Friday, July 17, 2009

The culture gap in healthcare

In a NY Times column this week, Pauline Chen, MD, tells the story of two Asian-American sisters, both infected with hepatitis B and one of whom is suffering from liver cancer.

The family would later discover that all six siblings contracted hepatitis B, which predisposes people to cirrhosis and cancer, from their mother, who died of liver cancer. Two brothers also later died of the disease.

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Hepatitis B is more common among Asians, and Chinese are at highest risk, Chen writes. But it seems clinicians the family members had seen earlier weren’t more aware of health risks of Asian-Americans.

Although this has been changing in recent years, and medical schools have been responding with “cultural competency” curricula, a level of cultural understanding seems critical for the health of the patient and the relationship between patient and doctor.

We addressed cultural competency in an article about how it can improve patient care and build your business.

Without some level of awareness of cultural differences, Chen points out:
- Clinicians could miss important medical implications
- The healthcare worker may risk alienating the patient
- The patient’s perception of the care may also be effected

Considering physicians' time constraints, it’s hard to know everything about everything. But, Arthur Kleinman, physician and professor of medical anthropology and psychiatry at Harvard Medical School, tells Chen: “What you don’t want is doctors carrying around plastic cards listing the five things you need to think about when you see, for example, an Asian-American patient.

“What you want is the ability to inquire, to ask questions.”

Have you had experiences like this that tested your cultural competency or prompted your practice to make changes? Is it possible to have a full awareness of cultural differences?

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