The Need for Cultural Competence in Health Care

Designed by Antoinette Fang

It had been 3 weeks now that Seema had been suffering from an intense pain in her ear, and she couldn’t stand it any longer. When she reached the doctor’s office, she was a little nervous, but not for the reasons one might typically expect. As an Asian immigrant, she had faced many experiences where her doctors had trouble understanding her. Was this because of her unique accent? Because she spoke English slightly differently? Meeting a new doctor had always been a nerve wracking experience for her.

When she finally met her doctor, she had hoped that he would be able to help her quickly and efficiently— a reasonable expectation. But this was not the case. When the doctor asked her questions, she felt as though she were being interrogated. And as he performed the check up she felt as though she were a farm animal, being poked and prodded without any concern for how it hurt her. Seema wanted it to stop, but how could she disrespect him? She had always been told that it was rude and disrespectful to talk back to authorities. Remembering those values that had been instilled in her, she remained quiet and instead tried to pull away, hoping the doctor would realize that he was hurting her.

He did not. The doctor continued his harsh procedure until he eventually drew blood, and then he blamed Seema for moving and causing it. Seema left in tears. She couldn’t understand why this had happened to her or why the doctor had been so aggressive throughout her appointment. Her pain had not been addressed and on top of that her ear was now bleeding. 

So why did Seema have such a terrible experience with this doctor? All she had wanted was a treatment for her ear pain— she had never expected to come out in more pain than before. In this situation, it boils down to a lack of cultural understanding between the doctor and the patient. While Seema came from a culture that valued not talking back to authority figures and offering them unlimited respect, the doctor came from a culture where verbal expression and directly stating one’s issues were valued. He could not understand the nonverbal communication coming from Seema, and Seema did not want to offend him by telling him that he was being too harsh. This lack of understanding between the patient and the doctor led to a miserable clinical experience.

Designed by Antoinette Fang

Unfortunately, this is a scenario that occurs often in today’s medical practices. There are many situations where a patient does not receive good quality healthcare due to their race or cultural background. This may be due to lack of understanding between the doctor and the patient— as it was in this situation— or it may be due to prejudices held by the medical professional, which result in providing lower quality of care (Grady and Edgar 2001). 

This brings us to the issue of cultural competence. Cultural competence in healthcare emphasizes medical professionals appreciating diverse values and being able to adapt interactions with a variety of patients to better fit their specific values. There have been various studies showing the importance of cultural competence in medicine as well as its effects on “improving patient centered care and increas[ing] access to high-quality care” (Jernigan et al. 2016).

It has been shown that “biases, prejudices, and stereotypes held by healthcare providers result in lower-quality healthcare provided to racial and ethnic minority populations” (Jernigan et al. 2016). In response, this lower-quality care often leads to building more distrust of medical professionals in minority communities. The end result is a decrease of communication between the patient and the professional, further increasing the challenge of providing proper health care to these patients. By increasing the emphasis on cultural competency, these biases can easily be avoided as medical professionals take the time to learn about how cultures and values can vary from patient to patient.

In addition to impacting the general quality of care, cultural competency also has a large impact on patient compliance. It has been shown that patients are less likely to follow recommendations made by any health care providers when the need for the treatment or medicine has not been explained to them (Young and Guo 2016). This issue is further amplified in culturally diverse communities that tend to have their own treatments to help alleviate symptoms. Certain cultures value these natural remedies over Western medicines and if these remedies are used alongside any prescribed medications they could lead to side effects if the ingredients were to interact. For example, St. John’s Wort is a yellow flowering plant used in traditional European medicine, and is currently used for depression, ADHD, OCD, and menopausal symptoms; however, when it is taken alongside some medications (including antidepressants and birth control), it can reduce the effects of the drug and may also lead to increased serotonin production resulting in potentially dangerous side effects (NIH). It is important to explain these risks to patients in a respectful manner in order to ensure that their ailments do not worsen due to improper use of medications.

This issue of cultural competence is not something that will eventually fade away— especially in a nation like America, where the population grows in diversity every year, and a number of different cultures are represented in various communities across the nation. As diversity increases, the need for improved cultural competence training increases as well.

Currently, there are courses in cultural competency offered at medical schools, and medical students are required to take an exam to show “a standard level of cultural competence upon graduation” (Jernigan et al. 2016). However, these courses lack consistency across schools and even then the majority of cultural competency training is received after medical school during residencies. Aspects such as cultural competence are “learned through a context-dependent informal curriculum” (Rothlind et al. 2020). Therefore, the training that an individual receives depends on factors such as the supervisor they are assigned to, the diversity of the communities they work with, and the ways in which these communities have assimilated with the normative culture. It is very possible that some individuals may have the chance to work with many diverse populations and practice much cultural competency while someone else may only be working with a racially and culturally similar population and therefore not have much of an opportunity to learn cultural competence. As a result, the amount and method of training different medical professionals may receive can vary greatly.

Although there is no consensus on the best educational strategy to teach cultural competence, it has been shown that there is great importance and value on culturally competent health care workers. This competency education should begin in medical school and then “continue throughout professional practice” (Young and Guo 2016). While this format is similar to the current methods of teaching cultural competency, a “complementary formalized training would be beneficial” (Rothlind et al. 2020) throughout training in order to reduce the impact of a single supervisor’s preferences. 

Overall, there is no single answer on how to increase cultural competence in the medical workforce. But it is not solely in the hands of medical schools to teach it. Cultural competence is something that takes time to learn and “is a process of inner reflection and awareness” (Young and Guo 2016). It is important when planning a career in the medical field to remain dedicated to the process of providing culturally competent care, due to this increasing diversity. When entering the medical field, doctors must commit to ensuring that patients receive the best quality of care possible and that they make the effort to better understand their patients. 

Through cultural competency training and better communication with patients, incidences such as the one Seema had can be reduced. Medical schools and residency programs must improve the current cultural competency training programs, but change does not depend solely on the improvements they make. Medical students must also make a commitment to remain open to learning about cultural competence and to make a conscious effort to improve with every opportunity received. The combined impact of improved competency training and the dedication of medical students to provide good quality health care to diverse populations will inevitably lead to a better experience for patients, and maybe then patients like Seema can finally feel comfortable the next time they walk into a doctor’s office.

Edited by Bindu Srinivasa

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