Cultural competency and culturally safe clinical care

Do you let me symptomatize? The potential role of cultural values in cross-national variability of mental disorders’ prevalence

“…Putsch and Joyce (1990) published a recommendation on how to treat patients from other cultures in the beginning of the 1990s. Almost three decades have passed since then, and there are still a vast number of papers (Constantinou, Papageorgiou, Samoutis, & McCrorie, 2018; Desapriya, Mehrnoush, & Bandara, 2018; Grandpierre et al, 2018) trying to prove that cultural competence would be indeed an important skill/knowledge in our everyday practice. One of the most recent example of this endeavor is the Healthy Diversity Project (http://healthydiversity.eu/our-project/), aiming to expand health professionals’ capacity in meeting the needs of patients with different cultural background.…”

Addressing culture within healthcare settings: the limits of cultural competence and the power of humility

“…4 Appeals for enhanced “cultural competence” also abound from researchers and physicians working to improve Canadian Indigenous health. 5 Together, such appeals and guidelines direct attention towards aspects of a patient’s culture that must be understood in order to effectively address his or her healthcare needs.…”

“…The central problem with the concept of cultural competence is its focus on the “other.” Indeed, as a recent letter in CMAJ argued, “it is important that current medical training includes and gives due importance to training culturally competent doctors,” which involves “requiring appropriate knowledge about different cultures, cultural norms and cultural values.” 5 This view of cultural competence implies that a cultural outsider (i.e., healthcare professional) can achieve a level of knowledge adequate to “know” a particular culture—to become competent. 6 Framed in this way, however, culture can be reduced inadvertently to a simplified and static “tick box” of sorts - an item to be checked-off a medical training to-do list.…”

“…Current appeals for enhanced cultural competence within clinical settings lack a full appreciation for the influence of biomedical cultures—ways of seeing and habits of acting. 3 -5 This is not surprising given that “the hardest thing to know in a relative and comparative sense might be one’s own culture: what anthropologists call the anthropological paradox.” 2 By recognizing the influence of biomedical cultures, however, important biases and values can be examined, critiqued, and taken into consideration. Can we as physicians become more aware of our own cultural perspectives so we do not bring unintended harm to others by intervening naively, excessively, or inappropriately (for example)?…”

“…This need for humility and critical reflection also applies to our healthcare systems and institutions. Although it may seem relevant to question how “to build health care institutions that are sustainably culturally competent throughout Canada,” 5 this focus on “competence” is equally problematic when discussed at institutional levels. Instead, by teaching and fostering an organizational environment of critical self-reflection, we can be encouraged to recognize, critique, and challenge inherent biases within biomedical settings.…”