Introduction

In most parts of the United States, encountering patients from other cultures is the rule rather than the exception. Obstacles to caring for these patients can involve not only language and socioeconomic factors, but also diverse health and disease belief systems.

Cultural values play an important role in how people behave when ill, and even what it means to be ill. They affect treatment decisions and can create problems in communication, rapport, and compliance. Insensitive handling of cultural variations in symptom expression, or the misunderstanding of treatment expectations creates barriers between physician and patient, endangering the effectiveness of treatment.

We all carry culturally based models for interpreting or explaining disease symptoms. Eliciting these explanatory models can yield a better understanding of our patients - their beliefs, health practices, treatment expectations. More importantly, keep in mind that as providers, our own attitudes and blindness to our assumptions play an equal role in creating obstacles to good care.

Many of the skills and attitudes important for effective care of patients from other cultures apply to all patients – learning some key patient-centered interviewing questions aimed at understanding our patient’s perspective on their health will serve you well in caring for all your patients, regardless of ethnic or cultural background.

This project involves the following:

1. Review of general concepts important to working with ethnically diverse patients, including tools for effective communication.

2. Review of guidelines and pitfalls using interpreters

3. Apply this knowledge by reflecting on the challenges presented by a difficult cross-cultural medicine case.

1. Read:

A. The Spirit Catches You and You Fall Down.

B. The Medical Interview Across Cultures, Pt Care, 4/93.

C. Caring for Patients in a Multicultural Society, 6/94.

D. A Teaching Framework for Cross-cultural Health Care, West J Med, 12/83.

E. A. Kleinman’s 8 questions Tool to Elicit Health Beliefs.

F. Guidelines for Using Interpreters… ” Chap. 5, Strategies for Working with Culturally Diverse Communities.

G. Cross Cultural Primary Care – A Patient Based Approach.

H. Tips for Enhancing Practitioners’ Culture-sensitive Interviewing Skills.

(Note: the above readings are in the syllabus)

2. View: Bilingual Medical Interview Videos

3. Answer Questions

4. Examples of culture specific questions.

5. Discuss your answers to the questions and reactions to the reading with Tom Egnew at the end of the rotation.