Cultural Competency

Cultural issues include disabilities and ethnicity. For example, there is a clear cultural divide in the deaf community between those who use sign language ("signers") and those who are referred to, often derisively, as "audists," or lip readers. The signers sometimes believe the audists have betrayed their disability by trying to "act as if it is not real." A signer is obviously deaf, but a lip reader is not. In addition to deaf patients, the following guidelines apply to patients with other physical and mental disabilities:

1. Be sensitive to patients with mental and physical disabilities.

2. Treat an adult as an adult. Do not patronize the patient.

3. Remember that a disability does not define intelligence.

One of the problems in being sensitive to cultural diversity is stereotyping similarities. Language, dress, or skin color may or may not be evidence of a particular ethnicity. Two people with the same skin color or the same language may be of totally different cultures. An American black, whose family has been in the United States for 200 years, has more in common with an American white than with a recent black immigrant from east Africa. A Hispanic person from Central America has an entirely different cultural experience than a Puerto Rican from New York City. A South Korean is very different from a Hmong from Laos, and a Japanese person and a Chinese person are not from the same culture or language.

The following recommendations address ethnicity in the primary care practice:

1. Provide pictures and magazines in the waiting room that reflect the cultural diversity of your patient population.

2. Provide written materials, such as home instructions and medication instructions, in the language of your patient population.

3. In all forms of diversity, avoid stereotyping similarities.

4. Pay attention to the languages that patients speak. If they speak only limited English, do not assume they understand what you are recommending medically. Ask questions. What is your country of origin? How long has your family been in the United States? What is your primary language?

5. Different cultures have different religious and cultural understandings of illness. How do you understand what the problem is that you are having?

6. Some cultural groups include other family members or healers in decision making. Being open and respectful, the patient is more likely to accept what the physician says. Ask questions to determine the situation. Are there others who will be included in the decision making for your medical care?

7. Be sensitive to the patient's language and to the patient's level of literacy when giving written instructions.

8. Thank the patient for coming and helping you understand their concerns.

Pearl

Avoid stereotypes and the myth of similarity.

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