Wednesday, September 29, 2010

Cultural competency training should not rely on stereotypes

Two physician readers submitted the following post about a topic that is becoming increasingly important to family physicians. In addition to the Curbside Consultation discussed below, AFP has also previously published clinical reviews of cross-cultural medicine and cultural diversity at the end of life.


While we appreciate Dr. Gupta’s insights into culturally specific care for Indian patients in the July 1, 2010 Curbside Consultation, “Improving Sensitivity to Patients from Other Cultures,” we feel that the article's emphasis on learning culturally specific stereotypes can be potentially misleading for clinicians. Cultural competency training has traditionally involved memorizing culturally specific “rules” (e.g., Muslims don’t shake hands). Although learning about a particular group’s cultural norms can be helpful, it may also lead to stereotyping and false assumptions. Because clinicians are caring for increasingly diverse populations, including growing numbers of immigrants and refugees, there are too many cultural groups with too many norms to become familiar with.

A more practical approach to cultural competency has emphasized not the patient’s background, but instead, the “implementation of the principles of patient-centered care, including exploration, empathy, and responsiveness to patients’ needs, values, and preferences.” In the words of another useful definition, cultural competence involves an “examination of one’s own attitude and values, as well as the acquisition of the values, knowledge, skills and attributes that will allow an individual to work appropriately in cross cultural situations.” Published tools aid in learning and teaching these skill sets. Busy clinicians are better served by using these tools to practice culturally sensitive and individualized patient-oriented care, rather than memorizing lists of cultural norms and “rules."

Bernadette Kiraly, MD
Peter Weir, MD
Hartland Refugee Clinic
Department of Family & Preventive Medicine
University of Utah School of Medicine