Cross-Cultural Medicine

Cross-Cultural Medicine - Cross-Cultural Medicine GREGORY...

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December 1, 2005 U Volume 72, Number 11 www.aafp.org/afp American Family Physician 2267 Cross-Cultural Medicine GREGORY JUCKETT, M.D., M.P.H., West Virginia University School of Medicine, Morgantown, West Virginia C 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). 1 Ten percent of the U.S. population is for- eign-born. By 2050, minorities will make up approximately 47 percent of the U.S. population. 2 Cultural understanding between physi- cians and patients will improve adherence, patient care, and clinical outcomes. Table 1 lists Web sites for additional information regarding cross-cultural medicine. Cultural Competency Culture is defined as the beliefs and attitudes that are learned and shared by members of a group. 3 Cultural competency refers to pos- sessing knowledge, awareness, and respect for other cultures. Physicians must respect- fully elicit needed information from patients from var ious cu l tures to make accura te diagnoses and negotiate acceptable treat- ment goals. 4 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 is unique. 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-
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Cross-Cultural Medicine - Cross-Cultural Medicine GREGORY...

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