What is culture? How do you define it? What's the difference between culture and race?
Cross cultural communication and cultural competence are two buzz terms you hear a lot lately. There has been, and still is, a big push towards understanding and appreciating the multitude of factors that influence someone's health and healthcare. But I take a little bit of issue with the terminology......not the concept. The terminology. Specifically associating the word competence with culture as the term culturally competent sets, in my opinion, an unreasonable expectation on the healthcare provider and cross-cultural communication becomes a daunting task.
Allow me to illustrate.
I asked my students to forget what they know about me and play along with the following scenario
[Scene] I am a patient walking through your pharmacy doors,
What is your first impression about my race?
"You look white Dr. A" was the unanimous response
Ok, now I handed you my prescription and you read my name. What now?
"I would think you are Muslim/Arab"
Cool. Now you we get to exchange professional pleasantries and you hear me speak. What do you think?
"You have little to no accent, I would think you grew up in a household that spoke two languages"
What else?
"Based on how you're dressed I'd say you are an educated professional" <-- It's amazing how much you can fool people by putting on a tie....but I digress
Alright, now let's say I ask you for a recommendation on an over the counter medication that would help me with my fever, how would you counsel me on that?
"Take Tylenol for your fever and if symptoms do not subside then you may want to contact your doctor" <-- to my dear pharmacy professionals, this was a paraphrase so forgive the obvious counseling gaffes as I have left out a lot
"what does subside mean?" I asked. Shock induced silence.
OK, let's back up and let me ask you, what culture am I? I am Muslim, I am Palestinian, I was born and raised in an Arabic, predominantly Muslim country but have lived in the western world for 20 years now. What box would you fit me in? How would that box influence how you care for me? You also made a few assumptions about my level of intelligence and my status because of the way I was dressed and you spoke to me one way. What if I had a thick accent? What if I was a black man wearing saggy pants handing you a prescription for a pain medication? How would your impression of me influence the way you care for me?
Creating shortcuts and generalizing concepts is a survival mechanism and a way of conserving brain energy. We gather clues and categorize subconsciously otherwise we would be paralyzed by the amount of information our brains process every second. But when we are healthCARE providers and our ultimate concern is the wellbeing of our patient we must acknowledge such conscious and subconscious biases, recognize how they may influence how we care for our patients and leave them at the door. I gave the students an example. I said, as a Muslim, premarital sex is a major sin in my religion. What if a pregnant 17 year old Muslim girl walk through my door and I view her through the lens of my religion, how would my care for her compare to my care of another girl in the same situation who is not Muslim? This is not to say that one is to lose their belief system or disregard what they value but this is to say that in the interaction with the patient, I am not the measuring stick....they are. Their life, their culture, their beliefs are the starting point and we build on that to get them to what we believe, from our standpoint as healthcare providers, to be the best outcome for their health. But getting to that mutual point of understanding and cooperation will not come if we walk into our interactions viewing the world from our sole perspective. Now this brings us back to the concept of cultural competence. I said that I disagree with the use of associating the word competence with culture because it creates a daunting task. Culture is fluid, it's dynamic and it many factors influence it. To be competent in a "culture" you need to be immersed in it and it is inconceivable to expect from a healthcare provider to be competent, and therefor well versed, in every culture that walks through their door. This expectation actually leads to further biases and unintentional discriminatory (in the sense of unequal) services. That's why I prefer the terms of cultural awareness or, my personal favorite, cultural humility. To recognize that there are other patient factors in play beyond the diagnosis but most importantly to recognize those factors within you as the one caring for others.
Cross cultural communication and cultural competence are two buzz terms you hear a lot lately. There has been, and still is, a big push towards understanding and appreciating the multitude of factors that influence someone's health and healthcare. But I take a little bit of issue with the terminology......not the concept. The terminology. Specifically associating the word competence with culture as the term culturally competent sets, in my opinion, an unreasonable expectation on the healthcare provider and cross-cultural communication becomes a daunting task.
Allow me to illustrate.
I asked my students to forget what they know about me and play along with the following scenario
[Scene] I am a patient walking through your pharmacy doors,
What is your first impression about my race?
"You look white Dr. A" was the unanimous response
Ok, now I handed you my prescription and you read my name. What now?
"I would think you are Muslim/Arab"
Cool. Now you we get to exchange professional pleasantries and you hear me speak. What do you think?
"You have little to no accent, I would think you grew up in a household that spoke two languages"
What else?
"Based on how you're dressed I'd say you are an educated professional" <-- It's amazing how much you can fool people by putting on a tie....but I digress
Alright, now let's say I ask you for a recommendation on an over the counter medication that would help me with my fever, how would you counsel me on that?
"Take Tylenol for your fever and if symptoms do not subside then you may want to contact your doctor" <-- to my dear pharmacy professionals, this was a paraphrase so forgive the obvious counseling gaffes as I have left out a lot
"what does subside mean?" I asked. Shock induced silence.
OK, let's back up and let me ask you, what culture am I? I am Muslim, I am Palestinian, I was born and raised in an Arabic, predominantly Muslim country but have lived in the western world for 20 years now. What box would you fit me in? How would that box influence how you care for me? You also made a few assumptions about my level of intelligence and my status because of the way I was dressed and you spoke to me one way. What if I had a thick accent? What if I was a black man wearing saggy pants handing you a prescription for a pain medication? How would your impression of me influence the way you care for me?
Creating shortcuts and generalizing concepts is a survival mechanism and a way of conserving brain energy. We gather clues and categorize subconsciously otherwise we would be paralyzed by the amount of information our brains process every second. But when we are healthCARE providers and our ultimate concern is the wellbeing of our patient we must acknowledge such conscious and subconscious biases, recognize how they may influence how we care for our patients and leave them at the door. I gave the students an example. I said, as a Muslim, premarital sex is a major sin in my religion. What if a pregnant 17 year old Muslim girl walk through my door and I view her through the lens of my religion, how would my care for her compare to my care of another girl in the same situation who is not Muslim? This is not to say that one is to lose their belief system or disregard what they value but this is to say that in the interaction with the patient, I am not the measuring stick....they are. Their life, their culture, their beliefs are the starting point and we build on that to get them to what we believe, from our standpoint as healthcare providers, to be the best outcome for their health. But getting to that mutual point of understanding and cooperation will not come if we walk into our interactions viewing the world from our sole perspective. Now this brings us back to the concept of cultural competence. I said that I disagree with the use of associating the word competence with culture because it creates a daunting task. Culture is fluid, it's dynamic and it many factors influence it. To be competent in a "culture" you need to be immersed in it and it is inconceivable to expect from a healthcare provider to be competent, and therefor well versed, in every culture that walks through their door. This expectation actually leads to further biases and unintentional discriminatory (in the sense of unequal) services. That's why I prefer the terms of cultural awareness or, my personal favorite, cultural humility. To recognize that there are other patient factors in play beyond the diagnosis but most importantly to recognize those factors within you as the one caring for others.