Special Considerations when working with Asian American Patients . . .

“Asian” refers to people having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent. It includes people who indicated their race or races as “Asian Indian,” “Chinese,” “Filipino,” “Korean,” “Japanese,” “Vietnamese,” or “Other Asian,” or wrote in entries such as Burmese, Hmong, Pakistani, or Thai. ^[21]

Again, there are great historical and cultural diversities within this group. The considerations outlined in this document are more relevant to those of East and Southeast Asian decent (such as Chinese, Japanese, Vietnamese, Korean, Hmong etc.). Although East Asians share some characteristics with Asian Indian groups, these recommendations may not be as relevant when interpreting cultural traits of Asian Indians.

As with other racial and ethnic groups, East and Southeast Asian in the United States suffer from some distinct health disparities, such as the following: ^[22]

• Common sites of cancers among Chinese women are the lungs, breast, colon, stomach, and pancreas. Invasive cancer rates are much higher among Southeast Asian women in general than in the majority US population.
   
• The rates of cervical cancer incidence and mortality for Vietnamese American women exceed those of any other minority or majority population in this country.
   
• Common sites of cancers among Chinese and Vietnamese men may include the liver, colon, stomach, and nasopharynx. ^[25]
   
• Newcomers may have hepatitis, intestinal parasites, malaria, and/or Hansen’s disease.
   
• The most common diseases among Cambodians are tuberculosis, Hepatitis B, and intestinal parasites (hookworm, giardia, and strongyloides).
   
• Some East and Southeast Asians may develop a severe form of Glucose-6-phosphate dehydroginase (G-6PD) deficiency.
   
• Newly arrived patients from Vietnam and other Asian countries have high rates of Hepatitis B and tuberculosis (TB). It is important to screen these patients for these diseases. [26]

As a reminder, individuals will fall within the continuum of acculturation. We wish to reiterate that these are generalizations that may be useful in formulating questions or determining patient preferences but should not be used to stereotype patients. These recommendations come from a variety of sources that have been cross referenced for consistency: ^{[3, 7, 14, 23]}

Communications

East and Southeast Asian cultures tend to emphasize respect and deference for authority. This can influence several aspects of the clinical encounter. The patient may not wish to seem disrespectful by disagreeing with or correcting the physician. Take the following under advisement.

Out of courtesy, the patient may . . .

• Seem to agree when they actually disagree. Always ask clarifying questions to ensure agreement.
   
• Indicate “yes” when asked if they understand when they do not. Always ask them to rephrase in their own words.
   
• Out of politeness, they may refuse medications or food at first offer. Always offer more than once.
   
• Out of respect, patients may avoid eye contact

Other communications issues . . .

• These patients will appreciate respect (Mrs., Mr., etc)
   
• Can be reluctant to express pain. Always offer pain medication more than once and insist upon it when necessary as many Asians may have fears about addition to pain medications

Family and Gender Concerns

Family decision making . . .

• Decisions are usually made at family level and family is very involved in treatment
   
• Due to cultural beliefs about incurability of some diseases, the family may not want patient to know diagnosis
   
• Always ask the patients with whom their results should be shared first. The patient and his/her family members may wish to protect the patient from a serious or terminal diagnosis.

Gender issues . . .

• Due to modesty – female patients may want same sex caregiver. Be sure to ask as cultural mores may prevent patients from making this request
   
• Eldest male is head of family and may take the lead in health decision-making

Complementary and Alternative Medicine

Yin-yang . . .

East and Southeast Asian patients may believe that health conditions are caused by an imbalance – in yin/yang or hot/cold. They may practice folk remedies that reflect this, such as wearing heavy blankets when there is a fever or eating foods identified as “cold” when their condition is “hot”

• Ask the patient if there are any special dietary needs and try to incorporate these into treatment
   
• May practice cupping/coining to address hot and cold imbalances
   
• May practice herbal remedies. Ask patients what they are doing as part of their home treatment for their conditions.

Adherence . . .

• East and Southeast Asian patients may abandon treatment when symptoms subside. If maintenance medications are required, be certain to explain this and its importance to the patient.

Religion

• There is great diversity in religious practices and affiliations. Ask patients how they wish to incorporate faith in their care. For instance, ask if they wish to have a clergy member, spiritual guide, or faith healer present for all or aspects of their care.

Definition of Terms Used

Cupping: A common practice in many cultures. Cupping involves heating a glass and placing it on the body. This leaves raised, circular marks on the body as a result of the vacuum produced when the heated glass is placed on the skin. Many cultures believe this practice helps remove the source of illnesses (cold air in the body, the presence of an evil spirit, etc.)

Coining/Coin rubbing: A traditional Asian form of healing, coining involves heating a coin or putting oil on it and vigorously rubbing the affected area. The result is raised welts or red areas on the kin where rubbing has occurred. It is believed that the skin will turn red if illness is present and that the red area represents the sickness coming to the surface and leaving the body.

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