Arab and Muslim Patients in Your Medical Practice:
A Guide for Medical Professionals
As a medical professional, you know that patients come to you with different backgrounds, expectations, and capabilities. Arab patients are no exception - some are Americans, while others are foreigners seeking healthcare overseas. Many are wealthy and well-educated, while others come from less privileged familes and may be new immigrants or visitors. With this in mind, this brochure is an elementary guide to help you provide better care to Muslim and Arab patients.
As you may know, not all Muslims are Arabs, and not all Arabs are Muslim (the Arab world has important Christian, Jewish, and other religious minorities). The guidelines suggested here are therefore general and are helpful for treating most patients of Middle Eastern origin.
It is important to remember the language needs of your patients. While many Arabs speak English well, this will not be equally true across categories of class and gender. Beyond language, there are several cornerstone concepts to remember when treating a Muslim or Arab patient:
1. Privacy & Sex Segregation
Modesty is a major concern for Arab and/or Muslim women. Gender mixing among patients is an unnecessary stress for Muslim patients. In addition, male practitioners are generally preferred by male patients; female practitioners are sometimes required for female patients (especially in gynecological matters).
An important point to remember when dealing with unmarried women, regardless of their age, is that virginity is conceived of as the presence of an intact hymen in much of the Arab world. This may necessitate a clear, tactful discussion of what certain procedures entail.
Although not all Muslims follow strict dietary rules, most do not eat pork and do not eat meat that is not "hallal," or killed in a ritual way. To be safe, you can order vegetarian or kosher meals. Furthermore, avoid alcoholic beverages (alcohol is prohibited by Islam) and foods/sauces made with wine or beer.
Food is important for morale and family support. If patient protocol allows, it will help the patient emotionally to have food from home. There is also a second benefit to home food: Older women in the family tend to have "traditional" remedies and may administer them in addition to medications. By giving these concerned family members an official function, they will be satisfied that they are assisting the treatment.
3. Medical Procedures and Explanations in the Office or Hospital
Communication: Communication is important, as Arab and/or Muslim patients may be disoriented in an American hospital setting. Use a translator to explain procedures and hospital billing procedures, American health care, insurance, etc. It is best to use a same-sex translator from the hospital, if possible.
Patients: Patients (especially older ones), even if residing the US, may speak little English. They also may not understand machines or invasive procedures. Explain images and procedures.
Writing Prescription/Daily Behaviors: Explain each medication and separate essential medicines from those for symptoms. Relate daily behavior to treatment regimen (ie: "eat one pill with breakfast") and explain in detail how medications are to be administered.
Family: Do not be surprised if the patient is accompanied by family, which is extremely important in the Middle East. Within the bounds of confidentiality, keep family members involved in decision-making and assume patients will not give you a decision about their care or finances without family consultation. Medical care in the Islamic world is often a family affair, organized and administered by mothers and younger female relatives who should be carefully instructed in treatment regimen. They can also be trained to administer home diagnostic tests and assist with special diets.
Isolation of patients is difficult to maintain in the home. Many traditional family environments involve mixing food and personal space with family members. If a treatment regimen requires isolation, take this into account.
For patients with extended hospitalization, consider also Arabic reading materials, books, and newspapers. Arabic language newspapers are available at Avril 50 at 34th and Sansom Streets. Also consider a subscription to an Arabic-language newspaper for the hospital. You may also want to locate other Arabic-speaking patients in the hospital for discussion, card games, etc.
4. Popular Practices and Religious Concerns
Ramadan and fasting: Muslims fast during the holy month of Ramadan. Some Muslims may consider medication as food from which they must abstain during Ramadan. Be sure to ask the patient whether he/she will fast for Ramadan. The Qur'an (Muslim Holy book) allows medical exemptions from fasting.
Traditional medical ideas and compliance: Ask the patient if s/he has any reservations about the treatment regimen. Discuss any traditional preconceived medical ideas that might contribute to the patient's compliance or non-compliance. Many families use home/folk remedies that may not be considered to be medication but may be counter-indicated with prescribed medication.
Death and grieving: As with all patients, consider the preferences of the deceased and the religious and traditional customs of the family when encountering loss. Also be aware that outward signs of grief are a sign of respect for the dead.
5. Patient-Physician Social Interaction
Arab patients accord a great deal of authority to physicians and will be comforted by some degree of formality in speech and dress, which shows respect for them and reassures them of physician competence.
Titles and formal address are usually preferable to first names and informality. Muslim patients may prefer to use your title followed by your first name, i.e. "Dr. Mary" or "Nurse Ellen". Likewise, note that older patients may prefer that you use a title with their name.
Greetings: Always shake hands with male patients or male family members when greeting them or saying goodbye. Shaking hands with females should be left up to the female patient.
Body Language: In the Arab world, good posture is considered polite. Putting your feet up or crossing your legs in such a way that the soles of your shoes are exposed is considered offensive.
Gifts: Do not be surprised if the patient's family offers you a gift. If so, accept it graciously.
Respect for the Elderly: Always remember that elders are held in high esteem in Arab culture and are treated with the utmost respect.
Stereotyping: While this brochure attempts to explain some of the broad characteristics of Muslim and Middle Eastern patients, patients should, of course, be treated as individuals.
DISCLAIMER: This is a cultural information brochure. All medical treatment decisions should be made by health care providers according to hospital regulations and US law. The Middle East Center of The University of Pennsylvania is not responsible nor liable for patient treatment practices