Imagine you are on a trip in a foreign country and you become sick. You are placed in a hospital surrounded by people speaking a different language. You are trying to communicate your symptoms, but find it very difficult with the language barrier. The hospital tries but is not able to find a translator for you. After some time, your physician becomes impatient and starts making assumptions about your lifestyle based on your race or ethnicity. This is a reality for many patients in America, as healthcare is not equitable for all. Some barriers exist beyond biomedicine that impact the way providers treat patients and the care that patients receive. Cultural barriers are present in several ways that affect the patient-provider relationship, such as language barriers, generational mistrust, and lack of cultural competency. Not only do these barriers affect the patient-provider relationship, but they also contribute to poor health outcomes.
The first and most prominent barrier present is language differences between providers and patients, which often lead to misunderstandings and impact diagnosis and/or treatment. The most natural cultural barrier that occurs between a provider and patients is a language barrier. One story that demonstrates this is Ysaura Rodriguez, a single mother from Dunn, North Carolina. Ysaura discusses in her interview how she came to America and the difficulties she faced as a single mother in her non-native country. She recounts one specific story about her son being hospitalized for a stomach virus. When the interviewer asked her what her experience was like communicating with the medical personnel, she responded, “That was a bad experience. It was kind of difficult because I didn’t know much English… what I didn’t know I made up… I made them understand what I was saying somehow.”[1] Ysaura also recounts, “I don’t remember that there were many people that could interpret…I don’t remember any doctors that were able to speak Spanish.”[2]. This example illustrates a lack of resources for non-English speakers and how that impeded effective communication. Al Shamsi conducted a review using data from multiple countries, including the United States, to understand the implications of language barriers in the healthcare setting.[3] He found that language barriers reduce not only the patient’s satisfaction but also the provider’s satisfaction, which decreases the quality of patient safety within healthcare. Ysaura’s story illustrates how language gaps can impact a patient’s experience and have its potential to have serious consequences in care.
Another cultural barrier present in healthcare today is generational mistrust, which can lead to reluctance in seeking healthcare. Generational mistrust in this context is defined as the lack of trust in medical systems passed down through families and/or communities. The origin of this mistrust typically originates from historical injustices and discrimination. One experience that exemplifies this is Stephanie Atkinson’s story. Stephanie describes how she had to go through cultural competency training as a nurse, which broadened her perspective. Stephanie recounts her training module discussing the Tuskegee experiment, “Guess who did this? The CDC. Guess who this is targeted? Black males of a certain age. Guess who some of the hardest patients to get to trust physicians are? Black males of a certain age.” She then adds, “and then you ask them to trust the same people… that’s why I see a mistrust in flu vaccinations”[4]. This is a nurse who has seen firsthand the effect a historical injustice has on the population that was affected. This historical injustice is the Tuskegee Syphilis Study, which was a 40-year medical experiment conducted on 600 African American men where the U.S Public Health Service denied them treatment for their syphilis. A Stanford report analyzed the correlation between the Tuskegee syphilis study with increased medical mistrust and mortality rates among African-American men. The researchers found a 1.4 gap in life expectancy for African-American men as a result of this study[5]. Damon Tweedy wrote in his Black Man in a White Coat, “Many black people, especially older ones, still refer to the Tuskegee experiment as a reason they don’t trust doctors or the healthcare system”[6]. Accounts like Stephanie’s and Damon Tweedy’s illustrate the effect generational mistrust has on communities and their healthcare decisions.
On the other hand, some patients have positive experiences with culturally competent providers, which leads to better care and trust. Cultural competency is recognizing and respecting cultures different from yours and adapting one’s behavior to meet diverse needs. This is especially important in healthcare, as providers work with patients from various cultures whose beliefs influence their healthcare preferences. Stephanie recounts her view on cultural competency: “I think I am a better nurse because of that. I have more compassion. I was always compassionate and empathetic, but I think the more that I can have insight about what patients have experienced or what they’ve been exposed to, it just helps me be better.”[7] Damon Tweedy describes in A Black Man in a White Coat an encounter with a patient who was distrustful of the medical system. “He reminded me of some older Black men I’d known growing up…and I realized that building trust with him meant listening more and judging less.”[8] Here, Tweedy recognizes that the best way to treat his patients requires empathy and understanding of the patients’ cultural background. Research conducted by Abrishami found that the patient-centered care approach is the best method for reducing health disparities among diverse patient populations. He concluded that the best way to achieve this is to train health care professionals to be culturally competent. These accounts and research show how culturally competent care can strengthen the patient-provider relationship and improve health outcomes.
Let’s imagine again you are a patient in a foreign country. This time, an interpreter is brought in, and the provider approaches your situation with compassion. You leave the hospital feeling heard and respected. This is the difference cultural competency can make. Throughout healthcare, there are cultural barriers such as language barriers and generational mistrust that affect outcomes of care. Breaking down these barriers requires cultural competency from the providers. This is done by understanding backgrounds and building trust. Breaking down cultural barriers is a necessary step for creating equitable healthcare for all.
Works Cited
[1] 00.13.57) Rodriguez, Ysaura. Interview by Joanna Ramirez. 29 June 2018. Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
[2] Ysaura (2018).(0:06:11)
[3] Al Shamsi, Hilal et al. “Implications of Language Barriers for Healthcare: A Systematic Review.” Oman medical journal vol. 35,2 e122. 30 Apr. 2020, doi:10.5001/omj.2020.40
[4] Atkinson, Stephanie. Interview by Kamney Maddy. Southern Oral History Program, 25 June 2018. Southern Oral History Program Collection, Wilson Library, University of North Carolina at Chapel Hill. (00:42:16)
[5] Alsan, Marcella, and Marianne Wanamaker. “Stanford Researchers Explore Legacy of Tuskegee Syphilis Study Today.” Stanford Report, 6 Jan. 2017,
[6] Tweedy, Damon. Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine. Picador, 2015.
[7] Atkinson (2018) (00:42:16)
[8] Tweedy (2015)