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Ramadan: taking a patient history from history

Author(s): Carey Jackson, MD
Date Authored: June 01, 2013

Quran and Beads ImageThis year Ramadan is in June/July. It is a month that most of our Muslim patients look forward to and enjoy.  Not that it is without its challenges, especially through the long summer days. But it is a time of spiritual renewal, a time the family and community are united in prayer and fasting, and a time of great dietary traditions once the sun has set. You will find many references to Ramadan in the pages of EthnoMed (see related content below) since it requires flexibility and some creativity to manage diabetes and other medication regimens. 

Those of us who practice in cross-cultural settings are sometimes asked to teach about cross-cultural skills. We often find ourselves looking for cases or good examples of where culture comes into play in medicine.  Ramadan always provides a great example. 

Food is central to community and cultural life: how it is prepared, when it is eaten, why it is eaten, and when it is not eaten.  Ramadan is infused with histories global and personal for families. It is a seasonal marker and measure of time passing. Ramadan is about forgoing calories, it is about feeling hungry, it is about values, and it is about faith.  Like a force of nature, the wise clinician works with it, and this requires first understanding the tradition and especially how your patient observes it. Anticoagulation, blood draws, surgeries, TID regimens, procedures, and provider schedules can all be frustrated if they are not designed with Ramadan in mind.

Discussing the fast with your patients will bring the clinician quickly into their community life and inner world and provide an opportunity to learn how culture and practice vary by region and by family.  Adapting medical practice in a flexible manner to accommodate Ramadan is a great first step toward a myriad of other conversations with patients about practices and values that confound medical therapies and are glossed over as “non-compliance” instead of as medicine’s failure to meaningfully engage the patient.  Ignoring the role of faith and religious practice in a patient’s life is naive and ill advised.  There is an old adage in medical culture that says “the best medicine is the one the patient will take” …well if they won’t take it, there is often a powerful reason why.

(this article was taken from the June 2013 edition of the EthnoMed Newsletter)

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