CROSS-CULTURALPERSPECTIVES

Craig Ernst MHS, PA-CProfessional TopicsLHUP PA Program

Empathy and CompassionImagine being in a foreign land and foreign culture.How would you feel?

Vulnerable?Scared?

Now imagine being sick in this same setting?What would you want from your foreign health care provider?

What is Culture?

Culture

Shared way of lifeTransmitted from generation

to generation

Way of LifeMannersDressLanguageReligionRituals

ValuesNormsBeliefsAssumptionsExpectations

Concept of CultureEthnic Group:

AncestryCountry of originSpecific subgroup identification

What about Culture and Ethnicity in our society?

Country founded by immigrating groupsMigration continuesEthnic Birthrates

Minorities account for 90 % of growth since 2000 Hispanics: 50 million (16% of population)

35 million in 2000

Asians: larger numeric gain than African Americans

AcculturationProcess whereby attitudes and behaviors of people from one culture are modified as a result of contact with a different cultureDepends on…

Length of timeAge of individual on arrivalSocioeconomic status

Cultural Effects on Behavior and Decision Making

Remember that you are the product of your cultureAs a provider you must avoid ethnocentric (eurocentric) biasApproach your patients with an open mind

Recognize that they hold different beliefs, values, and assumptions than youTheir world view is not wrong, just different from your own

Comparison of Western and Non-Western Culture

Patient CareRESPECT is KEYProbably the most comfortable patient care situation is where patient & provider share the same ethnic background & life experiences!

Mutual respect

Health Disparities?

Cultural FactorsAcculturation & AssimilationSocioeconomic Factors

Cultural FactorsCultural beliefs & practices

BirthChildrearingDietPerceptions of DeathTraditional definitionsAccess to traditional healers

Acculturation & AssimilationNumber of years in the countryLanguage(s) spokenComfort with host cultureIntegration with decision making process of dominant culture

Socioeconomic FactorsPoverty

Crowded living areasIncreased spread of communicable diseasesDelay in seeking treatment Difficulty in getting meds/tests

Insurance…Community environment

Clinical Case Mrs. R is a 55 y/o Mexican-American woman with Type II Diabetes. She comes into your clinic with CC: of fatigue. Her glucose is 228. On exam she has diabetic retinopathy & decreased sensation on both feet.On review of the chart, you note that she was last seen 18 months ago. At that time she was counseled on diet and exercise. She was also started on metformin. She was instructed to follow up in several weeks.

Clinical Case ContinuedShe is not currently taking the meformin and has not followed any of the other recommendations given.

Why is this patient noncompliant?

Possible Explanations…Cultural beliefs & practices?Acculturation? Socioeconomic status?

Caring for Patients: Cross Cultural Perspective

How does the patient think about the illness…

…stems from the pts belief system which contains…

Their explanation of the illness based on spiritual, religious, or social circumstances

Explanatory Model QuestionsWhat do you think has caused your problem?Why do you think it started when it did?What do you think your sickness does to you? How does it work?How severe is your sickness?What kind of treatment do you think you should have?

Ask these questions with Listen with sympathy & understanding Explain your perception of the problem Acknowledge & discuss the differences &

similarities Recommend treatment Negotiate agreement

Exotic Cultures!