“We have become not a melting pot but a beautiful mosaic. Different people, different beliefs, different yearnings, different hopes, different dreams.”
With Western medicine, we are often trained to adopt a “fix-it” mentality. We learn how to take a history and as we do so, we take the signs and symptoms we discover and try to assemble a theory of what is happening to a person. Like Sherlock Holmes, we can deduce what is happening using the information we are given.
However, medicine requires taking this further. Signs and symptoms don’t tell you who the person sitting in a room with you truly is. Why do they feel they have an illness? What does that illness mean to them? What is guiding how well they will comply with any treatments you suggest? What other treatments will they try (with or without telling you about them)? What is their agenda for the visit? Taking time to explore these issues can lead to a better healer-patient relationship and to better outcomes. (For some thoughts about how beliefs can affect health, see thisarticle from the Curinghealthcare blogspot.)
As you explore these areas, it is vital that you remain aware of how your own beliefs and experiences influence your interactions. Many refer to this realm where awareness of others’ beliefs and awareness of one’s own interrelate as “cultural humility.”
This page focuses on four main areas:
1. Self Assessment: How Culturally Aware Are You?
2. Resources – Cultural Competency and Health
3. Links to Information About Specific Groups (different religions, cultures, etc.)
4. Cultural Humility: The Intersection of Self-Awareness and Awareness of Others
How Culturally Aware Are You?
To develop a sense of how aware you are of how culture and beliefs in your practice, take the Georgetown University Cultural Competency Health Assessment. This takes roughly 30 minutes to complete, and when you finish it, you receive suggestions for weblinks and articles which can help you strengthen any areas where your score is low. (Taking the survey itself is useful education in being more aware of others’ needs and how you can enhance your practice through that awareness.)
This simple list (in pdf format) of questions from the American Academy of Family Physicians is also worth thinking about. The Georgetown Center also offers links to a number of other self-assessment surveys.
Resources – Cultural Competency and Health
http://etl2.library.musc.edu/cultural/competent_care/index.php – Tips in culturally competent care from Medical University of South Carolina. Also Ssee their definitions of “culture“.
Harvard Medical School Center for Cultural Competency
https://cccm.thinkculturalhealth.org/ – US Department of Health and Human Services Culturally Competent Healthcare Website. Has 9 hours of CME available in culturally competent care
American Academy of Family Physicians online Cultural Competency CME training
http://www11.georgetown.edu/research/gucchd/nccc/index.html – National Center for Cultural Competence at Georgetown – multiple links, resources, and cases centering on aware healthcare.
http://www.scu.edu/ethics/practicing/focusareas/medical/culturally-competent-care/ – Markkula Center for Bioethics. Includes case studies in cultural sensitivity.
http://stfm.org/corep.html – STFM Core Curriculum Guidelines in Culturally Sensitive and Competent Healthcare.
http://www.diversityrx.org/HTML/DIVRX.htm – DiversityRx website. Provides examples of how culturally sensitive care is incorporated into various healthcare institutions.
http://www.hrsa.gov/culturalcompetence/ – Cultural competency resources for health care providers, with resources that focus on care of special populations, such as migrant workers, children with disabilities, and people with HIV.
http://www.culturalhealing.com/healthprofessions.htm – National Center for Cultural Health. Nice compilation of journal articles and books focusing on cultural competence in health care.
http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=15 – United States Office of Minority Health. Outlines standards of care for minority populations.
http://ncmhd.nih.gov/ – National Center for Minority Health and Health Disparities
http://cdh.med.wisc.edu/index.php – University of Wisconsin Center for the Study of Diversity in Healthcare
http://www2.umdnj.edu/fmedweb/chfcd/index.htm – Robert Wood Johnson Medical School center for Healthy Families and cultural diversity
Links to Information About Specific Groups
– Association of College and Research Libraries site, with excellent links on various religious traditions.
http://www.bbc.co.uk/religion/religions/ – BBC Religion and Ethics Site. Provides history and overall descriptions of major world religions. Excellent sections on ethics, customs, and major holidays. Also discusses the differences between ‘subdivisions’ within each religion.
http://www.adherents.com/ – Adherents.com offers statistical details about numbers of adherents to various belief systems, defines these systems in detail, and lists religious affiliations for various famous people. Provides information on each religious group’s holy places, sacred texts, and historical origins.
http://www.beliefnet.com/ – Beliefnet is an informational site with humor, interesting writings on an array of topics by people from an array of religious traditions. Take the “Spiritual Type Quiz.”
http://www.worldreligions.co.uk/ – World Religions Photo Library offers photos of various elements from major world religions, with an emphasis on rituals, festivals, and various symbolic objects.
http://www.itmonline.org/ – Institute for Traditional Medicine. Interesting array of articles regarding various healing systems from around the world, especially Central and Eastern Asia. Check out the section on “Shen Disorders.”
http://www.mindandlife.org/ – The Mind and Life Institute is an organization which exists to establish a dialog between scientists and spiritual leaders. Interesting dialog arises.
http://culturedmed.sunyit.edu/index.html – Culturedmed links to an array resources specific to different groups.
University of Virginia Chaplaincy Site
http://findarticles.com/p/articles/mi_qa3919/is_200210/ai_n9130454 – articles on health care and the Amish.
http://www3.baylor.edu/~Charles_Kemp/indian_health.htm – care for Indian patients.
http://www.hrsa.gov/culturalcompetence/qualityhealthservices/ – Cultural competence for caring for Hispanic populations.
http://medicaleconomics.modernmedicine.com/memag/article/articleDetail.jsp?id=156420 – Medical Economics article featuring detailed list of links for caring for Muslim patients
http://www.metrokc.gov/health/glbT/providers.htm – Guidelines for offering culturally competent care to gay, lesbian, bisexual, and transsexual people
http://ethnomed.org/ethnomed/ – Resources for care of recent immigrants. Features information on caring for Hmong patients.
http://www.hmongnet.org/ – Nice site focusing on all things Hmong. The General Information links are worth a look.
Guidelines for Caring for Hmong Patients – pdf
As Linda Hunt puts it in an article entitled “Beyond Cultural Competence“:
Cultural humility has been described by Melanie Tervalon and Jann Murray-Garcia as a lifelong process of self-reflection and self-critique. Cultural humility does not require mastery of lists of “different” or peculiar beliefs and behaviors supposedly pertaining to certain groups of patients. Rather, the provider is encouraged to develop a respectful partnership with each patient through patient-focused interviewing, exploring similarities and differences between his own and each patient’s priorities, goals, and capacities. In this model, the most serious barrier to culturally appropriate care is not a lack of knowledge of the details of any given cultural orientation, but the providers’ failure to develop self-awareness and a respectful attitude toward diverse points of view.” (See full article athttp://www.parkridgecenter.org/Page1882.html)
See also http://www.cahealthadvocates.org/news/disparities/2007/are-you.html for more information on this and some self-reflection exercises, as well as some additional resources on cultural humility.