What the scalpel is to the surgeon, words are to the clinician ... the conversation between doctor and patient is the heart of the practice of medicine.
Philip A. Tumulty, MD (1912-1989)
The cultural aspects of physical diagnosis and medicine are becoming increasingly important. By the middle of the 21st century, the majority of the population in the United States will no longer be white. It is imperative that all health-care professionals understand the dimensions and complexities of caring for individuals of culturally diverse backgrounds in the United States. Equally important is the provider's knowledge of the cultural and socioeconomic factors that affect the patient's access to and use of health-care resources. When treating recent immigrants, clinicians must be aware that their attitudes toward illness and treatment may be very different from those of the indigenous population. Second-generation immigrants may have yet a different appreciation.
The United States is home to one of the most ethnically and culturally heterogeneous populations in the world. There are more than 100 ethnic groups and 400 tribes of Native Americans in the United States, each with diverse practices and beliefs. This chapter provides some relevant issues of cultural diversity in health care and is intended to sensitize the health-care provider to the impact of cultural diversity on health-care delivery. This chapter is not comprehensive, because not all groups are represented; no culture was intentionally omitted. The chapter is divided into two main sections: (1) a discussion of some general considerations in delivery of health care in a multicultural society and (2) selected cross-cultural perspectives.
The names used to identify various groups change with time. Within a cultural group, there are variations as to how its members identify themselves and what name they prefer. The names of cultural groups often grow out of ethnic and ideologic movements.
The examples of health-care practices in this chapter illustrate traditional cultural differences. However, not all patients of a certain group hold that group's traditional beliefs. Many patients who are now second- or third-generation Americans may not follow these practices but may know of them from parents or grandparents. Caution should also be taken to avoid stereotyping the patient by race, lifestyle, cultural or religious backgrounds, economic status, or level of education; this is detrimental to establishing a solid doctor-patient relationship. The health-care provider must recognize that there is also great variability within cultures. The following is intended not to stereotype or label any particular group but rather to teach how to recognize common cultural characteristics to understand better the needs of patients.
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