This last category of cultural factors relates to the therapeutic encounter itself. The patient may be in a state of acute discomfort or pain and he will expect the provider to have an appropriate reaction, most likely an injection. The health care setting may be embarrassing to the patient if there is no privacy or he is ashamed of his condition (as is often the case with venereal diseases). The sex of the provider may also be important. In Ban young men are reluctant to use the health centre because the midwife is a young woman. In general such factors may often lead to a choice of a folk or popular provider although their drugs may not be so effective as those of the professional provider. But if the prime concern of the patient is to conceal his condition or obtain fast treatment, a choice of a folk healer or a popular provider would be more rational. In these settings the client can be fairly sure of convenience, privacy and a drug/drug administration of his choice.
The patient-provider exchange and the subsequent evaluation of the encounter by the patient also depends on the explanatory models of the two parties. These interactions will be discussed in detail in the next chapter. The explanatory model of the patient, although specific to this particular illness episode, is rooted in the medical culture of his therapy management alliance. The rationality of his choices are therefore dependent on cultural as well as individual factors. The provider, on the other hand, is equally influenced by culture although this is primarily the culture of his profession and institutional setting. However, a positive evaluation of the treatment outcome is not necessarily dependent on congruence of the explanatory models of the provider and patient.