Challenges of Cultural Diversity in Healthcare: Protect Your Patients and Yourself
Susan Shepard, MSN, RN, Senior Director, Patient Safety and Risk Management Education, The Doctors Company

Ensuring safe and quality healthcare for all patients requires physicians to understand how each patient's sociocultural background affects his or her health beliefs and behavior.

The Doctors Company's closed claims studies have shown that inadequate provider-patient communication is a frequent contributing factor to patient noncompliance, poor patient outcomes, and litigation. In multicultural and minority populations, the issue of communication may play an even larger role because of behavioral, cognitive, linguistic, contextual, and cultural barriers that preclude effective patient-provider communication. Research has shown that services for minorities can be improved by removing language and cultural barriers.

How can physicians easily acquire and maintain the skills to provide culturally responsive and appropriate care to the increasingly diverse population of patients in the United States?

Consider taking the following steps:

• Evaluate any personal attitudes, beliefs, biases, and behaviors that may influence your care of patients.
• Conduct a self-assessment: Cultural and Linguistic Competence Health Practitioner Assessment available from the Georgetown University National Center for Cultural Competence.
• Use a communication model such as ESFT or LEARN:
  • Listen to the patient's perception of the problem.
  • Explain your perception of the problem.
  • Acknowledge and discuss differences and similarities.
  • Recommend treatment.
  • Negotiate treatment.
• Ask the patient or interpreter to repeat back what you said during the informed consent process, during the discussion of the treatment plan, or after any patient educational session with you or your staff.
• Use "Ask Me 3," a tool that identifies three simple questions all physicians should be ready to answer—regardless of whether the patient asks. More information is available in our article, "Rx for Patient Safety: Ask Me 3," and "Ask Me 3: Good Questions for Your Good Health" on the Institute for Healthcare Improvement's website.
• Use language services for your limited English proficiency (LEP) patients.
  • Partner with your health plans and hospitals to identify written and oral language services.
  • Find out your state requirements. In some states, Medicaid plans may call for providing language access.
• Explain to patients who refuse interpreter services that it is very important to the patient's care and safety that you and the patient/family member understand each other. Suggest a referral to a physician who speaks the patient's primary language. Be sure to document in the medical record the patient's refusal and your explanation of the risks and benefits of an interpreter.
• Improve cultural competence:
  • Recognize that culture extends beyond skin color.
  • Find out each patient's cultural background.
  • Determine your cultural effectiveness.
  • Conduct culturally sensitive evaluations.
  • Elicit patient expectations and preferences.
  • Understand how your cultural identity affects your practice.
• Obtain more information from these useful websites:
  • U.S. Department of Health and Human Services, Office of Minority Health, National Standards for Culturally and Linguistically Appropriate Services (CLAS)
  • U.S. Department of Health and Human Services, Think Cultural Health, A Physician's Practical Guide to Culturally Competent Care
  • Agency for Healthcare Research and Quality, What Is Cultural and Linguistic Competence?
  • Health Resources and Services Administration, Culture, Language, and Health Literacy Resources