A few years after Alejandra Borunda, 31, a resident of Phoenix, was diagnosed with young-onset Parkinson’s disease, she began experiencing depression. On her neurologist’s recommendation, she made an appointment with a therapist, who asked her some unsettling questions. After telling him she was from the city’s West Side, which has a sizeable Hispanic population, he asked if her home had ever been shot at and expressed surprise that she had graduated from her high school.
He also assumed that members of her family didn’t know much about Parkinson’s disease. “It was weird,” Borunda recalls. “It’s not horrible to grow up on the West Side, my high school has a high graduation rate, and eight members of my family have Parkinson’s, so we were familiar with the disease. Every assumption he made was based on my ethnicity and was incorrect.”
Seth M. Keller, MD, a neurologist in private practice in New Jersey, wishes a consultation with a Middle Eastern patient with migraine had gone differently. The patient’s husband joined her for the consultation and did much of the talking while she sat quietly – a situation that was normal for them, but unusual for Dr. Keller. “I know that in some cultures, a woman won’t come in by herself to visit a male physician, but I was used to talking directly to patients,” says Dr. Keller.
The fact that the woman was not on medication for her headaches, even after seeing a primary care physician, suggested to Dr. Keller that she and her husband were not comfortable with her taking medications – or perhaps with dealing with Western medicine in general. Dr. Keller says he felt torn between acting on his own instincts as a physician and recommending medication and holding back out of concern for the patient and her husband’s reluctance and respect for their culture. He broached the subject but found himself trying to convince the husband, rather than the patient, of the value of medication. “They never came back to see me,” Dr. Keller says.