For many years, cultural factors were largely absent from health care dialogues around patient-centered care and medical home initiatives. The current strong emphasis on cultural factors in medical care mirrors the rapid demographic changes in this country, and cultural competency has now become a favorite buzzword of policy makers, researchers, medical educators, and health care providers. The term cultural competency is most often used, but there is also debate about its applicability; its detractors say the word competency suggests one is either competent or incompetent, which in turn points towards a kind of pass/fail attitude that necessitates measurement. Measurement, however, follows being able to define and codify “competency” – which most of us would agree is a work still in process.
Even with CLAS Standards in place (National Standards on Culturally and Linguistically Appropriate Services) one only has to follow conversations on relevant list servs to see that people are still debating what it means to be culturally competent. The CLAS standards are primarily directed at health care organizations, and though individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible, the standards contribute little to the challenges of somehow measuring individuals’ cross-cultural knowledge, skills, and attitudes.

What Is Culturally Responsive Care?

As a cross-cultural communications instructor, I prefer the term culturally responsive care, defined as an extension of patient centered-care that includes paying particular attention to social and cultural factors in managing medical encounters with patients from very different social and cultural backgrounds. The word “responsiveness” places emphasis on the capacity to respond. In practice this boils down to health care providers utilizing a set of tools – questions and skills for negotiation based on cultural knowledge – which they can incorporate into their interactions with patients from diverse cultural backgrounds. Examples include finding out about the patient’s history of present illness, their health beliefs and use of alternative treatments, expectations of care, linguistic challenges, and culturally-based family dynamics that guide decision-making processes. The literature supports the fact that it is important for physicians to not only be aware of cultural factors, but to demonstrate an ability to manage and negotiate them in order to improve health outcomes.

A basic premise of culturally sensitive care is that health care professionals must be able to recognize the client’s culture, their own culture, and how both affect the patient-provider relationship. The following are key in addressing this important premise:

• Everyone has a culture.
• There is an American medical culture and it is very different from many of the cultures that our patients and their families come from.
• We need to understand where our American medical culture differs from other cultures in significant ways that impact communication and influence health outcomes for patients.
• Resistance to cultural difference is part of being human, and reactions to cultural difference are automatic, often subconscious, and can have strong influence on the patient-provider relationship.
• A provider’s culture is influenced by his/her own personal values and beliefs, as well as those of the western medical culture.
• A provider’s ability to communicate effectively in cross-cultural interactions is greatly enhanced by his/her grasp of cross-cultural communication skills.
• Culturally sensitive care requires a broad understanding of how culture affects health beliefs and behaviors.
• Providing linguistically appropriate care requires being able to assess the need for interpreters in the clinical setting and interact with interpreters effectively.

 

 

‘Culturally Responsive Care’ by Marcia Carteret. Copyright © 2011. All rights reserved.