A Case of Culture
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A Case of Culture

When Patient and Doctor Disagree

Photo by Kampus Production from Pexels

This book excerpt is from Chapter 8 of my recently published book, A Case of Culture, now available on Amazon (99¢ ebook promo) & Kobo. Learn more about the book here.

Pellegrino’s father had a hard time navigating his way around this strange British culture that stood in stark contrast to his own Italian culture, and it only got harder when Pellegrino left Bath to pursue higher studies in Leeds. As Pellegrino’s father grew older and his health began to deteriorate, trips to the doctor’s office became routine. He developed hypertension, and his doctor prescribed him pills to take each morning.

But Pellegrino’s father didn’t feel like the medication was helping, so instead of taking one pill a day as prescribed, he would take two. When Pellegrino found out, he chided his father. “Why are you doing that?”

“The one pill wasn’t enough. I feel better taking two.”

“But that’s not the point. You’ve got to tell the doctor that you’re changing the dose. Otherwise, it can kill you.”

Pellegrino had a point. By taking two pills instead of one, the extra medication could cause his father’s blood pressure to drop to a dangerously low level, and the doctor wouldn’t know why.

“I didn’t say anything because I didn’t want to offend the doctor,” said Pellegrino’s father.

In Italian culture, the title “doctor” was a very revered title. As Pellegrino put it, doctors were equivalent to God and so their word was to be respected. In a culture where the doctor is so highly respected, it’s almost impossible for patients to disagree with the doctor. It’s very much a “you listen to me and accept what I say” kind of culture, which made sense given the years of schooling and education required to earn the title of “doctor.”

In Anglo-Saxon cultures, the “doctor” title is still respected, but the stereotypical UK or US doctor is imagined as “burnt out and overworked, as someone who’s really doing their best but is understaffed and underfunded,” in Pellegrino’s words. There’s more freedom in these cultures to question the doctor and openly ask, “Are you sure about that?” and “Could I get a second opinion?” But in high-context hierarchical cultures that regard doctors with much respect and reverence, there isn’t that freedom to question the doctor so openly.

So, the patients do it secretly…very secretly. Not wanting to offend the all-knowing doctor, they respond with the classic head nod and “okay.” And then, they go home and verify the info for themselves and make changes as they see fit. This was exactly what Pellegrino’s father did for years. He nodded “okay” to the doctor, went home, and took his own dosage as he saw fit. Thank goodness he finally told someone about it.

As soon as Pellegrino found out, he immediately called the doctor to inform him. “My father has been taking a different dose from what you prescribed because he feels it is not helping, but he didn’t want to offend you by saying so.”

It turned out that the doctor was anything but offended. In fact, it made his job much easier to know the new dose Pellegrino’s father was taking and to understand why he was reluctant to say so. But because Pellegrino’s father was so reluctant to expose himself to the local British culture, he could not communicate openly with his own doctor. He was unable to get beyond his cultural perception of “offending” the doctor. He needed his son to step in for him.

In this article series, I share excerpts and stories from my book, A Case of Culture. If you would like to learn more about what happens next, you can find the rest of the story in Chapter 8 of my book, out now on Amazon (99¢ ebook promo) and Kobo. If you enjoyed this book excerpt, please consider subscribing to this weekly excerpt series and sharing it with your network. To learn more about the book, visit my website. If you would like to connect with me, you can reach me here via email at snigdha.nandipati@gmail.com or @snigdhanandiauthor on Instagram and Facebook.



A nonfiction book about how patients from different cultures navigate the challenges of Western medicine with the help of cultural brokers.

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