People seeking healthcare in North America are increasingly global in their make up. Some 50 million are culturally diverse and operate with understandings of health and medicine that are unfamiliar to most healthcare professionals. Nevertheless, we must effectively understand and communicate with these individuals and families to be successful in assisting them. Consider the following scenario:
In a busy emergency department at an urban hospital, a Hispanic mother sits crying in an exam room while a resident physician examines her month-old baby. The infant is severely dehydrated, and immediately is given IV fluid. Throughout the encounter, the mother is very detached, sitting across the room, and continuing to weep uncontrollably. The resident senses there must be important dynamics at play, but feels frustrated and at a loss to understand what’s really happening.
This young healthcare professional is not alone. A recent survey of physicians in the Healthy Families program reveals that 71 percent believe that culture and language are important in delivering patient care. Over half also believe that their patients do not adhere to medical treatments as a result of cultural or linguistic barriers. Yet, over half of these physicians also report never receiving any form of cultural competency training.
In any number of culturally confounding situations, a most helpful question to ask is simply, “Help me to understand why…” In the case of this health care professional assisting the weeping mother, “Help me understand why you are crying,” “Help me understand why your baby is ill,” and “Help me understand how I can assist you.” Asking questions of this sort with an air of genuine warmth and interest often reveals the concepts or behaviors that lead to ill health. This sort of tactful inquiry also preserves self-respect and may prompt patients to discover for themselves important insights or corrective actions. Lets see how our resident physician deals with this situation…
Through an interpreter, the young physician takes his time asking the mother about what is wrong. A few minutes of conversation makes it obvious that she is suffering from post-partum depression. The astute resident asks, “Help me understand why you are not nursing your baby,” and discovers that the mother believes she must not nurse when she has sad feelings or thoughts, for these are caused by evil spirits that will then be passed on to the baby via her breast milk.
This resident physician was successful in bridging significant barriers between himself and this mother, calling upon essential cross-cultural skills. Most healthcare professionals would do very well to strengthen their abilities in this field, and when cultures conflict, remember to ask, “Help me understand why…”