We often talk about the need to foster an inclusive environment in medicine, both for our learners and for our patients. Educating ourselves about various religious customs and beliefs, in my opinion, is one way to promote such inclusiveness. In mid-April 2021, Muslims across the world will observe the month of Ramadan. This is a time of spiritual reflection, marked (among other things) by the practice of fasting, during which Muslims abstain from eating or drinking from dawn until sunset. As Muslims follow the lunar calendar, in recent years the month of Ramadan has fallen during long spring and summer days, with an average daily fast of around 16 hours in many parts in the U.S. in 2020.
Recently, a non-medical friend reached out to her primary care physician to discuss management of her blood pressure medication during Ramadan. Her physician’s response was, “Well, the medication needs to be taken 12 hours apart, so I don’t understand your questions.” My friend was left with the option of not taking her medication—“Ah, the ‘non-compliant’ patient”—or deciding to forgo the fast to ensure timely administration. When she reached out to discuss this with me, I was disappointed at her physician’s response. The doctor did not take the time to ask further questions to understand what fasting entailed and to explore her patient’s goals and values. She treated her treatment strategy as the only right choice, when in reality, there are some simple options that can be employed in this case—for instance, an evaluation of alternative medications for management of hypertension that are dosed once a day.
Over the past decade of living here in the U.S., as a Middle Eastern Muslim woman, I have picked up the habit of asking my patients about their religions and cultures and taking the time to actively listen and educate myself. Experiencing being on the other side of a health care interaction as a patient myself, I was surprised by how I was rarely asked about this and how many prejudices and stereotypes came in play. Especially as an oncologist, where developing long-term relationships with our patients and building rapport is imperative, I have found that asking about any religious or spiritual beliefs is key to exploring my patients’ goals and values. Often patients are reluctant to volunteer such information unless first asked and physicians may not realize how that knowledge can enhance patient-centered care. We all carry inherent biases and assumptions that we need to correct while caring for our patients, especially those from minority groups.
From a learner’s perspective, as one scrambles to adjust to the hectic demands of a new training environment, we are often left with little time to integrate within the local community. I remember moving from a heavily diverse area on the East Coast to start my training in the Midwest and spending my first Ramadan feeling completely isolated. Between my call schedule and the long fasting days, little time was left to observe the month or to connect with the Muslim community. As a minoritized individual, there is the extra burden of having to work during your religious events and holidays with limited schedule flexibility.
During Ramadan, you can help facilitate an inclusive, supportive culture at your institution in some of the following ways:
- Take the time to check in on your patients and your colleagues this month. This is even more essential during the COVID-19 pandemic, as many are suffering from a lack of community and connection.
- Acknowledge that people’s sleep hours, medication schedules, and ability to meet at certain hours may be different this month.
- Greeting a colleague with a simple “Ramadan Mubarak” (“Blessed Ramadan”) can go a long way.
- Consider a simple one-day call switch with a colleague so that they can attend Eid prayers.
- Offer the option of remote work for someone if that is available.
- Consider joining a co-worker for iftar, the meal that we eat after sunset.
- Avoid stereotypes and assumptions. As with any religion and culture, you will find that different people may practice and observe the month differently.
Ultimately, we should all be working towards truly fostering a supportive and inclusive environment for our colleagues and patients by taking the time to actively listen and to reach out.
Ramadan Kareem—may you have a blessed month!