Introduction
In my clinical experience, treating Orthodox Jewish patients has highlighted the importance of cultural sensitivity and the need for more accessible information specifically tailored to manual therapists, such as osteopaths, physiotherapists and acupuncturists. While there is some guidance available for doctors and hospitals, manual therapists often face a gap in knowledge regarding the nuances of care for this community. This guide aims to address this gap by providing practical insights to ensure respectful and compliant care. I have also shared a draft of this guideline with a couple of my Orthodox Jewish patients, who have kindly reviewed it and confirmed its accuracy in reflecting their cultural practices.
Based on "Caring for Jewish Patients" by Spitzer (2003), this guide primarily reflects the customs of the strictly Orthodox Jewish community. However, as with any cultural framework, individual preferences may vary, so it’s important to approach every patient with open communication and flexibility.
At Reception
The patient’s journey begins at reception, where demonstrating cultural sensitivity can set the tone for a respectful interaction. While it is not necessary for receptionists and practitioners to follow Orthodox Jewish dress codes, modest attire is appreciated. This can include long sleeves, skirts covering the knees, and high necklines.
Strictly Orthodox Jews generally avoid physical contact between members of the opposite sex. This means no handshakes or unnecessary touch, and instead, patients may prefer indirect handling of objects. For example, they may place forms or pens on a surface rather than passing them directly. Similarly, prolonged eye contact may be avoided by some Orthodox Jewish patients, especially with the opposite sex. It’s essential to recognise these behaviours as cultural norms rather than a sign of disrespect or disengagement..
Key Points at Reception:
Avoid physical contact with members of the opposite sex (e.g., handshakes).
Orthodox patients may prefer not to handle objects directly with the opposite sex.
Eye contact may be limited for cultural reasons, not due to disrespect.
During the Case History
Language differences may arise during consultations, as Yiddish-speaking men may bring their wives (or occasionally their mothers), who tend to be more proficient in English. Additionally, Jewish patients often ask many questions about their care, reflecting the cultural tradition of deep inquiry and dialogue. This questioning, part of the traditional Talmudic style, is not meant to challenge authority but to fully understand treatment options. Patients may also seek confirmation of medical advice from a trusted Jewish practitioner or pharmacist, particularly when it comes to matters like the kosher status of medications.
Key Points During Case Histories:
Men may bring their wives to appointments due to language proficiency differences.
Expect and welcome detailed questioning, which is part of a cultural approach to informed decision-making.
Patients may cross-check treatment advice with their regular Jewish healthcare provider.
Topics to Consider During the Consultation
Within Orthodox Jewish belief, the body is viewed as belonging to God, and therefore, its care is a religious obligation. However, strictly Orthodox communities often place less emphasis on preventive care and physical activity, leading to sedentary lifestyles. Furthermore, cultural norms often keep serious illnesses or hereditary conditions private, making it difficult for practitioners to gather complete medical histories. Psychiatric issues, in particular, carry significant stigma, with many families opting for medical-only solutions and avoiding talking therapies like counselling.
The Laws of Family Purity introduce an interesting cultural dynamic: while Orthodox Jewish women are expected to be modest in dress and behaviour, they are also open to discussing intimate health matters with their doctor or rabbi.
Key Points on Consultation Topics:
Strictly Orthodox patients may place less emphasis on preventive care and lead sedentary lifestyles.
Serious illnesses or psychiatric conditions may be concealed due to privacy concerns or stigma.
Despite the general modesty, women may discuss reproductive health matters openly with a doctor or rabbi
Confidentiality
Confidentiality is a critical aspect of patient care, especially within the Orthodox Jewish community, where family members may inquire about a patient's health, particularly in the context of arranging marriages. It is essential to make it clear that patient information cannot be shared without explicit consent. This includes explaining confidentiality rights to family members who may not realise that the health information of adult children is protected.
Key Points on Confidentiality:
Ensure written consent is obtained before sharing any confidential information.
Clarify patient confidentiality rights to family members, particularly for adult patients.
During the Examination and Treatment
Orthodox Jewish men and women often cover their heads as part of their religious observance. Women may wear wigs, while men typically wear skullcaps, or yarmulkes. When performing examinations involving the head, practitioners should respectfully address the need for removing these coverings and offer alternatives, such as a theatre cap, to maintain the patient’s comfort and modesty.
Modesty is paramount in the Orthodox Jewish community. Some ultra-Orthodox patients may only allow small areas of their bodies to be uncovered during examinations. Forcing a patient to undress beyond their comfort can compromise the clinical effectiveness of the exam. Providing appropriate coverings like gowns and blankets ensures that patients maintain their modesty while receiving necessary care.
Key Points During Examination:
Respect the religious practice of head coverings and offer suitable alternatives if removal is required.
Be sensitive to modesty concerns; provide coverings to limit exposure.
After the Consultation
Hygiene holds a central place in Orthodox Jewish life. Many religious rituals, such as prayer and meal preparation, require a state of physical and spiritual cleanliness. Even after a clinical examination, patients may request facilities to perform ritual handwashing, regardless of whether their hands are physically soiled.
The ritual of handwashing in Orthodox Judaism is often performed using a cup and bowl. Water is poured over each hand in a specific manner, typically three times per hand, while reciting a blessing (brochoh). This ritual cleansing is observed upon waking, after using the toilet, before eating, and even after touching certain body parts or shoes. In a clinical setting, patients may request a cup and bowl to wash their hands after an examination, especially if they need to pray or eat afterward.
As a practitioner, it’s essential to provide the necessary facilities for this ritual. Offering a bowl, cup, and access to clean water demonstrates respect for the patient’s religious needs and helps them feel comfortable in your care.
Key Points After the Consultation:
Hygiene is central in Orthodox Jewish life, and patients may perform ritual handwashing even if their hands are physically clean.
Handwashing involves pouring water over each hand three times using a cup, often accompanied by a blessing.
Providing the necessary facilities for ritual handwashing—such as a bowl and cup—helps patients maintain their religious practices after consultations.
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