Culturally Responsive Medical Care

1. Culturally ResponsiveMedical Care [Insert Name of Presenter] Ethics Resource Center American Medical Association

2. Learning Objectives 1. Define culturally responsive medical care. 2. Understand the benefits of providing culturally responsive care. 3. Identify factors that contribute to disparities in health among patients of different cultures. 4. Learn how better patient-physician communication can promote culturally responsive care. Ethics Resource Center American Medical Association

3. What Is “Culture”? A learned pattern of knowledge, beliefs, behaviors, and norms shared by members of a racial, ethnic, religious, or social group that is passed down from one generation to the next. Ethics Resource Center American Medical Association

4. Another Aspect of Culture • The values, norms, and practices shared by those engaged in similar work, eg, the culture of IBM; the culture of medicine. • In this sense, most patient-physician encounters are “cross-cultural” as reflected particularly in language differences. Ethics Resource Center American Medical Association

5. What is Culturally Responsive Medical Care ? Culturally responsive medical care is: • Medically competent care, that is • Adapted to meet cultural-specific needs of individual patients. Ethics Resource Center American Medical Association

6. Culture-Specific Needs Culturally responsive care requires physicians to be more aware of: • Relationship of cultural customs and beliefs to health behaviors, • Disease prevalence, incidence, and treatment outcomes for different patient populations. Ethics Resource Center American Medical Association

7. Possible Pitfalls Poor attempts by physicians to become more culturally responsive to their patients can lead to either: • Cultural stereotyping, or • Cultural “blindness.” Ethics Resource Center American Medical Association

8. Demand for More Culturally Responsive Care • Changing US demographics are producing an increasingly diverse patient populations • Legislative, regulatory and accreditation mandates require physicians to provide more culturally responsive medical care Ethics Resource Center American Medical Association

9. Benefits of Culturally Responsive Care • Reduce the likelihood of miscommunication that can lead to poor compliance and greater liability. • Attract new patients and keep current patients. • Reduce disparities in health of patients from diverse racial, ethnic, and social backgrounds. Ethics Resource Center American Medical Association

10. Reducing the Likelihood of Miscommunication An informed consent process that is sensitive to cultural differences among patients can: • Promote greater compliance with treatment recommendations. • Reduce the liability risk if health outcomes are less than optimal. Ethics Resource Center American Medical Association

11. Attracting and Retaining Patients In light of an increasingly diverse patient population and growing “consumerism” in health care, culturally responsive physicians are: • More likely to attract new patients, and • Retain existing patients. Ethics Resource Center American Medical Association

12. Reduce Health Disparities • Culturally responsive care seeks to address medically important differences in disease outcomes among racial, ethnic, and cultural groups. • Some reasons for disparities in health outcomes: • Genetic contributors to different health outcomes. • Lack of health insurance coverage and less access to care. • Inappropriate variations in the use of health care services. Ethics Resource Center American Medical Association

13. Reasons for Inappropriate Variation in Use of Health Services Each of the following may contribute to inappropriate variation in use of health care services: • Physician bias. • Patient preference. • Poor communication between patients and their physicians. Ethics Resource Center American Medical Association

14. 1. Role of Physician Bias:Unintentional Stereotyping • Physicians’ clinical assessment and recommendations may be influenced by the patient’s race, ethnicity, social class, and education level. • Physicians may inadvertently treat medically similar patients of one racial and ethnic group different from those in another. Ethics Resource Center American Medical Association

15. 2. Role of Patient Preference • Some use (and nonuse) of health care services may be attributed to culture-related patient preferences and values. • Inappropriate use of health care services may reflect a patient’s lack of adequate information or understanding of the clinical situation. Ethics Resource Center American Medical Association

16. 3. Role of Poor Communication • Studies have found that physicians provide less information and engage in less participatory decision making with minority patients. • Good communication during the medical encounter can improve both compliance and diseases outcomes. Ethics Resource Center American Medical Association

17. Explanatory Models and Patient-Physician Communication • How patients perceive illness affects how they explain it to their physicians. • An individual’s perception and thus explanatory model of disease, is shaped by many factors including race, ethnicity, gender, education, social class, religious beliefs, and personality traits. Ethics Resource Center American Medical Association

18. Sharing an Explanatory Model “Negotiating to a shared model should be the principal task of the medical interaction.” • Ask for the patient’s explanation of the symptoms and their causes. • Offer a medical explanation in a way that the patient can understand. Ethics Resource Center American Medical Association

19. Improving Physician Communication • Speak slowly. • Use plain, non-medical language. • If the patient looks confused, stop and ask for questions. • Explain instructions fully: "Take one of these with breakfast and one with dinner" not "Take these twice a day." Ethics Resource Center American Medical Association

20. Patient Communicationand Physician Behavior Research shows that patients can influence physician behavior by: • Providing a health narrative, • Asking questions, • Expressing concerns, and • Being more assertive. Ethics Resource Center American Medical Association

21. Helping Patients Better Communicate with Physicians • Take more responsibility for eliciting questions from patients. • Ask patients to repeat what you have said in their own words. • Ask whether the patient will be able to comply with instructions and return for a follow-up. If not, ask why? Ethics Resource Center American Medical Association

22. Conclusion • Cultural responsiveness is not: • Mastering knowledge of all cultures. • Culturally responsive physicians: • Recognize their own cultural beliefs and potential biases. • Communicate with patients to better understand their explanatory model of disease. • Help patients communicate information that will lead to better health outcomes. Ethics Resource Center American Medical Association

23. This ethics education presentation was created by the: Ethics Resource CenterAmerican Medical Association515 North State StreetChicago, IL 60610Phone: (312) 464-4077Fax: (312) 464-4799Email: erc@ama-assn.org Web: www.ama-assn.org/go/erc