Friday, January 25, 2013

Providing culturally competent health care

- Kenny Lin, MD

The increasing diversity of the U.S. population has made it more likely that family physicians will care for many patients with cultural backgrounds, beliefs, and practices that are dissimilar to their own. As a previous article in American Family Physician observed, patients' beliefs regarding health and disease causation may pose obstacles to communication even when physicians and patients speak the same language. Using medical interpreters is another skill that takes practice to achieve proficiency, but has clear benefits, according to the author of a Curbside Consultation: "The skills of a medical interpreter or translator include cultural sensitivity and awareness of and respect for all parties, as well as mastery of medical and colloquial terminology, which make possible conditions of mutual trust and accurate communication that lead to effective provision of medical health services."

In the review article "Caring for Latino Patients" in the January 1st issue of AFP, Dr. Gregory Juckett notes that this population faces a number of special medical concerns:

Approximately 43 percent of Mexican Americans older than 20 years are obese, compared with 33 percent of the non-Latino white population. Diabetes and hypertension are closely linked with obesity; 11.8 percent of Latinos older than 20 years have type 2 diabetes (13.3 percent of Mexican Americans), making it the foremost health issue in this population. A higher-calorie diet, a more sedentary lifestyle, and genetic factors contribute to this problem. Because of less access to health care, Latinos with diabetes are often diagnosed later and have a greater risk of complications.

To navigate and resolve cultural differences that may impede understanding and effective treatment, Dr. Juckett advises that clinicians use the LEARN technique for cross-cultural interviewing:

1. Listen sympathetically to the patient's perception of the problem,
2. Explain his or her perception of the problem to the patient,
3. Acknowledge and discuss any differences and similarities between the two views,
4. Recommend a treatment plan, and
5. Negotiate agreement.

For practices that see sizable numbers of Latino patients, the article also includes a helpful list of strategies for creating a culturally sensitive office environment.

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