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January 10, 1996

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

Author Affiliations

Johns Hopkins Bayview Medical Center Baltimore, Md
University of Washington Seattle

JAMA. 1996;275(2):109. doi:10.1001/jama.1996.03530260021016

In Reply.  —Dr Fitzgibbons makes several points that trouble us and require clarification. Our article describes a "cultural gap" between Western biomedical providers and our Navajo informants regarding the discussion of negative information, and we conclude that treating all Navajo patients by Western standards is ethically troublesome. However, we do not say that "bad outcomes can be avoided by not speaking of them." In the Navajo view, bad things result from a variety of mechanisms, only one of which is speaking about them. While we do not advise physicians to completely avoid discussions of "sickness, injury, and death" with Navajo patients, we do relay the views of our informants who find explicit and direct discussion of these issues troublesome (a view, by the way, that is not foreign to the Western tradition1). As Dr Kazal points out, creative, caring clinicians can together with their patients often devise "culturally sensitive"