The Role of Culture in Patient Care
You have to know about the culture in order to take
care of the patient effectively.”
It’s not enough to be able to diagnose the
disease and provide the treatment — physicians
must be able to understand how a patient’s
culture will impact the care.
“
Cultural competency is a developmental process,” said
Dr. Steven B. Owens of the National Association for
Equal Opportunity in Higher Education. “It
is something you’re really going to have to
work at.” Owens was one of three black speakers
this week at a Centra Health/Lynchburg Family Practice
Residency conference “Focus on the African-American
Patient.” He is a family practice physician
who also holds a degree in public health and is deputy
director of the Association for Equal Opportunity’s
Division of Health Education.
Speakers described a patient population which
has some distrust of health systems; one
which often
has traditional home remedies that need to be
considered when providing care; and a group
with deep religious
convictions which need to be respected. The legacy
of slavery and segregation also shape the patients’ attitudes
toward seeking care or following regimens.
Nationally, black Americans have higher rates
of diabetes, lung, colon and prostate cancer.
The
rates are higher for obesity, heart disease,
kidney disease,
and for complications of diabetes. Black American
men have the highest rate of prostate cancer
in the world.
“There’s a lot of work to be done, not just on African Americans,
but on health issues.
Being culturally competent means understanding
your own path and other cultures’ heritage,
and what makes them unique, said Owens. “The three R’s of cultural
diversity are respect, relationships, recognition.”
“
Knowing the cultural history can provide clues to the health-seeking behaviors
people use,” said Owens. For example, some black Americans fear biopsies
because of a tradition that says a disease will spread “when the air
hits it.”
Black Americans also have some distrust of the
health care system, Owens noted, particularly
in light of the Tuskegee, Ala., research
in which
doctors left
a group of black men untreated for years in order to study the
way syphilis progresses over time.
Golden Bethune, a nurse and a Centra Health senior vice president,
noted that by 2050, whites will comprise about 51 percent of the
nation’s population.
Hispanics will be the largest minority, followed by blacks, and then Asians.
“
As we continue to diversify, we have to learn to take care of each other,” said
Bethune. “Cultural competency means better care. You have to know about
the culture in order to take care of the patient effectively.”
Bethune grew up in the South, and she said that
among black Americans “you
will hear that health is a gift from God and disease is a curse.”
And some diseases are thought to be work of evil
spirits. Blacks from Caribbean countries
will tell you someone put a curse
on them.
Very religious people may refuse care. “As caregivers, that is a very
hard to accept or to understand excuse (because) it is different from what
we believe,” she said.
In Central Virginia, blacks have a higher infant
mortality rate than whites and one of the
highest rates of Sudden
Infant Death
Syndrome
in the state.
Owens said that the two occur at higher rates
in blacks across all socio-economic levels
across the nation.
To understand the black American patient requires
being able understand what some have experienced
in the culture
and
what that means in
terms of patient-doctor
relationships.
“
One of the consequences of racism is that the victims flee when no one is chasing
them,” said Bethune. “As a physician, what are you likely to feel
when someone comes in to you, paranoid, not looking at you and acting like
they’re angry when they walked in the door. It sets us up. It happens
to all of us.”
Bethune said she took an informal survey of a group
she was speaking with, asking them what they wanted
in a
doctor.
“
The first thing people say is to listen, ‘to hear what I have to say.
Don’t act like I’m not important tot you … look at me. I’m
a person with feelings.’
“
Before you can begin to understand culturally diverse patients,” Bethune
continued, “you must examine your own values, beliefs and prejudices.”
To value diversity is to become a stronger country,
she said, “because
we are different, we bring so many diferent things to the table.” Lynchburg
News and Advance, May 4, 2003
