land advises the doctor to be willing to accept the dependence of the
patient on the doctor during postsurgical care; the doctor should not
reject or fend off the patient during this period.

The average American physician will want to speed recovery to the
point where the patient achieves his independence once again. That
desire is born of our culture's emphasis on independence, hard work,
and the virtue of earning one's own way. As Sutherland points out, this
"Yankee" virtue may not fit the ideas of some convalescing patients from
other cultures or subcultures [15]. The doctor may feel obliged to return
the patient to gainful activity, but the patient may feel no such
ambition.

The patient's cultural background may dictate that continued de-
pendency, based on a minor physical handicap, is a perfectly fine way
of life. The patient's family may agree that work is no necessary goal of
a cure. Both family and patient may be quite content if the patient does
not return to a job. The doctor may consider the patient a rehabilitation
failure, and he may either blame himself for the "failure" or he may
accuse the patient of malingering. Neither accusation is warranted. It is
a case of culture conflict where doctor and patient have different ideas
about how a person should live his life.

Sutherland warns against the doctor starting needless trouble in the
doctor-patient relationship. The doctor should not confuse acculturation
(teaching a person the values of a given culture) with rehabilitation.
In the case of many patients from peasant societies (Sicilian, Neopolitan,
Spanish American, Southern rural Negro) the doctor may achieve medi-
cal rehabilitation without his patients ever going back to work. The
understanding and acceptance of cultural differences is a necessary
ingredient for the maintenance of a steady doctor-patient relationship.

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