December 1, 2005
Volume 72, Number 11
American Family Physician
GREGORY JUCKETT, M.D., M.P.H.,
West Virginia University School of Medicine,
Morgantown, West Virginia
ultural diversity is increasing
worldwide as immigration, travel,
and the global economy make
national borders more permeable.
Latinos of all nationalities will make up the
largest U.S. minority group with 12.5 per-
cent of the population, followed by blacks
(12.3 percent) and Asians (3.6 percent).
Ten percent of the U.S. population is for-
eign-born. By 2050, minorities will make
up approximately 47 percent of the U.S.
Cultural understanding between physi-
cians and patients will improve adherence,
patient care, and clinical outcomes.
lists Web sites for additional information
regarding cross-cultural medicine.
Culture is defined as the beliefs and attitudes
that are learned and shared by members of a
Cultural competency refers to pos-
sessing knowledge, awareness, and respect
for other cultures. Physicians must respect-
fully elicit needed information from patients
diagnoses and negotiate acceptable treat-
Ethnocentrism, the conviction
that one’s own culture is superior, can hin-
der effective cross-cultural care.
It is important to distinguish between
stereotyping (the mistaken assumption that
everyone in a given culture is alike) and gen-
eralizations (awareness of cultural norms).
Generalizations can serve as a starting point
and do not preclude factoring in individual
characteristics such as education, national-
ity, faith, and acculturation. Every patient
Views of Disease Causation
A person’s worldview (i.e., basic assumptions
about reality) is closely linked with his or
her cultural and religious background and
has profound health care implications. For
example, persons with chronic diseases who
believe in fatalism (i.e., predetermined fate)
often do not adhere to treatment, because
they believe that medical intervention cannot
affect their outcomes. Patients’ worldviews
and religious beliefs also affect how they view
disease causation. Some see illness as having
not only physical but also spiritual causes.
Physicians should respectfully explore a
patient’s beliefs within the context of the
patient’s religion and culture. Some immi-