0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter   |    
H. Steven Moffic
Psychiatric Services 2007; doi:

To the Editor: In their November Open Forum, Deegan and Drake (1) call for a shared decision-making process in prescribing medication instead of the traditional authoritarian compliance process. They argued that deciding to take medication is a complex decision that needs to be processed with the patient. They even mention that clinicians who make decisions for patients may be acting unethically unless it is an emergency.

Although these authors state that there may be situations such as emergencies in which shared decision making may not fully apply, they seem to ignore situations in which it should generally not apply at all. Specifically, patients from some cultural backgrounds expect the physician to tell them what medication to take. In such cases, should the physician ask them for their opinion, they may view the clinician as incompetent (2). Hmong patients who are not acculturated to mainstream values in the United States constitute one such group. The same is true of other recent immigrants or refugees who are used to a paternalistic society. In some cultural groups, it is also common for certain people in the family to make health decisions for others in the family.

Therefore, although Deegan and Drake's strategy may well apply to most mainstream, acculturated Americans (perhaps with the exception of those who have strong dependent personality traits), it will not be applicable cross-culturally. Cultural competence will call for a more adaptable prescribing practice. Individual prescribers can try to adjust their level of paternalism on the basis of their cross-cultural knowledge and an assessment of the degree of acculturation of the individual patient. A question as simple as "Would you like to know more about this medication?" may help.

Medication prescribing is even more complicated than Deegan and Drake indicate if cultural background is taken into account.

Dr. Moffic is professor of psychiatry and behavioral medicine and family and community medicine, Medical College of Wisconsin, Milwaukee.

Deegan PE, Drake RE: Shared decision making and medication management in the recovery process. Psychiatric Services 57:1636-1639, 2006
 
Moffic HS: Seven ways to improve cultural competence. Current Psychiatry 2:78, 2003
 
+

References

Deegan PE, Drake RE: Shared decision making and medication management in the recovery process. Psychiatric Services 57:1636-1639, 2006
 
Moffic HS: Seven ways to improve cultural competence. Current Psychiatry 2:78, 2003
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 45.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 45.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 4.  >
DSM-5™ Clinical Cases > Chapter 18.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 40.  >
Topic Collections
Psychiatric News