An older woman from Southeast Asia (ethnicity not further specified) presented to the intensive care unit with hemorrhage into a highly anaplastic carcinoma of the liver that had previously proved unresponsive to radiation or chemotherapy. She requested aggressive life-prolonging therapy, which seemed totally unrealistic to the medical staff, and consideration was given to denying her request on the grounds of medical futility. Further discussion with the patient revealed that she fully accepted her terminal prognosis. Her religious beliefs convinced her, however, that if she died during the present lunar cycle, a curse would fall on her family for the next 5 generations. She requested aggressive therapy only to the extent that it could help her survive a few more days until the change in the lunar cycle. Once this request was understood in context, the staff agreed and were able to keep her alive for the requested period.8
These success stories depend in large part on someone having sufficient curiosity to want to know why the “other” is acting in a seemingly inexplicable manner. Dr M, sadly, has a lot of labels to pin on her noncompliant patients, but very little curiosity about them.
As Engel4 would remind us, the activity of science starts with curiosity. Most of us ended up going into the medical profession because as children we loved to take things apart and put them back together. (Or, in some cases, we just loved to take things apart.) Curiosity was probably the first impulse that prompted us toward a medical career. The first step in becoming excellent patient-centered and culturally competent physicians might be as simple as recapturing that basic sense of why we became physicians in the first place.