Challenges of Cultural Diversity and Practice of Medicine

Dr. Rita Luthra
Women's Health & Education Center (WHEC)
United States of America

Culture is a lens through which people see their world. In large measure culture determines one's thinking, believing, working, eating, dressing, relating; and healthcare. In order to maximize the opportunity to provide good healthcare and to minimize the risk of doing harm to patient, healthcare providers need to recognize that every professional encounter with a patient involves three cultures: that of the patient, that of the healthcare provider and that of the environment. Ignorance may be forgivable; neither ignorance nor arrogance provides a good foundation for building of a trusting physician-patient relationship. Respecting cultural diversity is not a legal mandate. A physician's ability and willingness to reach beyond the boundaries of his/her own culture is likely to be perceived as a statement of respect for the patient. It is both good medicine and good risk management.

The purpose of this document is to enhance better understanding of interaction between cultural diversity and practice of medicine and to recognize the ethnic, religious, familial, and/or societal forces that influence any one patient. To treat the patients effectively, he/she needs to value the cultural diversity of his/her patient population. The ability to respect the integrity of each patient's cultural beliefs is the first step in developing "cultural competence". Communicating respect for the patient's beliefs and be sensitive to the traditions of a patient's culture, may lead be better patient-physician relationship.

Cultural Diversity

Cultural Diversity is a very present reality in medical practice today in each and every country. Individuals representing a myriad of different races, ethnic backgrounds, world experiences, learned behaviors, values, religions, beliefs, languages, and health practices may all be or become the patients of one hospital, one surgicenter, one walk-in clinic, or one office practice. The burden falls upon the physician to try to reasonably accommodate the patient.

What are the responsibilities of the physician to these populations? Conversely, what is the responsibility of these patients to the physician? What is reasonable in such situations? How can physicians navigate the sometimes-treacherous-waters of cultural diversity? It may be difficult for a physician to respect a patient's cultural beliefs or practices when those choices challenge some of the most deeply held professional beliefs of the physician. How can a physician reconcile his/her own belief that a terminally ill patient should get his/her affairs in order with the family's protests that in their culture the suggestion that, a Will (legal-document) be prepared, is tantamount to a death wish? How can a physician do nothing as a patient asserts his/her religious preference to refuse the transfusion that could save him/her from exsanguinations? And how can an allopathic physician honor his/her patient's choice for acupuncture, alternative medicines or any other "not scientifically" proven management?

Competent adults have the right to make their own choices about their healthcare. To workout a compromise that balances the patient's beliefs and the physician's judgment, sometimes is the best, a physician can do. In most cases, the physician who takes the time to at least understand what cultural dictates, helps to determine the healthcare practices of his/her adult patients. Then he/she will be able to work with those patients for the betterment of their health. With minors, the question is not one of culture but of law.

Cultural diversity in now the norm in medicine in each and every country. Physicians and other healthcare providers need to adapt their practices to the needs of all their patients, not simply because it is the law but rather because it is good medicine. It is even a good risk management.

The Power of Thoughts:

By virtue of the thoughts, which we choose and encourage, both of the inner garment of character and the outer garment of circumstance may weave in enlightenment and happiness. We are the makers of ourselves. Most of us understand this law in the natural world and work with it; but few understand it in the mental and moral world. All those seeking wisdom and tranquility in a turbulent and complex world - only the wise persons whose thoughts are controlled and purified can find peace of mind. We are literally what we think. A noble and God-like character is not a thing of favor or chance, but is the natural result of continued effort in right thinking and the effect of long cherished association with God-like thoughts. By the right choice and true application of thought, we ascend to the Devine-Perfection. We are the master of our thoughts and the maker and shaper of condition, environment and destiny.

Thought and character are one, and as character can only manifest and discover itself through environment and circumstance, the outer conditions of a person's life will always be found to be harmoniously related to our inner state. As a progressive and evolving being, we are where we may learn and grow. Every thought seed sown or allowed to fall into the mind, and to take root there, produces its own blossom sooner or later into an act. Good thoughts bear good fruit and bad thoughts bad fruit. The outer world of circumstance shapes itself to the inner world of thought, and both pleasant and unpleasant external conditions are factors, which make for the ultimate good of the individual. We are the sole authors of our character. Good thoughts and actions can never produce bad results; bad thoughts and actions can never produce good results. We cannot directly choose our circumstances, but we can choose our thoughts and so indirectly we shape our circumstances. The world is our kaleidoscope, and the varying combinations of colors, which at every succeeding moment represents the exquisitely adjusted pictures of our ever-moving thoughts.

An individual's view of wellness, illness, and treatment modalities is significantly influenced by his/her culture. For most of us who were raised in the West, illness is often seen as the body's response to a virus, bacteria, accident, or injury. For those, in some religious traditions, however, it may be an illusion or a mistaken belief. The physician or any healthcare provider who is culturally competent does not need to accept or even to fully understand the cultural beliefs or practices of his/her patients. However, to treat the patients effectively, he/she needs to value the cultural diversity of his/her patient population. "The Vision that you glorify in your mind, the Ideal that you enthrone in your heart - this you will build your life by, this you will become".

Effects of Thoughts on Health & Body:

The body obeys mind. Disease and health, like circumstances, are rooted in thoughts. Anxiety quickly demoralizes the whole body and lays it open to the entrance of disease. Many patients, unsure of the American medical system, "offering the only answer" to their chronic medical problems, are now complementing the traditional approach of their physicians with such approaches as Ayurveda, traditional Chinese medicine, Native American sweat lodges, dietary changes, vitamin therapy, and herbs. Others may simply accept illness as a part of the balance of life and death. These traditions are neither bad nor wrong. They do, however, challenge the belief that western medicine is the best of all worlds. Many of these patients do not believe in an either/or approach to healthcare, but a both/and. Non-judgmental physician or healthcare provider who can help formulate an integrated approach to their healthcare may be helpful than either an allopathic or alternative approach alone. We should be willing to understand and accept where the patients are "coming from". Respecting belief systems, not judging them but learning from them, perhaps is providing the best care possible to the patients.

Working with the patient's entire healthcare network (family and his/her other healers) may be vital to a full recovery. A therapy that honors religious obligations is more likely to be successful than one that contradicts strongly held cultural beliefs or ethnic background. It is unfair to generalize or stereotype individuals. Within the arena of cultural diversity, there are few issues as troublesome to the physician as that of language. Respecting individuality and respecting privacy is the best way of effective communication.

Emotional Intelligence:

The hallmark of principle-centered emotional intelligence is: persuasion, patience, gentleness, teach-able-ness, acceptance, kindness, openness, compassionate, confrontation, consistency and integrity. We must strive to become emotionally intelligent and principle-centered leaders. By our actions, we are role models for the communities in which we serve. We then become more effective physicians, teachers, parents and individuals - we can be. Emotional intelligence is often preferable to intellectual intelligence. According to experts, though, the attributes of emotional intelligence are most easily taught to the young. We must focus our efforts early, with our children and our students, to help them develop into the kind of individuals we value. Traditionally, intelligence has been measured in academic terms. Factual knowledge is emphasized. Our IQ, or intelligence quotient usually defines intelligence. But what does IQ really mean and does it have any relevance to our success and happiness? Society, and medicine in particular, places great emphasis on academic intelligence (IQ) to predict professional success. However, academic intelligence offers virtually no preparation for the turmoil or opportunities that life's vicissitudes brings. We as a culture undervalue emotional intelligence.

Birth and death, both are the ends of spectrum of life in this mortal world, and cannot exist without one another. Neither is more or less important than the other. The objective principles and temporal relationships of beginning-of-life care are nearly identical to those of end-of-life care. In our specialty - Obstetrics and Gynecology, we can train to maximize the skills in attending to both life and death - miracle of life and privilege of death. There are personal rewards to be gained from the skillful handling of these events, but training of these skills should be a part of the curricula in medical trainings. We learn from each patient, and privilege to take care of them helps us with our personal growth and job satisfaction. The proper skills, mentorship, and the openness to learning from patients provide the optimal rewards. The dying process is as certain as the process leading to birth; likewise, it is no less important and certainly no less rewarding.

Calmness of mind is one of the beautiful jewels of wisdom. It is the result of long and patient effort in self-control. Its presence is an indication of ripened experience, and of a more than ordinary knowledge of the laws and operations of thought. The more tranquil we become, the greater is our success, our influence and our power for good. Self-control is strength; Right Thought is mastery; Calmness is power.

Access to Affordable & Quality Healthcare:

As members of the medical profession we have ethical responsibilities not only to patients, but also to society and to other health professionals. The welfare of the patient is central to all considerations in the patient-physician relationship including respecting the rights of patients, colleagues and other health professionals. The principle of justice requires strict avoidance of discrimination on the basis of race, color, religion, national origin, or any other basis. The United States is one of the few industrialized nations in the world that does not guarantee access to health care for its population. Access to healthcare for all women is a paramount concern of Women's Health & Education Center (WHEC). Pregnant women and infants are among the most vulnerable populations in many countries including USA. Millions of women are caught in the gaps in the current healthcare systems, leaving them in a vulnerable position regarding their health status. Lack of healthcare coverage creates access issues that affect women, practitioners, and the healthcare system as a whole. Language, within the arena of cultural diversity is an important issue to the physicians and healthcare providers in an office or hospital settings. With over 2,000 religious groups now recognized in the United States, more than 300 languages are spoken here. That is true whether it is the patient whose cultural background may be considered outside the mainstream or the physician whose upbringing, education, and training may have taken place in a society with values occasionally at odds with those of western culture. The answer to the situation is as simple as the issue is complex.

Some healthcare facilities meet the needs of their limited English proficiency patients with bilingual staff. Available resources for interpreting skills and services can be accessed in USA, such as: Language Lines, Pacific Interpreters, Cross Cultural Communication Systems, Inc (CCCS), Cyracom - telephone interpretation of over 150 languages. These options are available 24/7.

Editor's Note:

There are no strangers at Women's Health & Education Center (WHEC) - only the friends you have not met. Our mission is to plan development together. In this forum we are all equals, working towards a common goal - to improve maternal and child health worldwide. We hope this is helpful. May it advance virtue and be a source of hope, strength, and blessings in our turbulent times. If there were any religion that could cope with modern scientific needs, it would be - an open mind. May all beings everywhere, with which we are inseparably interconnected, be fulfilled, awakened, free, and find peace in this world and may we all together complete the spiritual journey. Culture often trumps science. The Laws...[aim] to ensure equal access to affordable and quality healthcare might be the way forward. Remain humble. Assuming cultural competency because of shared race, language or background is to overlook the fact - that the patient is more than one cultural factor. The ability to respect the integrity of each patient's cultural beliefs is the first step in developing "cultural competence".

Suggested Reading:

  1. Women's Health & Education Center (WHEC). Internet health learning to improve women's health. Bulletin of the World Health Organization. Volume 83, Number 7, Page 557.
  2. Women's Health & Education Center (WHEC). Health-care patents andinterests of patients. Bulletin of the World Health Organization.November 2006; Volume 84, Number 11, Page 919. (Requires Adobe Reader)
  3. Women's Health & Education Center (WHEC). Contraception counselling and compliance. Bulletin of the World Health Organization. November 2007; Volume 85, Number 11, Pages 899-900.

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