Should Doctors Be Culturally Competent?
As the American landscape diversifies, it is crucial that doctors are aware of the cultural nuances that exist between ethnic groups. While cultural collisions are inevitable when working within a diverse community, it is possible for healthcare professionals to minimize these potentially harmful situations.
Federal regulations regarding cultural competency are governed by the National Standards on Culturally and Linguistically Appropriate Services (CLAS), which dictates the level of culturally competent care, access to language services and organizational support that must be provided to patients. Federally funded facilities are required to follow the 14 CLAS standards, while individual doctors are encouraged to embrace these practices to deliver culturally and linguistically appropriate services.
In January 2011, the Joint Commission handed down a more stringent set of cultural competency standards, while the Office on Minority Health, which developed the CLAS standards, are currently working with federal, state and national accrediting agencies to turn the remaining recommended guidelines into mandates.
What is Cultural Competency?
Being a culturally competent healthcare provider means offering all patients effective, comprehensible and respectful care that shows consideration for cultural practices, values, behaviors, languages and health beliefs. In order to decrease the disparity gap that exists in health care, all doctors must have some cultural competency training and organizations must actively recruit a diverse staff that represents the demographics of the community.
Cultural and religious beliefs have a significant impact on issues pertaining to health, from dietary patterns to perceptions about how illness is caused and cured. When these beliefs diverge from Western practices, health, healing and well-being can suffer. Doctors who develop the competency to manage cultural differences often succeed in breaking down barriers that prevent access to quality healthcare.
There are four components of cultural competence: awareness, attitude, knowledge and skills. Additionally, there are five major sources of cultural differences in perceptions of health, illness and death: relationship rules, individualism verses collectivism, emotions, how far to get involved and how status is accorded.
The Diverse Landscape of America
The 2010 Census Report proves America is rapidly becoming a strong multiethnic nation, with people of color representing more than one-third of the U.S. population. However, advocates who work with low-income communities of color and immigrants, groups who rarely participate in the Census, say these numbers are actually much higher.
In some states, such as California, New Mexico and Texas, more than 20 percent of the population does not speak English at home. And, with the American landscape witnessing a nearly 30 percent increase in diversity during the last decade, the need for culturally competent doctors is intensifying.
Not only are doctor-patient relationships complicated by ethnic customs, but also religious beliefs, gender, age and economic status. Even within an ethnic group, there are vast differences in values, practices and dialects, so it is crucial that doctors avoid grouping cultures together. For example, although Brazilians are from South America, their native language is Portuguese, not Spanish. Additionally, Orthodox Muslims and Jews will follow stricter guidelines than secular citizens.
Why Being a Good Doctor is no Longer Enough
Due to a long history of documented abuse, many cultures mistrust the medical system. Cultural and religious beliefs regarding healthcare that diverge from Western philosophies also play a substantial role in creating cultural collisions. Doctors who lack knowledge about other cultures often express their frustrations at getting patients of color to follow instructions. These clashes occur when doctors attempt to impose their worldview on patients, instead of incorporating cultural beliefs into an individualized, comprehensive care plan.
In order to provide quality service, doctors must understand culture-rooted behavior. Muslims, for example, are prohibited from ingesting pork and alcohol, so gelatin capsules, insulin, cough suppressants and opiates will be refused. In some cultures, medical conditions are extremely private matters, so even the worst conditions will not be shared with spouses or children. In the African American community, a pervasive belief that God is the source of pain and healing can lead to a loss of personal responsibility for one’s own health.
How to Make a Cultural Assessment
It is not enough to recognize how worldviews vary across cultures. Doctors must also be aware of their own cultural convictions. Cultural competency consultants can help doctors successfully complete an honest self-assessment to unearth any cultural biases and to generate awareness about their own beliefs.
When conducting a culture assessment on a patient, it is critical that doctors do not overinterpret or underinterpret behaviors. In addition to being culturally sensitive, doctors must possess some background knowledge on the culture so that they can properly interact with patients. Officewide procedures, such as posting signs in various languages and offering a comprehensive intake interview, can make a tremendous difference in providing culturally competent care.
The TransCultural Nursing Assessment form asks such crucial questions as country of birth, ethnic and religious identity, fluent languages, support network, education, occupation and restrictions dictated by beliefs, as well as open-ended inquiries about perceptions on what caused the illness and types of healing practices being used.
Communicating with Non-English Speaking Patients
The CLAS mandates outline specific rules for providing patients with free access to written and verbal language assistant services. Unless the patient requests it, the standards prohibit family members, friends and other unaccredited professionals from serving as translators due to HIPAA regulations.
While large healthcare facilities may have timely access to a bilingual staff or on-call translators, smaller practices may struggle to provide these services. Yet, there are several small ways doctors can easily communicate with patients who do not speak English. Picture boards allow patients to indicate symptoms, affected body parts and languages spoken. AT&T offers a Language Line Service that employs interpreters who speak more than 170 languages. Translation services can be delivered via phone, online video or in writing.
In order to ensure non-English speaking patients receive proper care, essential materials, such as vaccination information, must be translated into various languages. Multilingual audio and videotapes are also available for patient education. The Dartmouth Biomedical Libraries offers a Cultural Awareness in Health Care site that provides teaching tools for health professionals, patient information resources in 24 languages, extensive library links and a four-part video series on cross-cultural healthcare.
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