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Unformatted text preview: PLoS Medicine | www.plosmedicine.org 1673 Essay October 2006 | Volume 3 | Issue 10 | e294 C ultural competency has become a fashionable term for clinicians and researchers. Yet no one can defi ne this term precisely enough to operationalize it in clinical training and best practices. It is clear that culture does matter in the clinic. Cultural factors are crucial to diagnosis, treatment, and care. They shape health-related beliefs, behaviors, and values [1,2]. But the large claims about the value of cultural competence for the art of professional care-giving around the world are simply not supported by robust evaluation research showing that systematic attention to culture really improves clinical services. This lack of evidence is a failure of outcome research to take culture seriously enough to routinely assess the cost-effectiveness of culturally informed therapeutic practices, not a lack of effort to introduce culturally informed strategies into clinical settings . Problems with the Idea of Cultural Competency One major problem with the idea of cultural competency is that it suggests culture can be reduced to a technical skill for which clinicians can be trained to develop expertise . This problem stems from how culture is defi ned in medicine, which contrasts strikingly with its current use in anthropology the fi eld in which the concept of culture originated . Culture is often made synonymous with ethnicity, nationality, and language. For example, patients of a certain ethnicitysuch as, the Mexican patientare assumed to have a core set of beliefs about illness owing to fi xed ethnic traits. Cultural competency becomes a series of dos and donts that defi ne how to treat a patient of a given ethnic background . The idea of isolated societies with shared cultural meanings would be rejected by anthropologists, today, since it leads to dangerous stereotypingsuch as, Chinese believe this, Japanese believe that, and so onas if entire societies or ethnic groups could be described by these simple slogans [11 13]. Another problem is that cultural factors are not always central to a case, and might actually hinder a more practical understanding of an episode (see Box 1). Historically in the health-care domain, culture referred almost solely to the domain of the patient and family. As seen in the case scenario in Box 1, we can also talk about the culture of the professional caregiver including both the cultural background of the doctor, nurse, or social worker, and the culture of biomedicine itselfespecially as it is expressed in institutions such as hospitals, clinics, and medical schools . Indeed, the culture of biomedicine is now seen as key to the transmission of stigma, the incorporation and maintenance of racial bias in institutions, and the development of health disparities across minority groups ....
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