Numbers are significant in every culture. In Western tradition, for example, the number 13 is considered unlucky, and seven is seen as lucky. There are many schemes and rituals for choosing the six magic lottery numbers-but is it possible that beliefs about numbers can affect our health?
When one physician, named "Dr. Smart" for this article, got a call from a hospital emergency room, he was shocked to hear that his patient, "Mrs. Cho," was being admitted to the intensive care unit with pneumonia. Only a few days earlier, he had put her on an antibiotic for a cough. His nurse had explained to Mrs. Cho that she must take the medication four times a day for to days. What Dr. Smart and the nurse did not know is that for this Chinese elder, the character representing the number four also means death. Mrs. Cho said nothing about this, but she did not take her medication and her condition deteriorated. Had she been a Navajo elder, she might have taken the medication happily, convinced it would cure her. In Navajo tradition, four is favorable: The earth rests on four pillars. People all absorb, consciously or subconsciously, a substantial number of cultural biases throughout life and cannot avoid their influence, even when those biases may affect their health.
SOCIAL, PERSONAL FACTORS
An elderly person in any cultural group who is isolated, poor or uneducated or has language difficulties is at an immediate disadvantage. Having more than one of these factors present compounds the problem. Language difficulties alone can be a barrier to a person's understanding of preventive measures, health problems and any proposed therapeutic plan, making compliance with therapy unlikely.
Embarrassment, either personal or culturally produced, can prevent an elder from mentioning symptoms viewed as unacceptable, such as impotence or urinary incontinence. For example, older women, especially in Asian cultures, can be embarrassed by intimate physical contact, such as vaginal examination, particularly by a male doctor. This embarrassment works against preventive care, early diagnosis and effective treatment.
Many cultures have a fatalistic attitude toward illness and death, and believe that everything in this life is preordained by deity or by fate. Health professionals should not attempt to change these ideas. Also, patients from some cultures may consider therapeutic health interventions to be inappropriate and futile, and may not follow them for these reasons. Furthermore, some elders may remain quiet about health problems because they fear burdening family members with demands on their time or finances. Apprehension about entering an unfamiliar medical system, or fear of being discriminated against or deported, are real concerns for elders from many racial and ethnic groups.
In addition, the attitudes of the primary care provider can powerfully affect therapy. A primary care provider who shows prejudice or cultural ignorance toward patients from different groups cannot build trust, and preconceived ideas can deprive patients of needed therapies. For instance, C. C. Cleeland and coresearchers at the University of Texas M. D. Anderson Cancer Center Pain Research Group showed that 65% of Latinos and African Americans with advanced cancer did not get adequate pain medication. In their study "Pain and Treatment of Pain in Minority Patients With Cancer" (Annals of Internal Medicine, November 1997), the researchers offered several explanations for this denial of pain relief. Physicians expressed concern about possible drug abuse and the effects of language differences and lack of patient assertiveness in seeking care. (The authors also noted, however, that when patients of any ethnic group are assertive they often are labeled "difficult," and disregarded for this reason.) Another factor was people's inability to afford needed medications. The study showed that 50% of white cancer patients did not receive adequate pain medication, either. …