By Stephany Rollins
“[E]very kind of disease they were testing me for when nobody did a simple test to find out if I had mononucleosis. It didn’t even occur to them…because all the researchers are thinking, ‘Ah! We’ve got an immigrant,’” details Lata Chatterjee, an Asian American professor of Geography and Environmental Engineering, about her experience with the U.S healthcare system. Many minorities today are experiencing the same issues with healthcare providers due to a lack of communication. A reoccurring theme among medical minority cases is ethnicity as a determinant of illness which causes providers to make assumptions about their patients, often leading to negative emotional and physical outcomes. Instead, ethnicity should be utilized under the context of culturally comprehending the patient’s needs to ensure quality care, as it can significantly influence healthcare decisions and outcomes. For this reason, it becomes essential for providers to obtain a set of skills and equitable attitudes that effectively address cultural interactions, often referred to as cultural competence (CC). Cultural competence is an asset to advocating minority health needs in healthcare as it establishes trust and constructively recognizes the importance of medical advice and patient concerns.
Incorporating cultural competence in medical practice helps diminish medical distrust within minority communities as care transitions from an illness-centered approach to a cultural understanding of patients to treat illness. Trust will help to encourage patients to take ownership of their health and actively engage in their health decisions. A study conducted to assess the outcomes of provider cultural competence in HIV care revealed that 336 nonwhite HIV patients exhibited an increase in self-efficacy in managing their medication as provider CC increased (Saha et al. 625).
As providers work to establish trust, patients will become more open about their health and to medical advice because they confide that their provider respects their needs and will incorporate them into treatment. However, trust relies heavily on time which many providers lack given the constraints of the healthcare system. Cultural competence aids providers in overcoming these restraints by treating illness based on a compiled cultural understanding of their patient by listening. Take, for instance, Ysaura Rodriguez, a Hispanic healthcare worker, explaining what sets her provider apart from others, “… I’m able to talk to her about whatever I want to talk [,] and she doesn’t seem rushing… I’m important and she wants to hear what I have to say.” In an unknown terrain of medicine and illness, patients are aware of the knowledge providers obtain. However, they need a reason to trust that they will prioritize a need all patients urge their providers to acknowledge: to be heard.
Miscommunication is another factor that cultural competence may improve by establishing a constructive dialogue that challenges the knowledge of both sides of the doctor-patient complex. As mentioned previously, it is evident that providers have a biological perspective of health based on how processes in the human body should interact with and without the presence of treatment. However, the patient perspective recognizes health as how the body should perform and feel. Both sides of the complex often clash due to miscommunication from a lack of mutual understanding. William Sessions, an African American non-profit owner, explains miscommunication from a patient perspective, “…when the doctor refuses to accept what the client is saying and choose, rather, to diagnose by what the book says”. The situation described demonstrates a negative outcome of an illness-centered approach that deems patient knowledge inferior to the provider’s. This miscommunication Sessions describes is seen with home remedies that providers dismiss without recognizing its impact on the doctor-patient complex and their patient’s health. Home remedies can be perceived as a patient’s interpretation of medicine used to improve their health. However, ignoring or rejecting these attempts of patient engagement may discourage patients from confiding in their providers and medical treatment.
For this reason, constructive dialogue on behalf of the provider can be implemented to reach a consensus on treatment that respects the patient’s input while acknowledging medical advice. An example of such can be seen in interaction with Ysaura Rodriguez and her provider: “… when I talk about home remedies, she doesn’t say, “You’re not supposed to do that,’… if I said I want to try this home remedy, and she said, ‘Let me know if it works. But think about your medicine…”. Doctors could also benefit from such dialogues by discovering a home remedy that is a safer treatment alternative or a source of reoccurring symptoms that may lead “…to harmful drug interactions” (Brach and Fraserirector 182).
Thus, it is evident that cultural competence is an asset to providers in developing a consensus on treatment plans while prioritizing patient concerns. Hospitals can work to implement cultural competence into healthcare to better accommodate treatment plans to patient needs. A possible step toward systematic cultural competency is establishing interpreter services that aim to eliminate language barriers that may interfere with a patient’s understanding of their illness, minimizing distrust and miscommunication in the doctor-patient complex. A study focused on assessing hospital performance by implementing cultural competence as an organizational intervention revealed an 8.3% increase in patient cultural competency by offering interpreter services and an 8.6% increase by incorporating translator services (Weech-Maldonado et al. 37). In addition, diversifying the medical workforce to include minority healthcare workers, community health workers, and traditional healers can help “…bring in individuals who had not previously sought care, provide cultural linkages, overcome distrust, and contribute to clinician-patient communication…” (Brach and Fraserirector 186)
Cultural competence brings providers and hospital staff a step closer to establishing trust, communication, and a diverse understanding of illness. From encouraging ownership of health to collaborative patient treatment plans, this foundational skill will prioritize patient needs as a cure to illness. Above all, urge providers to listen to patients like William Sessions, “… let’s not continue this cookie-cutter doctor’s treatment…”.
Brach, Cindy, and Irene Fraserirector. “Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model.” Medical Care Research and Review 57.1_suppl, 2000, pp. 181-217.
Chatterjee, Lata. Interview with Nick Allen. 11 December 2018 (Y-0084). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Rodriguez, Ysaura. Interview with Joanna Ramirez. 29 June 2018 (Y-0044). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Saha, Somnath, et al. “Primary care provider cultural competence and racial disparities in HIV care and outcomes.” Journal of General Internal Medicine 28.5 (2013): 622-629.
Sessions, William. Interview with Joanna Ramirez. 27 June 2018 (Y-0049). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Weech-Maldonado, Robert, et al. “Hospital cultural competency as a systematic organizational intervention: Key findings from the national center for healthcare leadership diversity demonstration project.” Health Care Management Review 43.1 (2018): 30-41.