Cultural Issues in Clinical CareCulture, Integrative Medicine, and Holism

“If a man be gracious to strangers, it shows that he is a citizen of the world, and his heart is no island, cut off from other islands, but a continent that joins them.”

--Sir Francis Bacon

"What lies behind us and what lies before us are tiny matters, compared to what lies within us."   --Ralph Waldo Emerson

Faculty Contributors

• Susie Gerik, MD—Associate Professor of Pediatrics

• Kay Sandor, PhD RN, LPC, AHN-BC —Associate Professor, School of Nursing

• Victor Sierpina, MD—W.D. and Laura Nell Nicholson Professor of Integrative Medicine, Associate Professor of Family Medicine

• Harold Vanderpool, PhD—Professor, Institute of Medical Humanities.

What is Cultural Competency?

Cultural Competency refers to the ability of people, organizations, and systems to function and perform effectively in cross-cultural situations.

Key Points

• Integrative medicine

• Holism

• Medical pluralism

• Cultural constructs about illness

Readings

• Kligler B, Maizes V, Schachter S, et al. Core competencies in integrative medicine for medical school curricula: a proposal. Academic Medicine. 2004;79(6): 521-531

• Engebretson J. Cultural contructions of health and illness. Journal of Holistic Nursing. 2003;21(3):203-227.

• Ernst E. Disentangling integrative medicine. Mayo Clinic Proceedings. 2004;79:565-566

Definition of Integrative Medicine

“Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches to achieve optimal health and healing.”

…..Consortium of Academic Health Centers for Integrative Medicine

INSTINCTUAL

EGOCENTRIC

CONFORMIST

RATIONAL

PLURALISTIC

INTEGRAL

TRANSPERSONAL

Some of the patient population groups that benefit from

a culturally competent healthcare system include:

American Indian/Alaskan NativeAsianAfrican AmericanHispanic/LatinoNative Hawaiian/Pacific IslanderGay, Lesbian, Bisexual, TransgenderedEconomically DisadvantagedIlliterate/low literateReligious diversitiesRecent immigrants

Cultural Competency in health care consists of:

Awareness & acceptance of cultural differences

Awareness of one’s own cultural values

Recognition that cultural beliefs impact patients’ health beliefs, help-seeking activities & interactions with health-care outcomes, including adherence to prescribed regimens

Ability & willingness to adapt the way one works to fit the patient’s cultural or ethnic background in order to provide optimal care for the patient

Bridging the Gap

Learn about your patients’ culturesBe NON-JUDGEMENTAL!

Use appropriate interpreter services

Practice culturally sensitive interpersonal dynamics

Accommodate your patients’ health beliefs

Practice the Platinum Rule: “Treat others the way they want to be treated.”