Doctors Must Learn 'Cultural Humility'

Marlene Busko

Disclosures

March 05, 2018

Treating Individual Patients as Individuals

"In trying to take care of the individual patient sitting across the exam table from us, we have to understand the position that they come from," according to McAneny. Clinicians need to be able to explain the condition in ways that resonate with a patient's life experience, whether "they are a PhD engineer or whether they are one of my patients from the Navajo nation." The treatment has to make sense for the patient.

For example, when McAneny and colleagues built a cancer clinic in Gallup, New Mexico, "we very carefully designed the building so that it would reflect the Navajo, Zuni, and Hopi cultures," she said.

Cultural competency includes understanding the challenges that a patient has to overcome to be able to comply with a regimen of medication, or changes to such a regimen. Some studies have shown that "ZIP code determines your outcome," she noted, in that people in affluent areas who don't live in food deserts can buy healthy food, and they can go outside and exercise without worrying about encountering violence—all of which improves health outcomes.

When clinicians help patients manage their diabetes, for example, they have to be aware of foods that are available to the patient and are part of their daily diet as well as foods that are part of celebrations.

LEARNing to Listen, Negotiate

The AMA module on cultural competency provides medical residents with tools to help them understand their unconscious biases and improve their communication with patients.

For example, clinicians can improve their patient interactions by using an approach summarized in the acronym LEARN[1]:

  • Listen, encouraging patients to explain their situation;

  • Explain clearly;

  • Acknowledge the differences between what patients understand and what you know;

  • Recommend a treatment plan that is consistent with your conversation with a patient; and

  • Negotiate to get agreement from patients on a course of action.

"While patients come to us for help, they also come with deep expertise related to their health and illness," said McAneny. "It is up to us clinicians to be humble enough to initiate a healing relationship of working together toward health and wellness. Young doctors are particularly prone to assuming that the more they say, the more the patient will understand and 'do.'"

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