How to treat a patient with strong religious views?

I'm a physio student, I've got a little stuck with an assignment and was looking for some help please!

I have a MSK group presentation about treating a woman with low back pain. The pain is worse when she sits for longer than 15 mins, it gets better with movement and when she extends her back it feels like she is being restricted. She also has poor posture when sitting and standing.

That's pretty straight forward however the patient has strong religious views that the pain she is experiencing is a punishment from God and that when she is forgiven the pain will go.

The aim of the presentation is to show how we would treat her but with respecting her religious beliefs. How would you approach this subject with your patients and explain that physio can help (but without undermining her views).

I understand that there might be too much information here, but I wanted you to understand the full situation!!

Thanks x

Hi

I don’t think there is any one right way of approaching this and there is no simplistic line to take with the patient. I suspect that your educator is wanting you to familiarise yourself with the concept of cultural competence. Cross defines cultural competence as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.”

There are a variety of models of cultural competence. I find Ronnie Leavitt’s books worth reading.

Have a look at this book:

Cultural Competence: A Lifelong Journey to Cultural Proficiency


Practitioners can move from an ignorant and antagonistic viewpoint of cultural destructiveness through a series of intermediate stages of development leading eventually to cultural competency, and cultural proficiency. A similar development can take place in whole service organisations.

One tool for developing cultural competence is the L.E.A.R.N. Model—A model for culturally effective communication

Listen—Identify and greet family or friends of the patient; ask patient with English as a second language if they would like an interpreter; start interview with an open-ended question; do not interrupt the patient as s/he speaks

Elicit—The patients health beliefs are elicited as they pertain to the health condition and the reason for the visit as well as expectations

Assess—Potential attributes and problems in the person’s life that may have an impact on health and health behaviors

Recommend—A plan of action with an explanation for your rationale

Negotiate—A plan of action with the patient after you have made your recommendations

The LEARN model may give you a way of thinking about how to develop cultural competence with a patient.

One key to this model is not to contradict the patient but to build empathy. In cultural competence the emphasis is not so much on gaining knowledge of a specific culture but rather understand the differences between the patients world view and your world view and finding an approach to the patients care that doesn't contradict their view but meets the criteria of what they consider acceptable therapy. Understanding the patient’s expectations of the treatment may help you work out what room you have to move. At the Recommend and Negotiate stages you may be able to put on the table an alternative viewpoint of the pain (ie the physiotherapy biomechanical model) that the patient may be willing to contemplate. However it is eventually the patient’s prerogative whether they feel able to adopt an alternative view.

I know this is a rather longwinded and vague answer. However these situations are complex and in my opinion it takes years to really develop cultural competence

Maybe use the explain pain model. If God is punishing her he is making her brain give her conscious self pain as a result of something. That simple thing might be that she is to sedentary? Hence if she did something proactive god might remove the pain that he is causing in her brain. It is an interesting topic and perhaps others might have some ideas.

There might also be an option to talk to another important member in her community such as a spiritual leader to ask his ideas on this.

Thanks so much!! These answers have been very helpful, I really appreciate your help! We were really stuck so these posts have been really constructive! x