Culturally Competent Care

CURE, Winter 2010, Volume 9, Issue 4

Whether for good or bad, communication can start with that first glance. Here are some guidelines for health care in a diverse world. These reflect trends, not stereotypes.

Language: As with any patient, it is extremely important that he or she understands what the doctor and other health care professionals are saying. That means the medical facility should provide an interpreter and not rely on a family member, especially a child, to translate. Even if the family is more comfortable translating for a patient, the hospital should try to have someone who can also speak the language present to make sure information is being delivered accurately. If a diagnosis is being presented, it should be done in the native language so patients and their families are not dealing with the stress of the diagnosis and the stress of translating.

Spiritual issues: Eastern philosophies and religions often embrace suffering as a state of being far more than Western philosophies and religions. However, this can pose several challenges related to guilt, shame and stoicism related to cancer and death. This also needs to be explored with the caregivers, who might feel it is their duty to be solely responsible for a patient when it’s not a good medical fit. Also, for some cases, getting several different versions of the Bible, from German to Amish to Korean, is a good first step.

Family: Although every family is unique, some trends do emerge: Hispanics still tend to provide caregiving support in large family groups, as do the Amish. Several cultures encourage patients to cede their decisions to a matriarch or patriarch, who must be treated with respect by medical professionals. Many cultures expect there to be one spokesperson for the family, and it’s important that the hospital determine who that is.

Modesty: Although Americans might like to look people directly in the eye, other cultures—especially in Southeast Asia—do not. Women, especially, might not be comfortable with such communication, where it might be perceived as disrespectful, or even as a flirtatious pass. Male and female patients might want to have same-gender physicians. Personal body space is also important, with medical professionals taking a clue from the culture to determine how close is too close.

Diet: Different cultures might have solutions beyond traditional American medicine, and health professionals need to make sure they know what the patient is eating or taking, such as supplements or herbs. Also, it’s critical that hospitals offer foods that follow religious guidelines, such as Kosher criteria.

Global issues: Although several cultures might traditionally have many family members to help with caregiving, the assumption of help can’t be made, since patients might be in the U.S. alone or with a minimal support group.