Challenge 5: Medical Anthropology Grand Rounds

Summary and Background

Originally trained as a medical doctor, Arthur Kleinman became a medical anthropologist when he recognized the role of cultural context and illness narratives in the experience and treatment of illness. Kleinman wrote an instrument with eight questions that he suggests every doctor ask their patient and/or the patient’s family to help understand their illness narrative. Medical anthropologists who work in healthcare settings also use the eight questions to make sense of illness narratives. While each patient has a narrative to explain their own illness, each practitioner who treats the patient also has a narrative. Sometimes these narratives align with each other, but most often, they differ. In medicine, “Grand Rounds” refers to the meeting of several different practitioners (as well as scholars and learners) to review a patient’s case and course of treatment.

Your Challenge

Your patient is seeing a combination of traditional healers and medical doctors in order to treat their illness. As medical anthropologists, your job is to “interview” all of the practitioners, as well as the patient and family, using Kleinman’s eight questions:

1. What do you call the problem?
2. What do you think has caused the problem?
3. Why do you think it started when it did?
4. What do you think the sickness does? How does it work?
5. How severe is the sickness? Will it have a long or a short course?
6. What kind of treatment do you think the patient should receive?
7. What are the chief problems the sickness has caused?
8. What do you fear most about the sickness?

For each person’s interview (patient and family, local healers, and medical doctors), please answer as many of the eight questions as you can. It’s ok if you cannot answer all eight questions for each person.

Instructions

Step 1: Open the case study linked below and read the Cultural Context section as a group.

Step 2: This case presents four perspectives: three practitioners and the patient/family perspective. Each team member will read the perspective of one of the four people and use the eight questions to collect information about their illness narrative. The last two questions will most likely be answered only in the patient/family perspective, so the person doing that “interview” should focus most on these two questions, while the people “interviewing” the practitioners should focus on the first six questions.

Step 3: Compare notes. As a group, write up a summary of the patient’s case, including all four perspectives. This summary should include:

• A bit about the patient – age, gender, family relationships, lifestyle, anything you learned about them through the “interviews.”
• All of the patient’s known symptoms.
• All possible explanations for the symptoms. You might make a bulleted list of symptoms, or organize them into categories of your choice using a Venn diagram or other kind of visual organizer.
• All treatments that have been tried.
• Any treatments that have been suggested, but not yet tried.

Step 4: Reflect. Write down your answers to the questions below, then submit them in Canvas > ASB 214 > Assignments > Challenge 5.

1. How did local cosmology influence the course and treatment of the illness in your case?

2. Do you think the eight questions are a useful tool for healthcare providers? If so, why? If not, what would you add or change?