Questions that elicit a patient’s explanatory model
- What do you call the problem?
- What do you think has caused the problem?
- Why do you think it started when it did?
- What do you think the sickness does? How does it work?
- How severe is the sickness? Will it have a short or long course?
- What kind of treatment do you think the patient should receive? What are the important results you hope she/he receives from this treatment?
- What are the chief problems the sickness has caused?
- What do you fear most about the sickness?
Suggestions for Health Care Providers
- Use questions to elicit a patient’s explanatory model
- Get rid of the term "compliance." It’s a lousy term. It implies moral hegemony (dominant influence or authority especially of one nation over others). You don’t want a command from a general, you want a colloquy (conversation, dialogue).
- Instead of looking at a model of coercion, look at a model of mediation. Go find a member of the Hmong community, or go find a medical anthropologist, who can help you negotiate. Remember that a stance of mediation, like a divorce proceeding, requires compromise on both sides. Decide what’s critical and be willing to compromise on everything else
- You need to understand that as powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful. If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?
From The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman (1997, pp 260-261)
Developed by Arthur Kleinman, psychiatrist and medical anthropologist at Harvard Medical School.
The original version of these questions appeared in Kleinman et al., “Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research”