The Relationship between the Armenian Patient and Armenian Medical Professional, Physician, Nurse and Hospital Staff is very interesting and challenging as discussed in this article.

The Relationship between the Armenian Patient

and the Helping Medical Professional

(A presentation given to medical professionals working with Armenian patients and families at a hospital in Glendale, California)

The relationship between the Armenian patient and the helping medical professional is a complex one. It is full of issues that go beyond medical conditions and treatment, that includes issues relating to a person’s cultural context. In fact, these generally ‘non-medical’ issues can affect an Armenian person’s view of health and illness to such an extent, that the actual medical issues sometimes become secondary, or at least not as central in the ailing person’s life priorities. At the beginning, such a relationship can cause great frustration and waste of time in the medical professional’s attempt to provide the appropriate medical attention. Eventually, these communication issues can cause delays in receiving the appropriate treatment, and lead to extra unnecessary medical expenses. The correct understanding of a patient’s cultural situation by the medical professional can lead to more effective diagnosis, higher quality of service, and lower costing treatment.

The greatest obstacle to the effective professional-client relationship for the highest quality of treatment at the appropriate cost is the lack of a patient’s cultural identity. Cultural identity refers to the context through which a person views, translates, and responds to life’s circumstances. The cultural context is necessary in order to provide the patient a basis and a set of options upon which he or she can make decisions. However, the Armenian patient does not find a clear and a concrete basis upon which decisions can be made and consequences discerned. This ambivalence leads to indecision, confusion, and chaos in a person’s decision making abilities. This ambivalence is magnified during times of human stress, most especially in the face of illness and the possibility of death. At a time when the most expeditious, rational, and factual decisions need to be made, a patient finds himself or herself isolated from others, with no means to ask for or receive help. This leads to utter frustration and even depression. As a result, the relationship between patient and helping medical professional is paralyzed. Understanding key relational influences is the first step to overcome this paralysis.

The cultural context for the Armenian person is the result of upholding and defending a way of life and values that have been maintained for centuries, for perhaps two thousand years. For that reason, although Armenians living in the United States today come from a variety of countries of origin, and may to some extent speak different dialects or even different languages, yet they have many cultural similarities due to centuries of commonality. The cultural similarities among the Armenians can be seen mainly in three different areas: Spirituality, historicity, and family. Spirituality refers to the perspective of that which is valued in life, and that which must to be upheld and defended under any and all circumstances, regardless of the social environment and surrounding conditions. Historicity refers to that which has been traditionally done, the ‘Armenian way of life,’ – both that which is important and perhaps not as important. Whereas spirituality may refer more to ‘content,’ the important values in life, historicity refers more to the living ‘process,’ how the important values in life are attained. However, neither spirituality nor historicity should be reduced to ‘content’ versus ‘process.’ Family on the other hand is the everyday living environment within which spirituality and historicity are applied and lived out. ‘Family’ in the Armenian community refers to more than the family of origin or the nuclear family. Instead, it includes both of these along with all of the extended family and even the small surrounding community. These family ties are much more important and influential in the decision making process than would initially appear, therefore, they must be acknowledged and understood. All Armenians may not uphold the same spirituality, historicity, and family values, however, they would still approach life’s decisions based on these cultural categories.

The Armenians living in the United States, especially those who live in large communities tend to discover opposing trends between the culture in which they were brought up, and those of the dominant culture in which they have to live, interface, and survive. Often the similarities and differences are attempted to be simplified to that of the Armenian as a ‘community oriented culture’ as opposed to the American ‘individualistic culture.’ It would seem that if a ‘non-Armenian from the individualistic culture’ were to understand and "step over" into the ‘Armenian community oriented culture,’ then there would be sufficiently effective communication. However, the situation is not as simple as that. In fact, research I have performed with college students and through my experience in working within the Armenian community, it has become apparent that these Armenians neither completely identify with the Armenian culture from the Near East nor with the American dominant culture. Instead, they live within an area between cultures to which I refer to as the intercultural domain. This is an area which is not completely new to the person because of similarities to existing cultures. Yet, it is sufficiently new because one recognizes that he or she does not belong to and completely uphold the values of either culture.

There are some key differences between the culture that an Armenian would experience in Armenia or the Near East in comparison with the intercultural domain experienced in the United States. Whereas one lives and develops a sense of belonging within a culture, that sense is not present in the intercultural domain. Whereas one finds a ‘home I can call my own’ and the ability to rest within a culture, one is always a stranger and never finding rest within the intercultural domain. Whereas one can use his or her cultural standards with which to communicate to others as well as interpret their responses, there are no such single set of standards within the intercultural domain. Perhaps most importantly, whereas in a culture one can develop a sense of vision based on past experiences and hopes for the future, there are no such clear visions or hopes of the future in the intercultural domain. Instead, within the intercultural domain, one has to develop and establish own values and way of life, and develop own community and ways of belonging to it. It is more of a day-to-day survival rather than planning for life. It is a continuously unfolding creative intercultural bridge. This experience can be exciting or frightening, or generally both.

Illness places a significant strain on one’s ability to be self sufficient or control one’s destiny in life. Consequently, one is forced into a new, deeper, and more dependent way of life. All these complicate the ability to live and make decisions within an already uncertain intercultural domain. For example, from a spiritual perspective, illness raises numerous questions for the Armenian: "Why is God picking on me? Have I done something for which I am being punished? Is God punishing me because I have left the fatherland? If I pray hard enough and make a vow of sacrifice to God, will He help me?" Historicity issues also have some aspects of guilt, but refer more to a sense of destiny: "It is always the destiny of the Armenians to suffer where ever we have gone!" Sense of historicity also has to do with the view and trust of authority. For centuries Armenians have lived under foreign domination. Although people had become law abiding citizens, but generally the attitude under those oppressors had been: "Don’t trust them! What do they know about us?!" This can be very problematic for the relationship between the Armenian client and the helping professional because the latter represents ‘authority’ to the Armenian. Family considerations also play a major role in the decisions that an Armenian patient makes: "I do not want other families to feel pity for us! We can be strong!" or "If other parents knew that I have cancer, they may not want to give their son (or daughter) to us in marriage!" All these factors complicate matters to such an extent that a medical professional may not be able to understand fully or clearly that which is bothering a person, or may not be able to prescribe the appropriate medical treatment for him or her. This leads to a great deal of wasted effort, excessive cost, and unnecessary stress for the patient, patient’s family, and the helping professional.

As difficult and complicated as this situation may sound, it is still not impossible. In fact, most experienced professionals learn over the years to relate to these patients. However, for the sake of more timely and effective service, a helping professional may recognize a few factors. First, the patient or client is not necessarily resisting treatment or the help extended to him or her. Rather, he or she simply does not know how to interpret, to accept help, or implement that advice. There are many factors the patient has to consider and decide upon. The more the helping professional can recognize these factors, the more patiently, directly, and in less stressful manner can he or she help the client. Second, the relationship between patient and client is developing in an uncertain manner, because the direction and outcome of the illness is uncertain, and there are no clear preset cultural structures to consider the consequences of treatment. This gives a sense that the relationship is not genuine, but superficial. Third, it is imperative to understand the basis of the relationship of those who will help the patient make decisions for medical issues. Although it may seem that it is the person who is saying ‘Yes’ or ‘No,’ yet the decisions that affect the proper care and treatment may heavily rest upon others. Although the person may say ‘I am making this decision for myself,’ yet ‘I’ is likely to have a larger scope than the individual person himself or herself. Fourth, the Armenians tend to be non-confrontational. Instead, they communicate in the most indirect manner hoping not to hurt the other’s feelings or dignity. This makes even some of the most basic conversations difficult to decipher. There are more factors that enter into the Armenian client-helping professional relationship than those described here, but this is a beginning.

At first glance the situation appears to be most complicated. However, as a helping professional gains an insight into the Armenian personality, and develops insights into own way of valuing and communicating to others, he or she is capable to more effectively reach out and help persons and families. All these lead to better and higher quality of medical care, lower cost and more timely service of a client, and a sense of satisfaction for both the client and the professional.

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