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Oct 31 2002

Take time to be culturally competent

 Categories:  Fondly, Carolyn Comments:   0 comments  Print Friendly Version  |   Share this item
Dear W:

Que pasa? How was your trip to Mexico? I hope you, your brother C, and your folks had a great time. I have a feeling that may be your last trip together as a family since you and C have such busy schedules of your own now. It was too bad B couldn't join you; I’m sure she missed you a lot. Did you get to do any dancing? You know your father, BG, is very good at the Texas Two-Step, and he taught it to me. It somehow reminded me of Cajun dancing and also of clogging and polka. Isn't it intriguing how different cultures sometimes have such similar dance styles and, for that matter, music, customs, and beliefs? You are such a curious and enthusiastic young man, W, I know you will enjoy exploring our world and learning about other cultures. That will help make you a better physician because it is very important for physicians to "Take Time to Be Culturally Competent."

Striving to understand other cultures is not only a compassionate and educational exercise for physicians to undertake but is becoming increasingly necessary to properly care for our patients. Did you know that the U.S. Census Bureau anticipates that in the next five years 48 percent of U.S. residents will be from cultures other than "white/non-Hispanic"? By the year 2050, Hispanics are expected to comprise 24.5 percent of the U.S. population, and African Americans, currently the largest minority, will constitute 15.4 percent of U.S. residents (Salimbene). Other major minority groups include Asians (currently about 3.4 percent), Middle Easterners, American Indians, and emigres from former Soviet Bloc countries, especially Yugoslavia (Bosnia) and Poland. Within each of these groups, there are subsets based on age, gender, religion, sexuality, etc, and the perspectives of these subsets and of individuals may differ from each other dramatically.

It is very important to learn about other cultures, but not to make assumptions about individual patients based on their nation or culture of origin. This is the difference between generalizing and stereotyping. It is reasonable to use generalizations learned about a culture or country in order to focus on a patient's potential beliefs or perspectives, but not to stereotype the patient. Often, it is helpful to ask the patient about his/her foods, beliefs, family, and health practices. A handbook about cultural differences can also be useful. The best that I have found are What Language Does Your Patient Hurt In? A Practical Guide to Culturally Competent Patient Care, by Suzanne Salimbene, PhD, (2000, ISBN 1883998247, 1-800-865-5549); and Pocket Guide: Cultural Assessment, by Elaine Geissler, PhD, (1999, 2nd Ed., ISBN 0815136331, www.us.elsevierhealth.com). Both of these are excellent and describe proper ways of addressing patients, touching patients, collecting and onveying information, reaching decisions, and understanding differing concepts of space, time, and causes/ cures of illness. Although these books are enlightening, it may be fun to learn about other cultures by experiencing them through travel (perhaps a medical work trip?), music (Yo Yo Ma's new CD, Silk Road Journey, is a wonderful product of many cultural influences), and food. I would also recommend listening to National Public Radio and viewing the Public Broadcasting System, exploring on the Internet, and reading (try When I Was Puerto Rican, by Esmeralda Santiago; Monkey Bridge, by Lan Cao; The Spirit Catches You and You Fall Down, by Anne Fadiman; and Aman: Story of a Somali Girl, by Virginia B. Lee). The best and most enjoyable exploration method of all is to simply chat with your patients, staff, and neighbors from other cultures.

As our society has digested the news of the 9/11/01 attacks and subsequent events, some of our innocent Middle Eastern immigrants, sadly, have felt the backlash of our shock. There have been some shameful examples of stereotyping, though several positive developments have also occurred. I believe we have felt more patriotic gratitude for daily freedoms, deeper respect for our protectors, and a heightened awareness of the rest of the world beyond our borders. We have been jolted into a "frightened eagerness to know about the 'other' world," according to Edward Brynn, director of International Programs at UNC Charlotte, in a recent interview with The Leader. Charlotte now has international information and support services (www.charlottemic.org/resource.htm), and many Charlotteans are learning or reviewing Spanish or other languages, demonstrating a welcoming attitude toward these newcomers. I mentioned a couple of months ago that I have been learning Spanish by listening to tapes and using a CD-ROM program, but my young patients have been my best instructors. At each visit, I ask them to teach me to say something in their language.

W, you are a lucky fellow to be bilingual and to have such familiarity with the Hispanic immigrants and American Indian communities near your Southwest home. Having grown up in an integrated mountain community in South Carolina, I thought I was similarly familiar with African-American culture but have come to realize that there is remarkable diversity among African-Americans' beliefs, backgrounds, and practices. Although most African-Americans help define "mainstream" American culture, others are of very different and unfamiliar backgrounds.

Many ethnic groups have traditional or folk healing methods that may be helpful, neutral, or harmful. I remember that you and your mother, L, have worked with some of the American Indians in New Mexico and Arizona. Did you have any chance to learn of their folk healing methods?

W, I am sorry this letter is a little longer than most, but cultural diversity is one of my favorite topics. You have a cheerful and inquisitive nature, and I know you will consider the project of learning about other cultures, not as a physician's obligation to his or her patients, but as a fun, lifelong exploration of the amazing mosaic of our world. Remember to "Take Time to Be Culturally
Competent" and have fun doing so! Hasta la proxima mes!

Fondly,
Carolyn

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