U.S. doctors must become more attuned to Islamic beliefs and values that could affect the physician-patient relationship with Muslim Americans, researchers found in a recently released study. This will become even more important as the U.S. Muslim population of nearly 7 million continues to grow, they found.
In focus groups of Muslim Americans, "women would say, 'I delay care because I can't find a provider that's of the same gender. They want me to put this gown on, but I'm uncomfortable,' " says the study's lead author Aasim Padela, a Muslim emergency medicine doctor at the University of Michigan who is a visiting fellow at the Oxford Centre for Islamic Studies in London.
Assessing how a preference for doctors of the same sex and anxiety about a revealing hospital gown might contribute to health care disparities between Muslims and other religious groups is tricky, Padela says, because patient databases identify individuals by ethnic group and race but not by religion.
Pockets of Pakistani Americans, whose native country is 97% Muslim, provide some clues, Padela says. For example, he says, an analysis of New York City residents found that Pakistanis were less likely to have had a screening colonoscopy — shown to reduce the risk of colon cancer — than Caucasians.
In the Journal of Medical Ethics, Padela and co-author Pablo Rodriguez del Pozo, a medical ethicist at Cornell University's Weil Medical College in Doha, Qatar, describe a scenario in which a woman wearing a hijab, a Muslim religious head covering, comes to the emergency department complaining of leg pain after a fall. She asks to see a female doctor.
According to Islamic bioethics, a Muslim patient's first choice of a doctor would be one who is also Muslim and of the same sex. Second choice would be a non-Muslim of the same sex, followed by a Muslim of the opposite sex and a non-Muslim of the opposite sex, Padela and his co-author write.
Simply acknowledging that a patient might be uncomfortable and asking how to put them at ease can relieve anxiety, Padela says. In his paper's scenario, the patient and doctor reach a compromise: A female nurse practitioner will examine the patient while the doctor observes.
"Physicians all across the country in all spheres of practice understand that making patients comfortable in a cultural context will really help," says Upland, Calif., neurologist Faisal Qazi, vice president of American Muslim Health Professionals. "It's a trust issue."
While even some women in hijabs might be OK with a male doctor, many non-Muslim women might not be, says Hasan Shanawani of the Islamic Medical Association of North America's ethics committee. Says Shanawani, a critical care doctor at Detroit's Wayne State University School of Medicine: "The onus is on you the doctor to make sure that your patients' modesty and personal dignity are being protected."
