Are you a culturally competent healthcare provider?

[LaurenJill]

What cross cultural issues have you encountered in the healthcare system? Even though they have the best intentions, many healthcare providers often don’t know how to address these differences. read more:
http://tasteslikechicken2me.wordpress.com/2009/03/15/the-culturally-competent-healthcare-provider/

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[cpants]

I think a lot of this stuff is overemphasized in medical education. You can't really learn how to handle every situation or to be "culturally competent". In fact I think too much of these competency classes can be counterproductive, leading you to make subconscious assumptions about traditional treatments, family dynamics, religion, etc. based on how a person looks or talks.

Of course it's a good idea to learn about the predominant groups in your area, but as long as you have good intentions and an open mind, you can get through most of these cultural dilemmas without a problem. I think the most important step is just to ask the patient how she prefers her care to be conducted.

 

[PeepshowJohnny]

I hate these culturally competent classes because they're long on lecturing, but short on practical tips.

It's the paradox of cultural competency training: They can't give details about differences between cultures because it involves a degree of stereotyping which they want to avoid. So you end up with vague details like "For many African American or Latino patients, the family unit is important for healing." Uuuh...no duh. I also find it's important for many of my white, asian, middle eastern, etc. patients. And they just love to throw in "...although this is not true for all pepole of [x] heritage." just to cover thei rasses.

 

[zenman]

I think a lot of this stuff is overemphasized in medical education. You can't really learn how to handle every situation or to be "culturally competent". In fact I think too much of these competency classes can be counterproductive, leading you to make subconscious assumptions about traditional treatments, family dynamics, religion, etc. based on how a person looks or talks.

Of course it's a good idea to learn about the predominant groups in your area, but as long as you have good intentions and an open mind, you can get through most of these cultural dilemmas without a problem. I think the most important step is just to ask the patient how she prefers her care to be conducted.

 

[Josh L.Ac.]

We had about 5 lectures on "Culturally-Competent Nursing" and it was just god awful. It was tragically funny when during each lecture, the instructor would talk about how male children are more important in China, and when the two female students from China pointed out that the instructor was stating a commonly-held misconception, the instructor never knew what to do.


They would look confused, repeat the point, and justify it by saying "that's what I learned".


Then they would repeat the claim the next time we were forced to listen to the same lecture in a different class...with the same result.

 

[Pharmavixen]

It's very nice and all to have a doctor who celebrates diversity and is inclusive and makes each and every one of his patients feel important and special.

Personally, though, I'd rather have a doctor who is up on EBM and knows what the he!! (s)he's doing.

And after the doctor fixes what's wrong with you, and you feel the need for some cultural sensitivity, call a social worker/priest/rabbi/shaman/Wiccan high priestess what have you.

 

[cpants]

It's very nice and all to have a doctor who celebrates diversity and is inclusive and makes each and every one of his patients feel important and special.

Personally, though, I'd rather have a doctor who is up on EBM and knows what the he!! (s)he's doing.

And after the doctor fixes what's wrong with you, and you feel the need for some cultural sensitivity, call a social worker/priest/rabbi/shaman/Wiccan high priestess what have you.

Of course, that preference is just a product of your cultural norms, to which we must be sensitive.

 

[Dirt]

I think a lot of this stuff is overemphasized in medical education.

Seriously!!!

I feel like screaming from the mountaintops, "I GOT IT THE FIRST TIME."

People have cultures, they are different, respect a patient's culture and autonomy, don't ram your own views down someone's throat, blah blah blah blah. Something that could have been taught to me in about 5 minutes, not 4 two hour lectures with ridiculous online exercises that just get in the way of my real work.

 

[NonTradMed]

I think our school does a bad job of teaching the concept of cultural competency. The way I see it, most cultural misunderstandings can be averted by showing professional courtesy.

But there are a few things that people born and raised in this country may not understand, and it's those "obvious" points that our profs should be teaching us. Things like people from this country/religion/ethnic group would feel looking at them in the eye is rude (or something that is the opposite to what people in this country would consider the norm). Those points are helpful when treating someone of a different background. Knowing that ____ group likes having support network because their culture is "family centered" is useless since that's true for EVERYONE. I feel these "cultural lessons" try so hard to not stereotype and offend, they end up becoming useless.

 

[ZincFingers]

Unfortunately, most of these "cultural competence" workshops are hard core racist.

For instance, LaurenJill's blog hypothetical about the Hispanic patient with the large family. Oh, really? Are you telling me that ALL Hispanics come to the hospital with a dozen relatives, all claiming to be immediate family? What if they're loners? What if they only value their nuclear family? Would LaurenJill allow that of them if they hail from Honduras? If I assume that a patient with the last name "Hernandez" is going to want 12 people by their bedside, isn't that flat-out racist of me?

My "cultural sensitivity" class made the same kind of racist generalizations, such as all African-Americans having a "flexible sense of time." Oooo-kay. There is a more, uh, "familiar," Dave Chappelle-esque term for what they are talking about and any student who uttered that phrase would instantly be terminated from medical school... and yet these people are now teaching it in class? How is this not crazy?

 

[cpants]

Unfortunately, most of these "cultural competence" workshops are hard core racist.

For instance, LaurenJill's blog hypothetical about the Hispanic patient with the large family. Oh, really? Are you telling me that ALL Hispanics come to the hospital with a dozen relatives, all claiming to be immediate family? What if they're loners? What if they only value their nuclear family? Would LaurenJill allow that of them if they hail from Honduras? If I assume that a patient with the last name "Hernandez" is going to want 12 people by their bedside, isn't that flat-out racist of me?

My "cultural sensitivity" class made the same kind of racist generalizations, such as all African-Americans having a "flexible sense of time." Oooo-kay. There is a more, uh, "familiar," Dave Chappelle-esque term for what they are talking about and any student who uttered that phrase would instantly be terminated from medical school... and yet these people are now teaching it in class? How is this not crazy?

Exactly. The lesson should be: do not make generalizations or assumptions about patients. Talk with them about how they would like their care conducted. Period.

The fun of the classes is that you can take offense to the lessons and complain. They are falling all over themselves to be PC, and if you and your classmates play your cards right, you can keep the tail-between-the-legs email apologies flowing all semester.

 

[GH253]

I'm not really into the whole PC thing.

 

[Bernardo_11]

Patients and families incorporate many of their values when making medical decisions.... and many of them are not based on EBM. Economics, family dynamics, type of insurance coverage..... all those things come into play when our families make seemingly insane choices which sometimes contradict our medical advice. To be "culturally competent" means to consider a patient's or family's culture or ethnicity when those decisions are made. Sometimes their cultural view of illness is different from our basic science understanding. So if that ever happens to you... and you have a "WTF?" encounter with a family..... take some extra time to learn of their ethnicity and cultural views on health and family. Then you may actually have a chance in "leading" them somehow to a better medical decision.

No Charge

Nardo

 

[Josh L.Ac.]

You all do realize that this thread is probably some graduate nursing research project that will state that by looking at the replies to this thread that "those in medicine are not culturally competent providers" or something along those lines.

 

[Instatewaiter]

You all do realize that this thread is probably some graduate nursing research project that will state that by looking at the replies to this thread that "those in medicine are not culturally competent providers" or something along those lines.

Unfortunately I'm sure you're right and I'm sure what ever comes out of it will also cause us to waste even more of our time watching useless videos and having useless coursework that actually leads us to be less "culturally competent."

I have such a knee-jerk reaction when I hear the term "culturally competent" because it has always been associated with something- videos, standardized patient encounters, exam- that was an enormous waste of time.

I firmly believe that most of the people who push this stuff are some of the dimmest people on the planet. I really am not being hyperbolic. Most of the material is presented as if the audience had an IQ of 85 and, if it is meant to be presented to a group of healthcare providers, you would think it would be a bit more advanced... unless the authors were incapable of anything more advanced.

/end rant

 

[cpants]

Unfortunately I'm sure you're right and I'm sure what ever comes out of it will also cause us to waste even more of our time watching useless videos and having useless coursework that actually leads us to be less "culturally competent."

I have such a knee-jerk reaction when I hear the term "culturally competent" because it has always been associated with something- videos, standardized patient encounters, exam- that was an enormous waste of time.

I firmly believe that most of the people who push this stuff are some of the dimmest people on the planet. I really am not being hyperbolic. Most of the material is presented as if the audience had an IQ of 85 and, if it is meant to be presented to a group of healthcare providers, you would think it would be a bit more advanced... unless the authors were incapable of anything more advanced.

/end rant

Hey at least the exam questions are easy.

A patient refuses an injection due to cultural reasons. Do you...

A) Call security to hold the patient down.
B) Give the patient the injection when she isn't paying attention.
C) Call a priest.
D) Ask the patient to tell you more about her culture.
E) All of the above.

 

[LeemerDO]

I refuse to be a culturally competent physician.
Why? I'm an American.
There is a nice element about being in a society where many cultures intermingle together and associate with each other, however, I will not bow down to conform to other cultures or hold any other cultures up any higher than I would hold my own. So, for instance, when I don't habla some patient's language, it should never be their place to be offended because first off, it's not my problem, nor should it be my duty to know said language. It is not my obligation to know the cultural norms and mores of other ethnicities. In fact some of their beliefs downright contradict good sound medical advice and therapy. Being aware is done only as a FAVOR to them, but I will not single out specific cultures for special treatment because frankly, no culture or ethnic group should be given special treatment or deference above others. It's illogical, stupid, and will amount to nothing in the long run, except possibly kill a few people by delaying or denying medical treatment.

 

[cpants]

I refuse to be a culturally competent physician.
Why? I'm an American.
There is a nice element about being in a society where many cultures intermingle together and associate with each other, however, I will not bow down to conform to other cultures or hold any other cultures up any higher than I would hold my own. So, for instance, when I don't habla some patient's language, it should never be their place to be offended because first off, it's not my problem, nor should it be my duty to know said language. It is not my obligation to know the cultural norms and mores of other ethnicities. In fact some of their beliefs downright contradict good sound medical advice and therapy. Being aware is done only as a FAVOR to them, but I will not single out specific cultures for special treatment because frankly, no culture or ethnic group should be given special treatment or deference above others. It's illogical, stupid, and will amount to nothing in the long run, except possibly kill a few people by delaying or denying medical treatment.

No one is asking you to give special treatment to one group of patients, just to treat all patients with respect. You don't have to study different cultures, but you better be aware of what's going on with the patient in front of you. You better ask questions like "Have you tried any home remedies?, Have you been seen by any traditional healers?, What is your understanding of your disease and treatment?" Tons of cultural factors can have an impact on the treatment that you give and its effectiveness. This isn't a favor to patients. It is part of your job.

As far as the language issue goes, you better use adequate translation or not treat at all, or you will be open to lawsuits when you treat improperly after not getting a good history.

 

[Trismegistus4]

Wouldn't it be better to just avoid all the supposed "need" for cultural competency by being a racially, ethnically, culturally homogenous nation, like we were pre-1965?

 

[fab4fan]

We had about 5 lectures on "Culturally-Competent Nursing" and it was just god awful. It was tragically funny when during each lecture, the instructor would talk about how male children are more important in China, and when the two female students from China pointed out that the instructor was stating a commonly-held misconception, the instructor never knew what to do.


They would look confused, repeat the point, and justify it by saying "that's what I learned".


Then they would repeat the claim the next time we were forced to listen to the same lecture in a different class...with the same result.

It's funny, I didn't even open the link but my first thought was "Dear God, this looks like it would be the sort of dreck they forced us to read when I was in nursing school."

I still remember one of my nursing professors having a go at describing different cultures. When she got to the part on the syllabus about AA, she said, (I'm not making this up) "Black people...well, they're just like white people anymore so we don't really need to cover any differences."

You could have heard a pin drop in that classroom, and that was 24 years ago.