Medicine in a Multi-cultural Society Flashcards
What is culture?
It is the learned and shared values of a particular group that:
Guides thinking; Actions; Behaviours; Emotional reactions to daily living.
Sum of beliefs, practices, habits, likes and dislikes.
Norms and customs that are learned.
How is culture a filter?
It is a filter through which people process their experiences and events of their lives.
Culture influences people’s values, actions and expectations of themselves and others.
What are the 3 main areas of culture to consider in medical practice?
- Misunderstandings in diagnosis or in treatment planning arising from differences in language or culture.
- Poor patient adherence with treatment and poor outcomes.
- Health care disparities.
Give examples of healthcare disparities in terms of disease outcomes.
Death rates from lung cancer are higher in black men than white men.
Ethnic minority women with breast cancer have poorer survival rates than white women, even with similar access to care.
Racial disparities in utilisation of total joint replacement for knee osteoarthritis not explained by prevalence.
Give examples of healthcare disparities in terms of disease prevalence.q
Rates of diabetes is 5x higher among Pakistani and
Bangladeshi women than in general population.
All male minority groups (except Chinese) have higher rates of heart attack.
Black Caribbean men have higher rates of stroke.
What are the different attitudes to treatment/health care usage - use Asthma as an example.
South Asian and white patients admitted with asthma coped differently.
South Asians - described less confidence in controlling asthma, expressed less confidence in their GP, unfamiliar with concept of preventers.
They managed asthma exacerbations with family advocacy without systemic corticosteroids.
Many had difficulty accessing primary care during exacerbations.
Describe an interventional trial that was carried out to deal with the uncertainty that asthma poses to South Asians and other cultures.
Specialist nurse intervention
Objective - to determine if these nurses can reduce unscheduled care in a deprived multi-ethnic area.
Cluster randomised controlled trial.
44 GPs in 2 borough of east London.
Results - intervention delayed time to first hospital attendance with acute asthma and reduced percentage of participants attending with acute asthma.
White patients benefited more than South Asian patients.
Conclusion - ethnic groups may not benefit equally from specialist nurse intervention.
Define cultural competence.
The ongoing capacity of healthcare systems, organisations and professionals to provide for diverse patient populations high quality care that is safe, patient and family-centred, evidence-based and equitable.
How can one gain cultural competence?
By gaining depth of understanding or subject positions and cultures other than your own.
How can one acquire cultural competence in a clinical setting?
Be sensitive to language barriers - does patient understand English? Consider literacy level, use visual aids and demonstrate procedure, check understanding. Interpreter?
Consider body language - eye contact, touching, personal space, privacy/modesty.
Consider religious/spiritual factors - birth/death, certain treatments, blood products, medications, etc.
Other factors include gender, social status, disability, sexual orientation.
What are the impacts of cultural competency?
More successful patient education;
Increases patient’s health care seeking behaviour;
More appropriate testing and screening;
Fewer diagnostic errors; Avoidance of drug
complications;
Greater adherence to medical advice;
Expanded choices and access to high- quality clinicians.
Describe the LEARN model.
L - listen to patient’s perception
E - explain your perception
A - acknowledge and discuss differences/similarities
R - recommend treatment
N - negotiate treatment
