Speaking through an interpreter, Joseph Carrese told the middle-aged, somewhat overweight man that he had diabetes. It was 1988. Carrese, fresh from completing his internal medicine residency at Johns Hopkins Bayview Medical Center, had recently arrived at the Navajo reservation to practice medicine through the Indian Health Service. As he discussed a regimen of medication and the risks of not taking it, the patient sat in silence. Then, the man walked out of the office and never returned.

Carrese couldn’t understand why this patient and others refused treatment after he warned them of the potentially dire consequences. 

He later learned that many traditional Navajos believe language shapes reality—so talking about the risks of not treating a condition may make those outcomes happen. He was in an ethical bind. He couldn’t help patients without their understanding and cooperation, but his words were driving patients away. 

To find a better approach, Carrese interviewed Navajo patients, traditional Navajo healers and other health care providers on the Arizona reservation. His recommendations: Frame medical information in positive terms, involve traditional healers and family members in health discussions, and prepare patients for potentially upsetting news.

“I came back to Baltimore with a much different frame of mind about being open to differences and avoiding the trap of making assumptions,” he says.

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