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#1Tobacco is mostly used as a way of comfort. It is one of the most dangerous things health wise. Helman states that there are over 60 carcinogenic chemicals in cigarettes. Cigarette smoking plays a major role in a patient’s daily activities. People tend to start smoking cigarettes to fit in or deal with a suffering. Studies show that a high rate of male smokers is associated a drop in economic status, divorce, or separation. Smoking rates in women were higher if the women worked outside the home. In teenagers, most stated they smoked to fit in. They used it to state what kind of image they wanted for themselves, others said they liked the effects it gave them. Most people do not see the harm in smoking because it is considered legal. Soto did a study on the American Indian culture in California. A surveyed was used to see if historical trauma, stressful events, or ethnic identity played a role in why they smoked. This survey showed a positive association with smoking. Once again, they were using tobacco as way to cope with trauma. I think that some people also start smoking due to the crowd they hang around. It seems that smoking is passed down from generations. I personally have never tried a cigarette or smoked anything for that matter. I think it comes with my social background though. My parents never smoked and growing up I was never around anyone that smoked. When I got to high school and the peer pressure to smoke I was too worried about what my parents would think and I could not handle the smell. Now, I was also watching my grandmother die from complications from when she did smoke. She was undergoing many heart surgeries and had many issues with her lungs. With smoking being acceptable in our society it has many negative effects on people’s everyday lives. What would happen if they made smoking illegal? Would people frown upon it like they do recreational drugs?

Soto C, Baezconde-Garbanati L, Schwartz S, Unger J. Stressful life events, ethnic identity, historical trauma, and participation in cultural activities: Associations with smoking behaviors among American Indian adolescents in California. Addictive Behaviors [serial online]. November 1, 2015;50:64-69. Available from: ScienceDirect, Ipswich, MA. Accessed February 13, 2017.

Helman states that pain is clumped into two large categories. The first, an involuntary reaction, which he describes as “pulling away from a sharp object,” while the second is a voluntary reaction, “such as removing the source of pain, and taking action to treat the symptom.” He goes on to quote Engel, saying that there are two components to pain “‘the original sensation, and the reaction to the sensation'” (Helman, p. 185, 2007). Although these reactions occur, they may occur differently according to cultural norms or norms associated with socioeconomic status.

Voluntary reactions will deviate with different cultural norms, while involuntary reactions remain generally the same. This is probably due to the fact that if a pain is noticed and the pain can be stopped, then moving away from the pain is the body’s natural instinct. Voluntary reactions have to deal with how cultures perceive pain and how expressing pain is deemed appropriate or inappropriate by the culture. Regardless of the culture that the individual is a part of, a voluntary and involuntary reaction always occur in response to a painful stimulus.

The health care professional and the patient agree and disagree on a few topics of pain according to a study done by KB White. It was found that patients and medical professionals agree that treating pain relief should be the primary concern. What did remain discordant was the next step to remove the pain after the initial visit of the patient and the long term goals to keep the pain away (White, 2016). In this study, these were two major ways in which patients and professionals differ in relation to pain.

In a similar study by Carsten Kruschinski, elderly patients and physicians disagreed on importance of pain in areas that the patients deemed painful, such as the knee, lumbar spine and the hip. This again shows that there are different levels of understanding of pain between a healthcare professional and the patient in question (Kruschinski, 2016).

I know that in some cases it is hard for physicians to understand what level of pain a patient can feel. This is only magnified in cases where patients fake pain in order to receive medications for pain. This may be a reason for which physicians and patients deviate in regards to the pain of the patient. In what ways can patients and doctors work together to understand different levels of pain so that it can be treated accordingly?


Helman, C. (2007). Culture, Health and Illness (Fifth ed.). Boca Raton: CRC Press.

Kruschinski, C., Wiese, B., Dierks, M., Hummers-Pradier, E., Schneider, N., & Junius-Walker, U. (2016). A geriatric assessment in general practice: prevalence, location, impact and doctor-patient perceptions of pain. BMC Family Practice, 171-8. doi:10.1186/s12875-016-0409-z

White, K., Lee, J., & Williams, A. (2016). Are patients’ and doctors’ accounts of the first specialist consultation for chronic back pain in agreement?. Journal Of Pain Research, Vol Volume 9, Pp 1109-1120 (2016), 1109.

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