Mary-Jo DelVecchio Good

Public and professional discourses in American society about what constitutes a "good death" have flourished in recent decades, as illustrated by the pivotal SUPPORT study and the growing palliative care movement. This paper examines a distinctive medical discourse from high-technology academic medical centers through an analysis of how physicians who are specialists in internal medicine tell stories about the deaths of patients in their care. 163 physicians from two major academic medical centers in the United States completed both qualitative open interviews and quantitative attitudinal measures on a recent death and on the most emotionally powerful death they experienced in the course of their careers. A subsample of 75 physicians is the primary source for the qualitative analysis, utilizing Atlas-ti."Good death" and "bad death" are common in popular discourse on death and dying. However, these terms are rarely used by physicians in this study when discussing specific patients and individual deaths. Rather, physicians' narratives are nuanced with professional judgments about what constitutes quality end-of-life care. Three major themes emerge from these narratives and frame the positive and negative characteristics of patient death. Time and Process: whether death was expected or unexpected, peaceful, chaotic or prolonged; Medical Care and Treatment Decisions: whether end-of-life care was rational and appropriate, facilitating a…

Early in the AIDS epidemic, when cases in North America were predominantly among men and little was known of the disease elsewhere, it should have been clear that HIV would pose a special threat to poor women. There are several reasons that this might be so. Some of these ...

The realities of the social, cultural, and political dimensions of mental illness are not the same for women and men across diverse sociocultural settings. Research over the past three decades has empirically established the vital roles of culture and
gender across a range of illness-related features such
as etiology, vulnerability factors, illness onset, formation,
social and occupational functioning, psychotherapeutic
and medication experience, resilience, and course and outcome

"In the past decade, notions of “cultural competence” and “cultural sensitivity” have gained rapid ascendance within American medical education in general and within psychiatric residency programs in particular. These innovations in medical education are elements of a multi-pronged, health sector-wide response to vast racial/ethnic disparities in health outcomes recently identified in the United States. The vast scope and magnitude of these disparities came to light at the turn of the millennium with the publication of the Institute of Medicine’s 2002 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, and the Surgeon General’s landmark 2001 supplemental report, Mental Health: Culture, Race, Ethnicity, among other studies. These disturbing findings were quickly interpreted as a clarion call to prompt and decisive action, and the field of medical education has been especially responsive to this call. One key consequence of this call has been a comprehensive effort to sensitize clinicians-in-training to the roles they might play – often unwittingly – in producing and reinforcing disparities in treatment and health outcome.
Although a wide variety of educational interventions have been implemented across medical school and residency training programs in recent years, it is striking how little is known about the on-the-ground challenges, problems, and pitfalls that arise when clinician-educators attempt to render issues of racial/ethnic and cultural difference “teachable” and “learnable.” In this commentary, we address this glaring absence from the literature by reporting findings of an innovative qualitative research study conducted at a major teaching hospital in the northeastern United States."

Medical humanitarianism—medical and other health-related initiatives undertaken in conditions born of conflict, neglect, or disaster —has a prominent and growing presence in international development, global health, and human security interventions. Medical Humanitarianism: Ethnographies of Practice features twelve essays that fold back the curtains on the individual experiences, institutional practices, and cultural forces that shape humanitarian practice.

Contributors offer vivid and often dramatic insights into the experiences of local humanitarian workers in the Afghan-Pakistan border areas, national doctors coping with influxes of foreign humanitarian volunteers in Haiti, military doctors working for the British Army in Iraq and Afghanistan, and human rights-oriented volunteers within the Israeli medical bureaucracy. They analyze our contested understanding of lethal violence in Darfur, food crises responses in Niger, humanitarian knowledge in Ugandan IDP camps, and humanitarian departures in Liberia. They depict the local dynamics of healthcare delivery work to alleviate human suffering in Somali areas of Ethiopia, the emergency metaphors of global health campaigns from Ghana to war-torn Sudan, the fraught negotiations of humanitarians with strong state institutions in Indonesia, and the ambiguous character of research ethics espoused by missions in Sierra Leone. In providing well-grounded case studies, Medical Humanitarianism will engage both scholars and practitioners working at the interface of humanitarian medicine, global health interventions, and the social sciences. They challenge the reader to reach a more critical and compassionate understanding of humanitarian assistance.

Contributors: Sharon Abramowitz, Tim Allen, Ilil Benjamin, Lauren Carruth, Mary Jo DelVecchio-Good, Alex de Waal, Byron J. Good, Stuart Gordon, Jesse Hession Grayman, Jean-Hervé Jézéquel, Peter Locke, Amy Moran-Thomas, Patricia Omidian, Catherine Panter-Brick, Peter Piot, Peter Redfield, Laura Wagner

Sharon Abramowitz is Associate Professor of Anthropology and Africa Studies at the University of Florida and author of Searching for Normal in the Wake of the Liberian War, also available from the University of Pennsylvania Press.

Catherine Panter-Brick is Professor of Anthropology, Health, and Global Affairs at Yale University, and Director of the MacMillan Program on Conflict, Resilience, and Health. She has coedited six books, most recently Pathways to Peace.

Many health professionals would now agree that "cultural competence" is important in clinical settings, but in what ways? Shattering Culture provides an insightful view of medicine and psychiatry as they are practiced in today’s culturally diverse clinical settings. The book offers a compelling account of the many ways culture shapes how doctors conduct their practices and how patients feel about the care they receive.

Based on interviews with clinicians, health care staff, and patients, Shattering Culture shows the human face of health care in America. Building on over a decade of research led by Mary-Jo Good, the book delves into the cultural backgrounds of patients and their health care providers, as well as the institutional cultures of clinical settings, to illuminate how these many cultures interact and shape the quality of patient care.

Sarah Willen explores the controversial practice of matching doctors and patients based on a shared race, ethnicity, or language and finds a spectrum of arguments challenging its usefulness, including patients who may fear being judged negatively by providers from the same culture. Seth Hannah introduces the concept of cultural environments of hyperdiversity describing complex cultural identities. Antonio Bullon and Mary-Jo Good demonstrate how regulations meant to standardize the caregiving process—such as the use of templates and check boxes instead of narrative notes—have steadily limited clinician flexibility, autonomy, and the time they can dedicate to caring for patients. Elizabeth Carpenter-Song looks at positive doctor-patient relationships in mental health care settings and finds that the most successful of these are based on mutual “recognition”—patients who can express their concerns and clinicians who validate them. In the book’s final essay, Hannah, Good, and Park show how navigating the maze of insurance regulations, financial arrangements, and paperwork compromises the effectiveness of mental health professionals seeking to provide quality care to minority and poor patients.

Rapidly increasing diversity on one hand and bureaucratic regulations on the other are two realities that have made providing culturally sensitive care even more challenging for doctors. Few opportunities exist to go inside the world of medical and mental health clinics and see how these realities are influencing patient care. Shattering Culture provides a rare look at the day-to-day experiences of psychiatrists and other clinicians and offers multiple perspectives on what culture means to doctors, staff, and patients and how it shapes the practice of medicine and psychiatry.