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    Why cultural competency in medical care matters


    Cultural competency is defined as the application of cultural knowledge and interpersonal and clinical skills to enhance effectiveness in managing patient care. It’s also the law.


    San Francisco—Cultural competency in medical care matters because it improves outcomes, is imperative because of demographic shifts, and is the law.

    Terri Pickering, MD, in private practice at the Glaucoma Center of San Francisco, defined cultural competency as the application of cultural knowledge and interpersonal and clinical skills to enhance effectiveness in managing patient care.

    “Cultural competency does not mean acquiring complete understanding of each ethnic, religious, or linguistic culture,” Dr. Pickering said. “Rather, as it applies to the individual practitioner, the goals of cultural competency are to understand that patients of diverse cultures may have diverse health beliefs and to realize there is more than one way to accomplish health goals.”

    Statistics on the increasing diversity of the U.S. population and high prevalence of non-English-speaking residents support the need for cultural competency in medical care. Additionally, there is a legal mandate for it based on the Supreme Court’s interpretation of Title VI, the Civil Rights Act.

    “The Supreme Court determined that discrimination based on language is equivalent to discrimination based on national origin,” Dr. Pickering said. “Therefore, any health-care provider who receives federal funding has to make a good faith effort to communicate effectively with all patients or risk losing funding.

    “This ruling has implications for licensure, as well as for accreditation for hospitals and graduate medical programs,” she said. “Additionally, certain states have laws requiring physicians to get continuing medical education in language access and cultural competency.”

    Basic considerations

    There are certain issues and missteps clinicians should be aware of when dealing with ethnic patients in general and some that are specific to certain subgroups. A common mistake made in the situation where a language barrier exists is to underestimate the patient’s level of education. Consequences of the incorrect assumption include provision of abbreviated or incomplete patient education that in turn may lead the patient to develop negative perceptions of the health-care system and noncompliance with treatment recommendations.

    Other common cultural competency errors are the belief that all people of the same culture are alike, the presumption that cultural differences are superficial, the habit of speaking in a condescending or correcting manner, and the use of children as translators.

    Discussing some practices and ideas applicable to specific cultures, Dr. Pickering noted that in some Asian American families, the first born son is often considered the most important family member and may act as the family representative. Another issue to keep in mind that may have relevance to other ethnic groups as well is the importance assigned to herbal medicine.

    “Be sure to ask patients whether they are using herbal medicines, and be aware that patients may believe herbal medicines work instantaneously,” said Pickering said. “Therefore, they may have the same expectations for Western medicine.”

    She added that a useful strategy for discussing herbal medicine is to acknowledge respect for it, while noting that it has not been proven to be effective for the patient’s disease.

    Considerations for interacting with Hispanic American patients include awareness that for some families, elders are respected, medical decisions are often made as a family unit, and folk medicine (“curanderismo”) may play a role. Building trust and friendship is especially important, Dr. Pickering said.

    With regard to Muslim Americans, a survey investigating glaucoma medication use during Ramadan showing that only 34% of Muslim American patients would use their glaucoma medications during fasting hours, while 11% stopped treatment completely.

    “These findings emphasize the importance of tailoring treatment to patients’ expectations and religious beliefs in order to improve compliance,” Dr. Pickering said. “Try not to criticize cultural beliefs and instead, work within the patient’s belief system to improve compliance with your medical plan.”

    Building competency

    Dr. Pickering reiterated the importance of developing cultural competency as current conditions represent a perfect storm for promoting health disparities.

    “The disease burden is increasing as the population ages and so is the number of patients with low English proficiency,” Dr. Pickering said. “Moreover, we are still reeling from the economic recession, and inequalities in income and education are increasing.

    “It is important for practitioners to take personal responsibility and be aware of their attitudes and generalizations,” she said. “When talking to patients, remember to try to slow down, keeping in mind that 40% to 80% of what we tell patients is forgotten immediately and half of what they do remember is remembered incorrectly.”

    Cultural competency resources

    • Training on cultural competency can be obtained for free through various websites, such as https://cccm.thinkculturalhealth.hhs.gov.

    • Practitioners may investigate programs available through academic or other institutions in their communities.

    • Hiring at least one employee who shares the same culture/language as the largest ethnic group served in the practice is recommended as well.



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