Transcript CROSS-CULTURAL PERSPECTIVES
CROSS CULTURAL PERSPECTIVES Craig Ernst MHS, PA-C Professional Topics LHUP PA Program
Empathy and Compassion
Imagine being in a foreign land and foreign culture.
How would you feel?
Vulnerable?
Scared?
Now imagine being sick in this same setting?
What would you want from your foreign health care provider?
What is Culture?
Culture
Shared way of life Transmitted from generation to generation
Way of Life
Manners Dress Language Religion Rituals Values Norms Beliefs Assumptions Expectations
Concept of Culture
Ethnic Group: Ancestry Country of origin Specific subgroup identification
What about Culture and Ethnicity in our society?
Country founded by immigrating groups Migration continues Ethnic Birthrates Minorities account for 90 % of growth since 2000 Hispanics: 50 million (16% of population) 35 million in 2000 Asians: larger numeric gain than African Americans
Acculturation
Process whereby attitudes and behaviors of people from one culture are modified as a result of contact with a different culture Depends on… Length of time Age of individual on arrival Socioeconomic status
Cultural Effects on Behavior and Decision Making
Remember that you are the product of your culture As a provider you must avoid ethnocentric (eurocentric) bias Approach your patients with an open mind Recognize that they hold different beliefs, values, and assumptions than you Their world view is not wrong, just different from your own
Comparison of Western and Non-Western Culture
Patient Care
RESPECT is KEY Probably the most comfortable patient care situation is where patient & provider share the same ethnic background & life experiences!
Mutual respect
Health Disparities?
Cultural Factors Acculturation & Assimilation Socioeconomic Factors
Cultural Factors Cultural beliefs & practices Birth Childrearing Diet Perceptions of Death Traditional definitions Access to traditional healers
Acculturation & Assimilation Number of years in the country Language(s) spoken Comfort with host culture Integration with decision making process of dominant culture
Socioeconomic Factors Poverty Crowded living areas Increased spread of communicable diseases Delay in seeking treatment Difficulty in getting meds/tests Insurance… Community environment
Clinical Case
Mrs. R is a 55 y/o Mexican-American woman with Type II Diabetes. She comes into your clinic with CC: of fatigue. Her glucose is 228. On exam she has diabetic retinopathy & decreased sensation on both feet.
On review of the chart, you note that she was last seen 18 months ago. At that time she was counseled on diet and exercise. She was also started on metformin. She was instructed to follow up in several weeks.
Clinical Case Continued
She is not currently taking the meformin and has not followed any of the other recommendations given.
Why is this patient noncompliant?
Possible Explanations…
Cultural beliefs & practices?
Acculturation? Socioeconomic status?
Caring for Patients: Cross Cultural Perspective
How does the patient think about the illness… …stems from the pts belief system which contains… Their explanation of the illness based on spiritual, religious, or social circumstances
Explanatory Model Questions
What do you think has caused your problem?
Why do you think it started when it did?
What do you think your sickness does to you? How does it work?
How severe is your sickness?
What kind of treatment do you think you should have?
Ask these questions with
Listen with sympathy & understanding Explain your perception of the problem Acknowledge & discuss the differences & similarities Recommend treatment Negotiate agreement