’s case. In theory, it would be great to have more than just biomedicine to treat to disease in the west. Many cultures have no problem with mixing biomedicine and their culture’s healing rituals. The problem comes from doctors in the west, who follow a strict schooling regimen in strictly biomedicine from the time they’re 18 until they’re 26 and licensed. In this schooling, doctors are taught, outwardly and subconsciously, that they know best. Because of this, medical pluralism cannot survive. Patient choice, whether it be to forgo a procedure or be cured by a shaman, and what’s deemed to be the best treatment should complement each other, but often clash because doctor’s feel that only they know what “good care” is (Mol); strictly biomedicine.