Cultural Considerations

Sharnjit Grewal, MD, a hospitalist at Mercy Medical Group in Sacramento, Calif., is familiar with what he calls “the double-take.” A Sikh born and raised in California, Dr. Grewal wears a traditional turban and full beard. When he walks into the room, some patient’s simply don’t know what to make of him, he admits.

“It’s confusing—even to my Hindu and Sikh patients,” Dr. Grewal says. “They sometimes say, ‘You talk like an American, you’re obviously from the West, but you follow a faith from the East. The line between religion and culture is obscured.”

Although the medical community stresses cultural awareness and sensitivity, Dr. Grewal’s experience highlights the fine line between religion and culture, and the barriers standing stand in the way of cultural awareness.

Today, hospitals experience shifting patient demographics and a growing number of languages and dialects observed in the United States today. Between 1990-2000, the foreign-born population in the U.S. increased by 57%, compared with a 9.3% increase for the native population and a 13% increase for the total U.S. population, according to the U.S. Census Bureau.

Differences Come in All Shapes, Sizes, Languages

The healthcare industry is addressing cultural competency and encouraging practices and policies aimed at increasing understanding. Sensitivity regarding patients’ sexual orientation is a component of cultural competency. Often, gay, lesbian, bisexual, and transgender individuals avoid “even routine medical visits after negative healthcare experiences due to providers’ lack of cultural competency,” according to the Gay & Lesbian Medical Association’s 2008 Healthcare Equality Index.

“One of the challenges of promoting cultural competence is that it is often believed to be aimed solely at individuals from minority backgrounds who may have unique beliefs,” says Amy Wilson-Stronks, Project Director for Health Disparities with the Joint Commission and principal investigator of the 2008 Joint Commission report One Size Does Not Fit All: Meeting the Health Care Needs of a Diverse Population. “The point is that we are all unique and cultural competency is important for everyone—not just ‘minority’ populations.”

Language barriers are an everyday occurrence for most hospitalists. The limited English proficient population grew from 14 million to 21.3 million between 1990 and 2000, according to U.S. Census figures.

The healthcare system also is dealing with multilingual populations in cities where language has not been a challenge in the past, according Cynthia Roat, MPH, a consultant and trainer on language access in healthcare. For example, limited English proficient populations in Georgia and North Carolina each grew by more than 240 percent from 1990-2000.

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