I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
-Excerpt of the Modern day version of the Hippocratic oath, written by Louis Lasagna (Academic Dean of School of Medicine, Tufts University)
Cultural competence is a term coined in 1989 by Cross et al, which effectively combines both words to describe an attribute needed to serve an ethnically diverse community. To be culturally competent means you have the ability to function effectively in a setting of beliefs, attitudes and values that are different from your own. Easier said than done, this skill requires a thorough knowledge of one’s own cultural beliefs and limitations as well as the capacity to identify and understand others’.
Although a valued skill gaining more and more recognition in all fields, as a result of our interconnected world, this dexterity is of particular importance in the healthcare field. Statistics point to an ever-increasing number of ethnicities not only seeking, but more importantly needing medical attention in the United States. There are also large numbers of prosperous immigrants travelling to American territories to obtain treatment.
Hospitals around the country have recognized this and are beginning to make the necessary changes. To that extent, they have begun to heavily invest in culturally sensitive programs. Every institution is different. In some cases the driving force behind the changes is purely financial, while in others it is the result of a visible need to better serve their patients. Either way, they are applying, for the benefit of the sick, all measures that are required.
Demographics are key drivers when deciding what cultures to target. Some hospitals, for example, are focusing on ethnic-related ailments, extensive interpreter support and strong alliances with local doctors. This happened in one case after detecting patterns in Chinese patients, who were unable to communicate their symptoms accurately, were misdiagnosed, discharged and consequently suffered an escalation of their previous symptoms. Needless to say, everyone in the community benefits from this increased cultural sensitivity.
In many cases, the care-providers and the patients speak the same language, are of the same ethnicity but do not share the same attitudes and values. In these cases, if there is no cultural awareness, the patients feel uncomfortable, since doctors and nurses, not knowing the correct questions to ask, make assumptions about their lifestyles and formulate a plan for care, based on false information. Needless to say, it does not adhere to the Hippocratic promise and deteriorates the patients’ emotional wellbeing.
Although language is the first distinguisher and many times barrier of cultural understanding, the caregivers’ beliefs are many times the largest impediment for the patient to heal successfully. Unbeknownst to most doctors, Native American tribes hold strong sentiments against the Western culture and firmly believe they are not capable of restoring their health. In one particular instance, a woman was in the hospital after a serious car accident. None of her family members appeared for the first week and she did not utter a word to any of the staff members. She was in a comatose state, although the tests indicated she had no brain injuries. Needless to say, the physicians were baffled. When her mother finally appeared, she requested to perform a water healing ceremony. The hospital agreed. Right after the ceremony, the woman spoke to her mother. It turns out, she had used one of her tribe’s consciousness altering techniques in order to avoid any contact with the “white doctors”. The hospital realized it needed to work with, and not against this belief and has consequently, begun to incorporate more Native American references into their practice, consulted with local tribes, offered training on alternative medicine and is flexible about allowing rituals and ceremonies. After all, there is art to medicine as well as science.
Hospitals seeking to increase the number of patients from a particular culture in order to increase their financial revenue are more proactive about cultural inclusion and hence, make every effort to recreate the warmth of their native countries. Some facilities have adapted their menus, the color of their paper and their interior decorating in order to make their foreign patients feel more at home. For a hospital serving South Asian patients, this meant changing the patient information pamphlets’ color. The practical, clean and very American white reminded those patients of death (clearly not something you want to publicize in a hospital!). So, the pamphlets were changed to red, the color of happiness. Who would’ve known that such a subtle difference could have such an impact on healing?
As we progress deeper in to the 21st century, medics are learning that there is a lot more to healing than a one-size-fits-all approach. To that extent, many healthcare providers around the country are dramatically altering the way they perceive and understand healing. They are addressing these changes on a mental, emotional, physical and spiritual level in an attempt to accommodate a larger range of perceptions. While the goal may take different forms, the underlying principle remains the same, to provide the best care for every patient. It won’t be long before many hospitals turn into ethnic hospitals, specializing in culturally sensitive practices, or perhaps we will all be so culturally competent that we won’t know the difference. Either way the hospitals of the future promise to look very different.