This project involves the dissertation research of a cultural anthropology student from Emory University. The student will study noncompliance with medical advice and therapy among Hmong immigrants in Fresno, California. The hypotheses that perceptions involved in the medical encounter differ between medical professionals and patients, and that perceptual differences and the structure of medical practice affect outcomes of the medical interaction and patient's health will be investigated. The project will focus on surgeons as representative of medical professionals, and the Hmong as representative of a non-western population. In addition to general participant observation in the hospital and the community, a total of 50 medical encounters will be videotaped and 150 interviews will be conducted , 50 each with surgeons, Hmong patients in a Fresno hospital, and Hmong persons in the community. Initially diagnoses of appendicitis and bone fracture will be selected as a sample. Measures will be recorded of Hmong patient medical decision-making and socio-economic background as well as physician time and quality of interaction with patients. The patient compliance as well as the health outcome will be recorded, and the student will look for patterns of variation according to age, gender, education, past experience, acculturation, physician's age, gender, training and past experience. This research is important because medical practice is becoming more dependent on high technology which is more difficult for patients to understand without more extensive preparation and interpretation. Advances in our understanding of misunderstandings between patients and physicians in this extreme case of surgeons and immigrants is likely to provide good ideas for investigating the more general situation of doctor-patient communication.
