Cultural Competence and Clinical Expertise

To identify the link between cultural competence and clinical expertise, their meanings should first be defined. Cultural competence is defined by the US Department of Health and Human Services, as “the level of knowledge based skills required to provide effective clinical care to patients from a particular ethnic or racial group”. Furthermore, it has been qualified and classified as: “…behaviors, attitudes, and policies that can come together on a continuum: that will ensure that a system, agency, program, or individual can function effectively and appropriately in diverse cultural interaction and settings….
” (US Department of Health and Human Services website). Although there has not been one single exact definition of cultural competence in the practice of medicine in general, each institution that has sought to define it did so within the premise of identifying ethnic differences in the general population that the medical community seeks to serve.
The growing ethnic diversity in the US population now currently at 15% averages in major urban centers (Elliott) and by 2050, at least a quarter of the elderly population (Elliott), the importance of cultural competence as it relates to clinical expertise and medical service efficiency cannot be denied. As such, if a health professional is not well versed in communicating or interpreting reactions of the patient (either the patient is the one belonging to the minority group or vice versa), the impact on diagnosis and prognosis could be substantial enough to affect the outcome of medical service provision.

Different ethnic groups have their varying interpretation with regards their interpretation of certain illnesses or diseases and how it impacts their family and well being. Thus, if a health professional aims to be well rounded and claim to be efficient in clinical applications, a degree of understanding all the varied cultural differences among his/her patient population should be reached. 2. Discuss a difficult interaction you have experienced or observed that may have resulted from intercultural differences (consider that every form of interaction between 2 people can be considered intercultural in some sense of the word).
Define the interaction and an optimal approach to resolve it. One particular experience that I can easily recall is an encounter with an elderly Filipino couple while on duty at the local community clinic. I wasn’t privy or aware of Filipino customs and traditions with regards to care for the elderly in general but I assumed that like most of Caucasian elderly or senior communities, anybody 65 and above would be living in a senior community, or at least living independently of their adult children.
When discussing the prognosis for the care of the husband’s post operative needs (he had colorectal cancer) and early symptoms of dementia, I assumed that he would be place in an elderly care skilled nursing facility. The couple, particularly the wife was livid even at the suggestion (or assumption) that her husband would be put away in a facility. After a lengthy discussion with the wife, and a succeeding session with an adult daughter, it was only then that I came to know that Filipinos are like most South East Asians. They have an extended family household setting.
They take care of their elderly at home and expect everybody to participate in the care of the elderly. They cannot fathom or even begin to think of putting one of their elders in a group home or skilled nursing facility no matter how difficult the post operative care requirement is. The encounter with the Filipino couple and their extended family was an eye opener for me. When I made the assumption that the husband will presumably be transferred from the hospital after corrective surgery, I just assumed wrong and simply offended the sensibilities of the wife and even the daughter.
It is a lesson that I will not make again in the future. I should have put into consideration their profile more closely rather than just go over the clinical and medical aspects of the patient’s profile. In conclusion, because of our growing diversity in the US, clinicians should not only be aware of one or two ethno-cultural group but be more “culturally competent” in dealing with each minority culture’s differences and how they would possibly interpret certain prognosis and care for each patient in the family. References: Cultural Competence in Action: Retrieved on May 28, 2007 from: http://convention. asha.
org/2006/handouts/855_1440Mahendra_Nidhi_091029_101806104800. pdf “Cultural Competence”. (2001). Mental Health Information. Friday’s Progress Notes – March 16, 2001. Vol. 5 Issue 6. Retrieved on May 28, 2007 from: http://www. athealth. com/practitioner/newsletter/FPN_5_6. html Elliott, V. S. (2001). Cultural competency critical in elder care. Health & Science. AMNews. Retrieved on May 28, 2007 from: http://www. ama-assn. org/amednews/2001/08/06/hll20806. htm US Department of Health and Human Services website (1994): HRSA, Bureau of Health Professions. Retrieved on May 28, 2007 from: http://bhpr. hrsa. gov/diversity/cultcomp. htm

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