Cultural Competence: Caring for your Muslim patients

When the doctor entered the exam room to meet with his Iranian patient, he found Seyyed huddled on the floor, mumbling. At first he thought Seyyed had fainted, fallen off the table, and perhaps struck his head. But when he tried to help him up, the patient became agitated and resisted his help. Seyyed spoke no English, and the doctor had no idea what the problem was.

He later learned that Seyyed had been praying. The Muslim would have preferred to pray on a prayer rug in a place where he wouldn't be interrupted, but it was growing late for the fourth of his five mandatory daily prayers. If the doctor had had an understanding of Islamic customs, he would have realized that his patient was praying and would have given Seyyed some privacy.

"To make your Muslim patients comfortable and keep them coming back, show respect for them as individuals as well as for their religion," says Anvar Velji, an internist and director of cross-cultural medicine and chief of infectious disease at Kaiser Permanente South Sacramento (CA) Medical Center. "Realize that they may look at things differently than you do." Also, ensure that you have adequate interpreter facilities in place. (For information on dealing with interpretation and translation, see "Cultural Competence: Caring for Latino patients," April 23, 2004, available at http://www.memag.com/memag/article/articleDetail.jsp?id=108876.) Muslims from different populations may speak Farsi, Urdu, Arabic, Pashtu, or Malay. If your patient will be hospitalized, there are dietary requirements to be considered. Some of them may even affect your prescription practices.

Dietary issues may affect medical care The Muslim patient who enters your office may be nearly indistinguishable from any other American-he may be assimilated to American ways, wear Western dress, and adapt his religious observances to a Western lifestyle. On the other hand, it may be very important to him to maintain traditional customs of dress, food, social relationships, and religious observance.

In general, practicing Muslims avoid eating pork or drinking alcohol, and are proscribed from taking medicines that contain alcohol or pig byproducts unless they are life-saving drugs and no substitute is available. Porcine heparin, for example, contains gelatin from pork products, and is the only heparin universally used.

"That was thought to cause a potential problem for Jewish, Muslim, and Seventh-day Adventist patients at this institution," says Doha Hamza, the coordinator of Muslim volunteers at the spiritual care service department at Stanford (CA) University Medical Center. "We investigated the issue with an imam and a Muslim doctor who concurred that the use of porcine heparin is lawful because of the chemical modification the product undergoes and the urgent need involved. Also the amount is so small, it doesn't fit the definition of consumption." Similar solutions might be found for insulin products derived from pork and porcine heart valves.