In fact, it's both. Many of the points and suggestions made in these exercises focus on understanding the patient's perspective and on tailoring your care to the individual. This concept of person-centered care is one of the major "pillars of quality" outlined in the Institute of Medicine's report, Crossing the Quality Chasm.
As such, it is applicable to patients of all cultural backgrounds. However, patients from diverse cultural backgrounds may have perspectives on health and illness that may be distinct from the mainstream, which makes person-centeredness even more crucial. Also, various cultural issues like language, customs, and immigration experiences are generally not considered to be an integral part of person-centered care.
Some evidence-based, factual information about specific ethnic groups can be helpful to know (immigration patterns, socioeconomic status, diet, etc.). However, much of the information about beliefs and behaviors of specific groups that is anecdotally reported in the literature is oversimplified, stereotypic, and not evidence-based. The most important cultural information will come directly from the patient him or herself. Quality Interactions courses emphasize how to do this, while providing the social and cultural context for certain patient populations.
The concepts and skills outlined in our courses can be used selectively, like a review of systems for cross-cultural interactions. In training we are taught the entire review of systems, while in practice we focus mostly on those questions that apply to the chief complaint. Identifying which questions will be most useful for a given situation is part of the art of cross-cultural medicine. In these instances, they may save time by improving communication, understanding, and trust. We will emphasize this throughout our case exercises.
Yes. The Institute of Medicine report, Unequal Treatment: Confronting Racial/Ethnic Disparities in Health Care, concluded that effective cross-cultural communication is linked to improved patient satisfaction, adherence, and clinical outcomes (such as blood pressure control).
There are two responses to this important question. First, as clinicians, we strive to treat all patients equally. However, research has shown that this may not be the case, as there are significant differences in the quality of care patients receive based on race, ethnicity, culture, and class. As a result, efforts to address disparities through education, training, and self-awareness are relevant to all clinicians.
Secondly, treating patients the same may not be enough. Different patients may have different responses when presented with the same clinical information. Assuring the highest quality of care requires understanding and adapting to these culturally-based differences. This is the essence of a person-centered cross-cultural approach.
No. All clinical interactions are a type of negotiation. Culture throws another important variable into that negotiation, but it is one of many things that need to be considered when working out a management strategy. The more you learn about a patient (including social and cultural factors) the more you will be able to negotiate for the most mutually acceptable middle ground. The biomedical approach and cross-cultural approach are not mutually exclusive. As clinicians, it is still important that we adhere to evidence-based clinical guidelines and the basic tenets of professionalism.
Quality Interactions has lead the industry in cultural competency training for healthcare providers for over a decade, with over 250,000 alumni at the country's largest hospitals, health plans, and medical schools.
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