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Cultural Competency - Approaches for Cross-Cultural Relationships

Approaches of Culturally Competent Clinicians

Understanding: acknowledging that there can be differences between our western and other cultures' health care values and practices.

Empathy: being sensitive to the feeling of being different.

Patience: understanding the potential differences between our western and other cultures' concept of time and immediacy.

Respect: the importance of culture as a determinant of health; the existence of other worldviews regarding health/illness. The adaptability and survival skills of our patients; the influence of religious beliefs on health; the role of bilingual/bicultural staff.

Ability: to laugh with oneself and others.

Trust: investment in building a relationship with patients, which conveys a commitment to safeguard their well-being.

10 Tips for Improving the Patient-Provider Relationship Across Cultures

  1. Do not treat the patient in the same manner you would want to be treated. Culture determines the roles for polite, caring behavior and will formulate the patient's concept of a satisfactory relationship.

  2. Begin by being more formal with patients who were born in another culture. In most countries, a greater distance between caregiver and patient is maintained through the relationship. Except when treating children or very young adults, it is best to use the patient's last name when addressing him or her.

  3. Do not be insulted if the patient fails to look you in the eye or ask questions about treatment. In many cultures, it is disrespectful to look directly at another person (especially one in authority) or to make someone "lose face" by asking him or her questions.

  4. Do not make any assumptions about the patient's ideas about the ways to maintain health, the cause of illness or the means to prevent or cure it. Adopt a line of questioning that will help determine some of the patient's central beliefs about health/illness/illness prevention.

  5. Allow the patient to be open and honest. Do not discount beliefs that are not held by western biomedicine. Often, patients are afraid to tell western caregivers that they are visiting a folk healer or are taking an alternative medicine concurrently with western treatment because in the past they have experienced ridicule.

  6. Do not discount the possible effects of beliefs in the supernatural effects on the patient's health. If the patient believes that the illness has been caused by embrujado (bewitchment), the evil eye, or punishment, the patient is not likely to take any responsibility for his or her cure. Belief in the supernatural may result in his or her failure to either follow medical advice or comply with the treatment plan.

  7. Inquire indirectly about the patient's belief in the supernatural or use of nontraditional cures. Say something like, "Many of my patients from ___ believe, do, or visit___. Do you?"

  8. Try to ascertain the value of involving the entire family in the treatment. In many cultures, medical decisions are made by the immediate family or the extended family. If the family can be involved in the decision-making process and the treatment plan, there is a greater likelihood of gaining the patient's compliance with the course of treatment.

  9. Be restrained in relating bad news or explaining in detail complications that may result from a particular course of treatment. "The need to know" is a unique American trait. In many cultures, placing oneself in the doctor's hands represents an act of trust and a desire to transfer the responsibility for treatment to the physician. Watch for and respect signs that the patient has learned as much as he or she is able to deal with.

  10. Whenever possible, incorporate into the treatment plan the patient's folk medication and folk beliefs that are not specifically contradicted. This will encourage the patient to develop trust in the treatment and will help assure that the treatment plan is followed.

Source:
Salimbene S. Graczykowski JW. 10 Tips for Improving The Caregiver/Patient Relationship Across Cultures. When Two Cultures Meet: American Medicine and the Cultures of Diverse Patient Populations, Book 1, What Language Does Your Patient Hurt In? An 8-Part Series of Practical Guides to the Care and Treatment of Patients from Other Cultures. Inter-Face International. Amherst Educational Publishing. Amherst, MA; 1995: 23-25.

Suggested Content for Enhancing Cultural Competency among Health Care Providers

  1. Interview and assess patients in the target language or via appropriate use of bilingual/bicultural interpreters.

  2. Ask questions to increase your understanding of the patient's culture as it relates to health care practices.

  3. Where appropriate, formulate treatment plans, which take into account cultural beliefs and practices.

  4. Write instructions or use handouts if available.

  5. Effectively utilize community resources.

  6. Request the patient to repeat back information provided by health care professionals to ascertain understanding of the message (educational and language barriers).

  7. Clearly communicate expectations . Speak slower, not louder. When appropriate, use drawings and gestures to aid communication.

  8. Make no assumptions about education level or professionalism.

  9. Avoid using phrases such as "you people" and "culturally deprived", which may be considered culturally insensitive.

  10. A reflective approach is useful. Health care providers should examine their own biases and expectations to understand how these influence their interactions and decision-making.

  11. Listen carefully.
Source:
Patient Education Oversight Committee, UMHS
www.med.umich.edu/pteducation/cultcomm2.htm