A Change in Thinking
When you approach a patient do you think, “I’ve learned about them, the behavior(s) they exhibit, or this belief that they have?” If so, how do you engage patients to help you understand who they are in their own cultural context?
A Muslim immigrant may share a cultural, ethnic, and/or religious identity with a Muslim citizen who lives in West Philadelphia, but there will undoubtedly be differences in how these 2 patients have experienced Western culture and perhaps even how they’ve interacted within our health systems. At what point does either patient get the opportunity to help us understand their identity and how this factors into their own experiences with illness? At what point do we begin to realize that what we’ve learned about others can inform us, but this information is — or rather should be — meant to provide a backdrop of possibilities rather than serve as the standard to guide all interactions with everyone who fits a cultural or ethnic description? This is the key difference in practicing with cultural humility.
Fisher-Borne and colleagues offer this list of critical questions for people and organizations to assess their cultural humility5:
• “What are my initial reactions to [patients], specifically those who are culturally different from me?”
• “What social and economic barriers impact a client’s ability to receive effective care?”
• “Does our organization’s culture encourage respectful, substantive discussions about difference, oppression, and inclusion?”
• “What training and professional development opportunities do we offer that address inequalities and encourage active self-reflection about power and privilege?”
• “Does our staff reflect the communities we serve?”5
I’ve come to realize that the idea of not knowing is not comfortable for everyone. What kind of power imbalance do we unknowingly create when we act as though we already know everything about the person in front of us? Imagine a provider labeling a patient as “difficult” and describing immense tension after the patient’s visit. Blaming the patient for “difficult” interactions is sometimes easier. However, if we were to examine perceived power imbalances from the patient’s perspective, consider how the clinician’s own statements or behaviors may have added to the tension, or explore whether patients of certain backgrounds within our institutions get labeled as “difficult” more often, then we would be looking at examples such as this through a cultural humility lens.
A more practical application of the dimensions of cultural humility can assist providers in “potentially creating an atmosphere that enables and does not obstruct the patient’s telling of his or her own illness or wellness story … only the patient is uniquely qualified to help the physician understand the intersection of race, ethnicity, religion, class … in forming his (the patient’s) identity and to clarify the relevance and impact of this intersection of the present illness or wellness experience.”4
As the United States becomes more of a “minority majority” nation, as described in the 2010 Census report, learning effective ways to communicate and build clinical relationships with people of diverse backgrounds is critically important. “Learning about culture will not eliminate disparities” and “becoming culturally competent is not a panacea for health disparities.”2 We must look continually within ourselves and within our institutions at our own beliefs and practices, recognizing and challenging power imbalances, and be accountable to truly meet our patients’ needs effectively.
To learn more about cultural humility visit the Online Learning section of the Association of Oncology Social Work website.
1. Chang ES, Simon M, Dong X. Integrating cultural humility into health care professional education and training. Adv Health Sci Educ Theory Pract. 2012;17(2):269-278..
2. Gregg J, Saha S. Losing culture on the way to competence: the use and misuse of culture in medical education. Acad Med. 2006;81(6):542-547.
3. Isaacson M. Clarifying concepts: cultural humility or competency. J Prof Nurs. 2014;30(3):251-258
4. Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117-125.
5. Fisher-Borne M, Cain JM, Martin SL. From mastery to accountability: cultural humility as an alternative to cultural competence. Soc Work Educ. 2015;34(2):165-181.