Cultural competence is our ability to cooperate effectively with people of different cultures. This is especially important in the increasingly complex cultural milieu of healthcare, whether set in Kansas City or Sri Lanka. Consider the case of Kate, a nurse practitioner at an urban safety net clinic in North America. Kate is interviewing a distinctly dressed, non-English speaking woman named Huang Ying. As you read excerpts of their conversation through a translator note the quality of Kate’s cross-cultural skills.
Huang: “I feel very tired since coming to America.”
Kate: “Why do you think you are feeling so tired?”
Huang: “I am missing my regular Qigong.”
Kate: “Well, your tests show that your are suffering from hypothyroidism. I will prescribe a thyroid supplement.”
Huang: “Will this medication restore by body’s balance of yin and yang?”
Kate: “Oh yin and yang. That’s nice. This thyroid supplement is modern medicine.”
Huang: “I personally think I should take shiitake instead.”
Kate: “What is shiitake?”
Huang: “You’re a doctor and you don’t know this? Shiitake is a medicinal mushroom. It restores the body’s balance of yin and yang.”
Kate: “My medical training tells me that you have a thyroid deficiency. Please trust me.”
Huang: “Can I please see a Chinese traditional medicine practitioner?”
Kate: “This is America. We don’t recognize such professions.”
How would you rate Kate’s cross-cultural competency? Let’s do so by considering one by one the four components of cross-cultural competency: (1) Awareness of one’s own cultural worldview, (2) Attitude towards cultural differences, (3) Knowledge of different cultural practices and worldviews, and (4) ability to cooperate across cultural divides. Observe Kate’s interaction with regards to each of these competencies:
(1) Kate’s statement that “My medical training tells me…” implies that she is not aware that ‘medical training’ in other cultures may not necessarily be an authoritative credential.
(2) Referring to yin and yang Kate says, “That’s nice. This thyroid supplement is modern medicine,” displaying an attitude of superiority over a concept that continues to heavily influence Asian thought.
(3) When Huang asked to see Chinese traditional medicine practitioner, Kate replied incorrectly. Most of the United States have avenues to license various Chinese traditional medicine practitioners.
(4) On a positive note, Kate asked “why” questions following Huang’s statements about fatigue and about taking shiitake. However, Kate failed to inquire about Qigong, which is a traditional form of exercise. Respectfully asking for more information is one of the most essential cross-cultural skills.
How would you rate your own cross-cultural skills? Most of us need to improve in this arena to make our healthcare profession skills truly relevant to people who are quite different from ourselves.