Smile! It’s Medical Cultural Competency 2.0.
“A warm smile is the universal language of kindness.”
Do you believe this? A recent question on Ask Mefi wondered the same thing, and received many interesting responses, both agreeing:
It’s supposedly one of the six universal expressions.
In my psychology class in college, the prof told us (IIRC) that these are the six expressions/emotions that babies have before they’re socialized to experience more self-conscious feelings like pride, shame, etc.
and disagreeing:
I’ve read that Vietnamese smile when they are frightened to show subservience and that this made American GIs think they were laughing at them with sometimes tragic results.
This, along with an interesting conversation (detailed below), set me wondering:
If even a smile is not universal, how universal can a medical tool that mediates human expression really be?
And furthermore, how universal can medicine 2.0 be?
Maybe this is a huge leap of logic to you, but this is actually how my mind works 
I love the idea of med 2.0, truly. Flashy toys, social media, buzz. Love it. But if it’s going to work in the real world, we have to be constantly reminded of why we really pursue “2.0”. How can the best version of medicine help us to become the best version of ourselves? The person is of course the end point, not the technology.
My emotion research in a nutshell.
My colleague (let’s call him Mr. H) and I were talking about my research, which happens to be on emotion and perhaps the analysis of the aforementioned smiles.
I have to admit: I’m a starting to be a bit in love with my project. Essentially, I am interested in developing a new modality that will enable children with profound disabilities — who are unable to physically or verbally express themselves – to communicate their emotions and preferences.
Why is this necessary? Well, children in complex continuing care (CCC) units can experience unimaginable frustration when attempting to communicate simple feeling such a pleasure and aversion. Likewise, clinical staff and family face intense difficulties providing care for patients who may not be able to provide feedback and engagement. My expectation is to harness the patterns evident in the children’s physiological signals and clarify how (and if!) they correspond to contextual data.
“We detect emotions,” I concluded with a grandiose flourish.
Mr. H says I need a bigger shell.
Mr. H thought it was just fantastic. So fantastic that it should be applied beyond children with disabilities.
“Well, what about me?” he asked.
And I considered him carefully.
As a lifelong student of Taoist philosophy, he has trained his body to shun anxiety. His heartbeat stays regular; his temperature maintains well between limits. Indeed, preliminary evidence from another lab at our institute indicates that even a somewhat obscure parameter as electrodermal activity can also be brought under voluntary control with practice (think secret agents fooling polygraphs). Mr. H’s comment got me thinking on how we would handle that, especially since the use of autonomic signals has been touted as pretty darn culturally-competent already, compared to the social masking that may accompany self-report of emotions.
How okay is it to assume that an elevated heartbeat is a universal measure of fear or anger?
Is it perhaps archaic even to be tossing discrete labels like “fear” and “anger” around?
The truth of the matter is: there really is no such thing as being culturally-competent enough, is there? If we start getting starry-eyed about our 2.0s and our panaceas, we are bound to overlook the patient.
Never. Overlook. The patient.
So I told him I would definitely work on it. And I will.
The universal languages, the universal expressions, are those avenues that we manage to create out of almost a desperation to communicate. They change when we change. Sometimes from medical necessity, sometimes from repercussions of following our own path.
In my research, I hope that I will be able to make a first step in eradicating some of the barriers to a patient-specific, context-sensitive device. Savvy technology for savvy patients. And in my personal culture, that’s something to smile about.
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Tags: cultural competency, disabilities, emotion, medicine 2.0, pediatrics, physiology, taoism
