By Lisa A. Eramo
Taking the time to understand a patient’s cultural context not only enhances a physician’s ability to diagnose and prescribe treatment, but it also helps create a closer bond that can lead to better outcomes.
In an increasingly diverse society in which racial, ethnic, socioeconomic, and cultural health disparities exist, it’s important for physicians to evaluate their own cultural competence to ensure that they can deliver care that is both sensitive and informed.
The Office of Minority Health defines cultural competence as a “set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.” In medical practices, being culturally competent means that physicians understand, respect, and take into consideration patients’ health beliefs, health practices, and cultural and linguistic needs.
In a video about how effective healthcare communication contributes to health equity, the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) identifies the following cultural factors that can contribute to health disparities: gender, gender identity, sexual orientation, socio-economic status, language, physical and mental capacity, age, religion, housing status, and regional differences. There is also often further diversity within specific cultural and ethnic groups. Identifying these factors can help to ensure positive health outcomes.
HRSA provides a web-based training course, “Effective Communication Tools for Healthcare Professionals,” that helps providers respond to patients’ cultural and linguistic needs. HRSA also provides various other resources to help providers address patients’ unique needs.
It’s important for today’s physicians to be culturally competent because they practice in an increasingly diverse society, says Darci L. Graves, MPP, MA, MA, senior health education and policy specialist with the Health Determinants and Disparities Practice (HD&D Practice) at SRA International, Inc. The HD&D Practice currently manages Think Cultural Health, an online clearinghouse of resources hosted by the Office of Minority Health. To become culturally competent, physicians need to consider a patient’s cultural framework as well as their own biases and assumptions, she says.
“Even if you look the same on the outside, chances are, you’re still having a cross-cultural encounter,” says Graves. Differences in religion, for example, may exist. Being culturally competent and sensitive means that physicians don’t ask cookie cutter questions but rather take the time to get to know each patient individually and adapt questions accordingly. This allows for a much more thorough and accurate history and exam, she adds. It also helps answer questions such as why a patient may not take a certain medication or follow through with treatment recommendations. In general, understanding cultural context can enhance the overall clinical picture and help providers render more informed care.
Cultural competency also enhances communication and understanding. A patient who won’t make eye contact, for example, isn’t necessarily disinterested in the clinical information a physician provides, says Graves. “That could just be their way of showing deference,” she says, adding that in certain cultures, this behavior is commonplace.
More thoughtful questions and communication can also help patients feel more connected to their physicians.
This, in turn, can lead to better patient engagement, compliance with medical treatment, and outcomes. Physicians who take the time to understand their patients’ complete stories may experience better patient retention.
According to kevinmd.com, responding to the unique needs of each patient, including his or her spirituality, contributes to patient-centered and family-focused care can enhance both patient safety and satisfaction.
Cultural competence is important for all providers, which is why it’s a focus area for the Association of American Medical Colleges (AAMC). More specifically, the AAMC strives to promote a “culturally competent, diverse, and prepared health and biomedical workforce that leads to improved health and health equity.”
However, today’s physicians practice an increasingly challenging and regulatory-driven environment that minimizes the time they’re able to spend with patients. Cultural competence is just one part of this complex environment, and it’s one that’s constantly evolving.
Graves says physicians shouldn’t feel burdened by cultural competence but rather empowered by it. “It’s not about adding something extra—it’s about tweaking what you already do. It’s about making sure that the questions you’re asking as well as how you’re asking those questions is culturally appropriate,” she says.
The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards) include several principles designed to foster health equity.
The Office of Minority Health also provides a blueprint that practices can use to operationalize these principles. Providers can register for free to download this document titled, “A Blueprint for Advancing and Sustaining CLAS Policy and Practice.” For example, the blueprint encourages providers to inform all individuals of the availability of language assistance services clearly and in their preferred language (verbally and in writing); provide easy-to-understand print and multi-media materials and signage in the languages commonly used by the populations in the service area; and partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.
The Commonwealth Fund suggests that providers should modify intake forms to include questions regarding health literacy, English proficiency, language spoken at home, and use of complementary and alternative medical practices.
Providers can also complete a cultural competence self-assessment, such as the one developed by Tawara D. Goode of the National Center for Cultural Competence, to identify areas in which they may be able to improve the quality of care provided to diverse populations. This assessment asks providers to evaluate their physical environment, communication style, and values and attitudes.
Looking for additional ways to make your practice more welcoming and culturally inclusive? Refer to these resources on the Think Cultural Health Web site. You can also download this terrific guide on improving patient engagement!
About the Author
Lisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.