Cultural competency: How to work with a patient who is not like you

As a resident, you may be privy to the very real effects that social determinants of health have on certain patients. A patient’s language and culture, after all, are known indicators of the quality of care they will likely receive from healthcare providers—and racial and ethnic minorities often suffer as a result.

This goal requires trainee physicians to examine implicit biases that may exist toward minorities—and which they themselves may have—and to understand that it is ultimately the patient who decides how safe they feel while interacting with their provider.

What is cultural competence?

The skills needed to navigate interactions with patients of all cultural identities fall under the umbrella term “cultural competence.”

According to a 2021 article published by eClinicalMedicine, cultural competence can be defined as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations.”^[]

Ideally, cultural competence can mitigate the barriers posed by language and culture differences among diverse patient populations. In particular, patients are notably more satisfied when their doctors exhibit knowledge pertaining to cultures outside of their own.

Efforts to retrain established physicians to address implicit biases and cultural incompetence may be fruitless, despite the continual-learning orientation that characterizes the field of medicine. Residents, however, are in a unique position to integrate cultural competence into their practice early on, as noted by eClinicalMedicine.

The Accreditation Council for Graduate Medical Education (ACGME) has named cultural competence in three of the six competencies required of residents —although many programs struggle to implement formal curricula.

How to practice cultural competence

It’s imperative that residents receive cultural competency training in clinical and didactic curricula in order to effectively combat existing healthcare-related disparities perpetuated by implicit biases.

Learn the community

Achieving this requires you to take a hard look at the obstacles a patient may face as a result of economic and cultural barriers. Additionally, developing this skill set invites you to reflect on your own implicit biases.

Offer language assistance and cultural brokerage

Improving cultural competence can also include language assistance. An article published by the Patient Safety Network states that bilingual physicians and qualified interpreters of different languages—including American Sign Language—can help to bridge the gap between patients and providers.^[]

Along with offering language assistance, the Patient Safety Network advises providers to use cultural brokers.

Cultural brokerage can be described as “the mediation between the traditional health beliefs and practices of a patient’s culture and the healthcare system,” the article states. Mediators can include interpreters, patient navigators, and community health workers who have a good grasp on the cultural background of the patient you’re working with, as well as of the healthcare system.

Cultural brokers also relieve physicians of the potentially unrealistic pressure to be intimately familiar with every culture represented in a highly diverse patient population.

A word on cultural safety

While cultural competence provides clinicians with the tools they need to navigate cross-cultural interactions with their patients and minimize healthcare disparities, there is another, closely related concept that also comes into play: cultural safety.

Cultural safety has been variously defined since it was first proposed in the 1990s, as noted by an article published by the International Journal of Equity in Health.^[] A key distinction between cultural competence and cultural safety is the element of “power.”

By being cognizant of the inherent imbalance of power in the doctor-patient relationship, along with acquiring increased cultural awareness, clinicians can begin to instill a profound shift in the quality of care that they and the healthcare system provides. Cultural safety emphasizes the patient’s rights and ideas about what safety implies, and it empowers them to voice any feelings of unsafety they may have with their provider.

You must assess the potential impact on quality of care as a result of your own biases, stereotypes, and attitudes—and hold yourself accountable for providing care in a culturally safe manner.

Finally, doctors who practice cultural safety must focus on decolonizing the provider-patient relationship and improving care through the continued awareness of difference and by engaging in self-reflective practices that seek to dismantle clinical ineffectiveness due to inherent power imbalances.