When the traditional health care system cannot accommodate their needs, what are doctors and nurses to do?

Question:
Elaborate on important details surrounding the practice of ‘modesty’ for Muslim patients in a healthcare setting. Do not simply state the obvious preference for same-gender care. Engage in more detail about other ways that you can support the Muslim practice of modesty in a healthcare setting. Are there additional suggestions for supporting the modesty of Muslim patients not captured in the article that you can think of?
Prompt:
A woman in her mid-30s wearing a hijab, the traditional Muslim head covering, comes to an urgent care center complaining of leg pain. The first thing she asks: “Are there any woman doctors around?”
She declines to be alone in an exam room with a male doctor. She does not want to be touched by a man who is not a family member, even as part of a medical examination.
It’s a hypothetical situation, recounted in a new paper in The Journal of Medical Ethics, but the scenario neatly summarizes some of the dilemmas confronting health care workers in hospitals serving observant Muslim patients. When the traditional health care system cannot accommodate their needs, what are doctors and nurses to do?
Dr. Aasim I. Padela, an emergency room physician at the University of Michigan, has some ideas. In the new paper, published on Monday, he explains the basic tenets of Islamic medical ethics, with recommendations about accommodating Muslim sensitivitiesLinks to an external site. within the health care system.
Though Muslims differ in their adherence to tradition, maintaining modesty is the “overarching Islamic ethic” pertaining to interaction between the sexes, Dr. Padela wrote. The awrah, or parts of the body that are not to be exposed, differ depending on who else is present. For observant Muslim women, covering up the body is important when they are in the company of non-mahram males, those not related by blood or marriage.
People who are non-mahram adults of the opposite sex are prohibited from being alone together in a closed place where sexual intercourse could occur or where even such an accusation could be made, Dr. Padela said. A prophetic tradition states that when a non-mahram woman and man are alone together, Satan is the “third among them,” Dr. Padela noted, so the laws prohibit not only adultery but “proximity” to adultery.
As a result, Muslim men, too, may be reluctant to be cared for by female physicians.
“I don’t want to be misconstrued — I’m not advocating for separate but equal facilities” of the type that exist in hospitals in Muslim countries, said Dr. Padela, a Muslim who devotes most of his time to research on Islamic medical ethics. “Sometimes it’s a simple matter of asking a patient, ‘Is there some way I can make you more comfortable?’ ”
Dr. Padela cited the case of a Muslim woman who had recently undergone surgery.
“She went to a physician whom she trusted and told him, ‘I need to at least have my head covering on when I leave the operating room,’ ” he recalled. The hijab is part of the dress code for many, though not all, Muslim women.
“When she woke up, she was wearing a gown, but her head was uncovered,” Dr. Padela said. “She was livid. She had been there many hours. She will never go back to that hospital again.”
Indeed, concerns about modesty can play out in unexpected ways in hospital settings. A few years ago, Dr. Padela was working in an emergency room when a middle-aged South Asian woman arrived by ambulanceLinks to an external site.. She had fallen on her back the day before and hadn’t been able to use the bathroom for 24 hours. It was possible she had suffered a spinal cord injury.
But there was no female physician on duty, and the patient, an observant Muslim, was reluctant to be examined by a male physician. Dr. Padela eventually convinced her to allow him to examine her spinal cord, offering to wear gloves so as to avoid direct skin-to-skin contact.
The patient refused a rectal exam, yet Dr. Padela’s supervisor later criticized him for not doing one, saying he could have missed a serious injury that might have caused permanent paralysis.
While most doctors are receptive to improving communication with patients like this one, others cite time constraints, saying they “don’t have time to do an anthropologic evaluation of a family,” said Dr. Joseph Betancourt, an internist who is director of multicultural education at Massachusetts General Hospital in Boston.
He cautioned that there is so much variation in practice among Muslims that health providers must be careful not generalize or make assumptions about patients’ beliefs and practices. Still, he said, it is helpful for doctors to know something about Muslim traditions. Having a better understanding usually improves communication and may actually save time.
Dr. Naureen Zafar is director of the Medina Clinic at Harlem Hospital Center, an initiative of the New York City Health and Hospitals Corporation that is open to all but is geared toward serving West Africans, most of whom are Muslim. She said that research has shown many devout Muslim women delay accessing health care and may have very advanced disease by the time they seek medical help. “They don’t even want to give personal histories to men who are strangers to them,” she said.
Pregnant Muslim women usually seek out a female obstetrician for prenatal care and prefer to have a female doctor present at delivery. That request cannot always be accommodated, Dr. Zafar said.
“It may depend on whoever is on call when they come in to deliver,” Dr. Zafar said, adding that Islamic law allows for exceptions when it’s a “life and death situation.”
Many health care centers have already taken steps to accommodate Muslim patients. Franklin Hospital in Valley Stream on Long Island, which is part of the North Shore-Long Island Jewish Health System, recently started offering patients halal food in keeping with Muslim dietary rules, said Joe Manopella, executive director of the hospital.
Other steps that hospitals might take include intake questionnaires where patients can list their religious concerns and values, Dr. Padela said. They also might provide more modest hospital gowns or give patients the option of wearing their own clothing.
The health care system may not always be able to fulfill all of a patient’s requests, but the providers should at least explain what can reasonably be done and what the limits are, Dr. Padela said.
“This way the patient feels heard and cared about,” Dr. Padela said, “as opposed to, ‘You’re in my hospital, this is how we do things.’ ”

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