We Need Cultural Competency in Health Care

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I fired my doctor. I couldn’t take her condescending attitude anymore. Fortunately, I am rarely sick and when I go to the doctor it means I am feeling pretty bad. This one particular day, I went to the doctor with a cold that wouldn’t go away. I tried everything, medicine, rest and fluids. Nothing worked. I decided to make an appointment with the hopes of getting rid of the cold once and for all. My doctor came into the examination room, sat at the computer, looked at the screen and said, “Have you ever thought about weight loss surgery?” She didn’t say, “Good afternoon Mrs. Grevious, what brings you to see me today?” or “My goodness, what a cough you have there!” No, she looked at my chart and asked me if I considered weight loss surgery. Shocked, I asked, “Why would you ask me about weight loss surgery if I am not here for that reason?” She says, “Well…your BMI is high and it is something to consider.” Still puzzled, I asked. “Is my cholesterol high? Am I pre-diabetic? Do I have high blood pressure?” She answered no. I continued, “Then why would you ask me to consider weight loss surgery? I am not here for that reason. I have a cold. I exercise, I have eliminated sugary drinks and I eat well. “ She continued to hand me pamphlets and talk to me about the different surgeries that are offered. I gathered my belongings and left. That day I didn’t discuss my cold with the doctor. I fired my doctor instead. I found another doctor, who was welcoming and warm, one who greeted me immediately, asked how I was doing, wanted to know what brought me in for a visit, asked me what I wanted to do and what my suggestions were for my own care. We had a conversation. She didn’t judge me. She didn’t make assumptions. Unfortunately, a lot of us are not as lucky to find the second doctor, we get stuck with the first one.

My doctor wasn’t culturally appropriate and probably didn’t care to be. She didn’t understand anything about me and didn’t take the time to truly understand me as her patient. She didn’t consider my body type or my strengths. She used a “one size fits all” approach to my health care and it was incredibly offensive. It is important for health care to be available and provided by people who understand different cultures.

Cultural competency in health care is defined as the ability of health care providers to understand and integrate individual values, beliefs, and behaviors about health, race, ethnicity, language, nationality, gender, socioeconomic status, physical and mental ability, sexual orientation and occupation into the delivery and structure of the health care system. Reducing health disparities remains a goal in the health system. Socioeconomic status, lifestyle behaviors, social conditions, and the lack of access to preventive health care services can contribute to racial and ethnic disparities. Elimination of health disparities requires culturally appropriate health care initiatives. Elimination of disparities for people of color is a gigantic task but it is possible.

Women of color face great challenges in accessing basic, preventive health care services. Eliminating health disparities is politically sensitive and challenging because the causes of health disparities are intertwined with a contentious history of the race relations in this country. Although there have been considerable advances in civil rights, a person’s race remains a factor in determining whether that person will receive quality health care and a positive health outcome. Lack of cultural competency is a concern. One in three residents of the United States identify as African American, American Indian/Alaska Native, Native Hawaiian/Pacific Islander, Latino or multiracial. By 2050 that number will be one in two.

Cultural competency is essential in the health care environment. Here are some recommendations for building a professional rapport with patients of color:

  1. Do not assume: Recognize the diversity of the United States population. Race and culture are two different concepts. Just because the patient is Black doesn’t mean that the patient is like the last Black patient that was seen. For example, the Black population is comprised of people of mixed ethnic and culture heritage. It is the responsibility of the health care provider to ask questions, listen closely and carefully to determine the patient’s expectations.
  2. Ask for causes and solutions: When taking the initial history, ask the patient about their symptoms and their concerns. Develop cultural skills for performing assessments.
  3. Listen without judgment: It is essential that the practitioner listen with empathy and respect. Do not express any body language or words that could be viewed as judgmental, condescending or ridiculing. Recognize the cultural influences on nonverbal expressions/cues. Strive to have face-to-face interactions with Black patients in order to establish trust and rapport.
  4. Understanding: Greet your patients. Some prefer to be greeted formally (Reverend, Bishop, Mr. Mrs., Ms., Miss).
  5. Understand the relationship with the church and religion: Respect the importance of church, prayer and religious practices during the times of sickness. Prayer, the belief in God and the Holy Spirit is pivotal in the well being of Black patients.
  6. Training: Cultural competency trainings increase cultural awareness in staff and leads to change in behavior and interactions. It is possible that people can be culturally appropriate when serving groups who are similar to themselves but not culturally sensitive to others. These trainings can be a one-time training or a series of training activities.

Public health professionals and health care providers should strive for cultural sensitivity in health care, increase awareness of culturally sensitive actions and advocate for appropriate health programs that are effective regardless of socioeconomic status, disease or cultural beliefs.   The communication between patients and providers need to be strengthened to increase interpretation services, expand the racial/ethnic diversity of health professionals and develop training programs to address cross-cultural education. With the proper cultural competency trainings and education, health care providers and public health professionals will improve our community for better health outcomes. We can do this. Invest in our health.

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