A West Indian mother took her son to the emergency room several hours after he began suffering from abdominal pain and vomiting. She reported that his symptoms were not responding to cerasee or ginger teas.
Noting the boy’s serious condition, the doctor harshly chastised the mother for not bringing him earlier. The doctor’s criticism was sound but did not take into account the family’s cultural background, where a home remedy is the likely first solution in all medical situations.
In South Florida, variations of this story occur daily. For this family, no long-term physical harm was done. The boy recovered quickly from his appendectomy and the mother was grateful.
However what lesson did the mother learn? Did she walk away in shame
after being chastised by the doctor? Or could she have possibly been so hurt that she might avoid interacting with other healthcare professionals?
Even worse, she may not have shared with her family and community what she had learned about the importance of immediately seeking professional help for certain symptoms.
The United States has significant differences in health status among racial and ethnic groups, with blacks having the shortest life expectancy and the worst rates of HIV/AIDS, diabetes, obesity and other major medical problems.
The Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care report, published in 2003, showed that ethnic and racial minorities receive a poorer quality of care even when insurance status, age, gender and
presenting conditions are held equal.
Miami-Dade County, for example, is as culturally diverse as almost any major city in the U.S. Approximately 20 percent of the county’s population is African American, according to the U.S. Census Bureau’s 2011 American Community Survey. That diversity exists in many
areas such as language, religion, customs, beliefs, and attitudes, and present daily challenges for all aspects of our society. The healthcare industry is no exception.
“In a medical setting, three types of cultures are present and interact with each other – namely, the culture of the patient, the culture of the physician, and a specific medical culture. To provide culturally appropriate care, it is essential to recognize how cultural factors may influence the patient, physician, medical staff and medical setting.”
That comes from professor of psychiatry Wen-Shing Tseng and psychiatrist Jon Strelzer in their book, Culture and Psychotherapy. Simply put, physicians can bridge the disparities gap by being aware of their biases,
being knowledgeable of the patient’s culture and by avoiding stereotypes.
As doctors, we try to educate our community so that providing and receiving proper healthcare becomes a shared responsibility and thus narrows the gap in disparities in health status among racial and ethnic groups. As professionals, however, we also recognize the need to educate our healthcare workers so they become aware of the problem and cultivate culturally responsive care.
The benefits of cultural competence in health care have been proven in studies and in patient outcomes. The approach is now global.
For example, according to Sarah Stewart of the Diversity Health Institute in Sydney, Australia, some of the benefits of cultural competence in health care are improved access and equity for all groups in
the population, as well
as improved patient
safety and quality assurance.
In the United States there is a mandate to include cultural competency education in all
curriculums by the Liaison Committee on Medical Education, which sets
the educational standards for all medical schools.
As for the West Indian mother, cultural ignorance caused the doctor to miss an opportunity to not only compassionately educate the mother, but to also demonstrate empathy,
understanding and support.
After all, they both wanted the same thing: the best health outcome for her son.
Dr. Cheryl Holder is an attending physician at Jackson Memorial Hospital