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January 10, 1996

Patient-Physician Communication: Respect for Culture, Religion, and Autonomy

Author Affiliations

Sage Memorial Hospital Ganado, Ariz

JAMA. 1996;275(2):108. doi:10.1001/jama.1996.03530260021013

To the Editor.  —My colleagues and I read the article by Drs Carrese and Rhodes1 with great interest. We practice rural medicine as employees of the Navajo Nation Health Foundation, a nonprofit, private Navajo organization located on the Navajo reservation in Ganado, Ariz. Nearly all of our patients are Navajo, and thus we encounter the Navajo concept of hózhó on a daily basis. The authors' findings are consistent with our experience. Over time, we have discovered that discussing potentially negative issues such as adverse effects of medications, complications from procedures, advance directives, and death is best done using the third person plural.2 For example, instead of "you might develop a stomach ulcer using too much ibuprofen," the physicians say, "when people take too much ibuprofen, they might develop a stomach ulcer."The third person plural approach has been well received by our patients. In general, Navajo patients quickly