A friend’s mom was recently diagnosed with colon cancer. Her experience provided a jolting dose of the reality that lies behind the rather lifeless terminology that advocates sometimes use – in this case, cultural competence — and what it means for good medicine.
Cultural competence, as former Greenlining Fellow Daniel Cano pointed out, simply means “care that respects diversity and honors cultural factors central to patients’ lives, including language, communication styles, and traditions.” Particularly in a state as diverse as California, good medicine can’t happen without it.
My friend and his family are immigrants, having come to the U.S. from Asia when he was a child. He picked up English pretty quickly and speaks as if he’d been born here, but for his parents English remains their second language. They sometimes struggle with its quirks and nuances.
When my friend told me of his mom’s diagnosis, I offered to help any way I can. While I didn’t expect to be that useful, I thought that as a former health writer and cancer survivor myself, perhaps I could help them navigate a journey that can be pretty terrifying. Trust me, that first time your doctor speaks the word “cancer,” your life truly does flash before your eyes. My friend thanked me for the offer but seemed pretty sure he and his family could handle it.
That changed a couple weeks later. His parents had met with her doctor to discuss treatment options and felt a bit overwhelmed. Happily, they’d recorded the key part of the doctor’s explanation. Could I maybe listen and help explain?
In the recording, the doctor went through the likely course of treatment: surgery, with possible chemotherapy and/or radiation. While her prospects look fairly good, the recovery process will be difficult. He casually tossed around some rather advanced medical terminology (quick, how many of you can tell me what an ileostomy is?). He used language advanced enough that, even though I’m a native English speaker with above-average knowledge of medicine in general and cancer in particular, I had to look up a few things to be sure I’d understood properly. My friend’s parents, with no prior experience with cancer and hearing all this in their second language, had every reason to be baffled, which they were.
This happens to immigrants a lot, often in situations even more problematic, with their small children getting drafted as translators. A seven year old brought up in the U.S. may know English better than their foreign-born parents, but relying on them to explain complex medical concepts and navigate between cultures is insane. It’s malpractice.
Hey, U.S. healthcare system: None of this is okay. Forget cultural competence for a moment– how about starting with some plain old competence? The bedrock principle of informed consent requires that “the information that’s given must be understood.” While that includes the patient’s responsibility to ask for clarification of anything he or she doesn’t understand, the physician must recognize that patients may feel intimidated or not even know what to ask. And they should proactively do what’s needed to be sure they communicate properly, including providing translation services.
In this case, the health care providers utterly failed. They apparently made no effort to offer translation, even though their patient’s imperfect grasp of English must have been obvious. At no point did the physician stop to acknowledge that he was using unfamiliar terminology or ask if further explanation would help.
Hey doc, if your patient has to ask their kids, friends or coworkers what the hell you just told them, you’re not doing your job. You’re not practicing good medicine. You’re not even practicing adequate, barely competent medicine.
One way to change this would be to bring more diverse doctors, nurses and other professionals into the health care system. It’s simple human nature that – particularly when dealing with something as unfamiliar and scary as serious illness – many feel safer and more comfortable speaking to people who look and sound like them. Alas, it seems like ingrained habits in both medical schools and hospitals work against diversity and cultural competence, as we found when we looked at the barriers faced by women of color in medicine.
Happily, my friend and his mom have a strong support system. They’ll be fine. But lots of people don’t, and good medicine demands that the health care system pay more attention to cultural competence.
Bruce Mirken is Greenlining’s Media Relations Director. Follow him on Twitter.