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• Is trust enough for Muslim women in the clinical encounter?
  Michelle McLean
  Published on: 18 May 2017
• Islamic opinions differ regarding physical contact between genders within a doctor-patient encounter
  Deen M Mirza
  Published on: 18 May 2017
• Teaching and assessing doctors competent to consult both Muslim and non-Muslim patients
  Engela Prinsloo
  Published on: 18 May 2017

• Published on: 18 May 2017

  Is trust enough for Muslim women in the clinical encounter?

  • Michelle McLean, Medical educator, lecturer

  No-one who would dispute that trust is the cornerstone of an effective doctor-patient relationship. Trust must, however, be earned, and probably more so in a cross-cultural encounter where factors such as the language of communication and the physician's understanding of the religious and cultural practices of the patient come into play. For Muslim women, the medical reason for their visit is probably the important considerat...

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  No-one who would dispute that trust is the cornerstone of an effective doctor-patient relationship. Trust must, however, be earned, and probably more so in a cross-cultural encounter where factors such as the language of communication and the physician's understanding of the religious and cultural practices of the patient come into play. For Muslim women, the medical reason for their visit is probably the important consideration, particularly relating to physician gender. As Padela and del Pozo point out, Muslims have differing interpretations of what is "allowed" in terms of a consultation involving a physician of the opposite sex. Trust may not be sufficient. While most reviews and summaries regarding the Muslim patient describe the consultation in broad terms, our results from a survey of Emirati women suggest that for medical conditions involving the awrah, besides male students and physicians being refused for examination, a male taking a history would also generally be unacceptable.

  When these women were canvassed about what they would allow male and female medical students (history-taking, presence, examination) to undertake and about their preference of physician gender, religion, nationality, etc. for four hypothetical scenarios (allergy involving eyes and nose, abdominal problem, gynaecological problem and pre-pubertal child), male students would generally not be allowed to take a history for a gynaecological problem. Only 66% of the women would allow them to take a history for an allergy involving the eyes and a "stomach" problem. These findings were not influenced by the women's literacy or education level, income, parity or marital status. As expected, examination of areas involving the awrah would be largely be off limits for male students and doctors. Fewer than 11% of the women would allow a male student to examine them for the two problems (stomach, gynaecological) involving the awrah (vs. 79% of female students being allowed). When asked about physician preference, gender (i.e. female) and to a lesser extent, religion (i.e. Muslim) were the most important considerations, with 97% of the women requested a female physician for a gynaecological problem and 95% requested a female physician for the "stomach" problem.

  Thus, while trust is important in the doctor-patient relationship, cultural or religious perceptions are still overriding considerations. In the interest of Muslim women's health and health-seeking behaviour, we would recommend that female physicians be available, particularly for medical problems involving the awrah.

  Reference

  1. McLean M, Al Ahbabi S, Al Ameri M, Al Mansoori M, Al Yahyaei F, Bernsen R. 2010. Muslim women and medical students in the clinical encounter: A United Arab Emirates study. Medical Education 44:306-315.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 18 May 2017

  Islamic opinions differ regarding physical contact between genders within a doctor-patient encounter

  • Deen M Mirza, Assistant Professor Family Medicine

  I would like to commend the authors on their well researched overview of doctor-patient interactions across a gender divide for a Muslim context. I would like to add two points to this discussion which I feel were overlooked:

  1) With the Muslim medical profession, there exists some disagreement amongst Muslim physicians as to what the limits are when a male doctor needs to examine a female patient.

  So...

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  I would like to commend the authors on their well researched overview of doctor-patient interactions across a gender divide for a Muslim context. I would like to add two points to this discussion which I feel were overlooked:

  1) With the Muslim medical profession, there exists some disagreement amongst Muslim physicians as to what the limits are when a male doctor needs to examine a female patient.

  Some Muslim physicians feel the rules limiting physical contact between genders should not be applied to a medical context. Those that hold this view cite the example (not mentioned in this article) of female Muslims treating wounded non-related Muslim males in the battles during the life of the Prophet Mohammed (peace be upon him).

  A further discussion of this view can be found at the website of the Islamic Organization for Medical Science, based in Kuwait (http://www.islamset.com/ethics/topics/index.html).

  2) The authors mention the concept of necessity: it is necessary to allow what is prohibited in certain cases. An example of this would be a pregnant female patient having complications during delivery. If the case required specialist skill beyond the ability of the female health care providers available, all would recognise and accept the intervention of a male obstetrician who had the necessary expertise. All Islamic jurists agree on this.

  However the subsequent question posed by this Islamic stance is how would such expertise be produced in a male physician? It undoubtedly requires prolonged exposure to normal and low-moderate complexity cases in such a specialty. A male physician cannot get such experience except by practicing in situations of non-necessity.

  This creates a dilemma for the Islamic jurist which I have not yet seen addressed amongst those scholars who state that female patients must be seen by female doctors. In order to create a male physician with expertise that can intervene in situations of necessity, such a physician must have gained experience with female patients in situations of non- necessity. So does this make it allowable for male physicians to examine female patients for the purpose of training?

  I feel that these Islamic differences of opinion are extremely relevant to this discussion of cross gender interactions involving Muslim patients.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 18 May 2017

  Teaching and assessing doctors competent to consult both Muslim and non-Muslim patients

  • Engela Prinsloo, Consultant Family Physician

  To the authors of Muslim patients and cross-gender interactions in medicine: an Islamic bioethical perspective

  Thank you for a very clear and comprehensive explanation of the Islamic bioethical perspective on cross-gender interactions in medicine. It is of utmost importance that doctors should at all time take note of the cultural and religious background of all patients and practice accordingly. I refer to a...

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  To the authors of Muslim patients and cross-gender interactions in medicine: an Islamic bioethical perspective

  Thank you for a very clear and comprehensive explanation of the Islamic bioethical perspective on cross-gender interactions in medicine. It is of utmost importance that doctors should at all time take note of the cultural and religious background of all patients and practice accordingly. I refer to a very important paragraph in your article "Muslims may be treated differently due to stereotyping or lack of familiarity with their cultural practices and values". You end the paragraph with the most important aspect of any interaction between people from different cultural and religious background even if they are of the same gender and that is "trust".

  All doctors must be equipped with basic knowledge and skills. It is expected of doctors to be able to diagnose and treat any patient presenting with a complaint within his or her scope of practice. Students should be encouraged to acquire these skills and become confident in applying them in all situations. The one threat is that by assuming and not enquiring whether a patient would object to being subjected to adequate physical examination to come to a working diagnosis, doctors may revert to defensive measures and do laboratory and radiological examinations without even trying to examine patients. This may compromise the quality of care and cause the impression of patients being stereotyped. Thus the most important aspect is to determine what the view of the patient is but also to communicate the need for certain physical examination procedures to be done. We should not create the impression that we can auscultate the heart or lungs through two layers of clothing or palpate the abdomen without exposing in a respectful way obtaining the consent from the patient. Patients do not know that these practices yield no valuable information. As you mentioned it is often only needed to ask and explain to find that patients who might have been reluctant to be examined may actually willingly submit to physical examination. Young students who come from the same Muslim background need to be guided and need to acquire excellent communication skills to build rapport and gain trust from patients to assist in the process of obtaining consent to examine and confidently draw appropriate conclusions and management plans.

  EAM Prinsloo Department Family Medicine Faculty of Medicine and Health Sciences UAEU

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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