Are You Culturally Competent?
As the diversity of the U.S. population increases, so do the challenges for hospitalists, as they seek to deliver truly patient-centered care in the 21st century. The March 2002 Institute of Medicine report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” concluded that, while some care inequities can be attributed to access and linguistic barriers, healthcare providers themselves may contribute to disparities in care for their minority patients.1
How can hospitalists ensure that they bridge the cultural divide between themselves and their patients from different racial, ethnic, and cultural backgrounds and avoid potential missteps in care delivery?
An Open Mind
Experts in cultural competency interviewed for this article explained that hospitalists can readily acquire the knowledge and skills necessary to effectively provide patient-centered care for all their patients. (See “Resource List,” p. 27.) But the most critical element in culturally competent healthcare delivery is the attitude with which the provider approaches his or her patients.
“I don’t think we can teach attitude,” says Alicia Fernandez, MD, assistant clinical professor of medicine, Division of General Internal Medicine, University of California, San Francisco, a nationally known researcher on language barriers and former full-time hospitalist. “But I think that any doctor who’s trying to do the best he or she can by their individual patients has the right attitude, which is to remain open to practicing patient-centered care.”
Hospitalists face more difficulty with some cultural issues than primary care providers because we’re thrust into a situation of an acute illness, whereas the primary care provider at least gets an opportunity to establish a relationship.
—Jack Percelay, MD
Physicians must be able to approach each patient on his or her own terms, and to acknowledge that members of different racial and ethnic groups hold beliefs about health and illness that diverge from those of Western medicine.
“You really need to have the capacity to empathize, and turn off all of your own belief systems, in some cases, to listen,” says Stacy Goldsholl, MD, a hospitalist based in Wilmington, N.C., and an SHM Board member.
Dr. Goldsholl recalls one situation involving a patient who was a Jehovah’s Witness who entered the hospital with a gastrointestinal bleed. Because of religious proscriptions, the patient refused a blood transfusion.
“It was extremely difficult as a scientist-trained physician, to watch someone bleed to a hemoglobin of 5, knowing that a simple transfusion would save this patient,” recalls Dr. Goldsholl.
The patient later underwent surgery without a transfusion and survived, but Dr. Goldsholl believes this case illustrates that delivering patient-centered care requires the practice not just of the science—but the art—of medicine.
“I think the real message is, you have to think outside of your own box,” she offers. “In addition, the cultural issues become much more pronounced when you start to approach end-of-life issues that take on more of a cultural, ethnic. and spiritual dimension.”
Awareness and Knowledge
Mitchell D. Wilson, MD, believes “the average American tends to be very ethnocentric. We are not taught cultural awareness in recognizing our own inherent biases, so we are unable to take the next step and recognize that there is a gap between our culture and another person’s culture that would require us to take a different approach.”
Dr. Wilson is associate professor of medicine, medical director and physician advisor, Department of Clinical Care Management, University of North Carolina (UNC) Hospitals, and section chief of hospital medicine and medical director, FirstHealth of the Carolinas Hospitalist Services, UNC School of Medicine, Chapel Hill. He is also an SHM Board member.
