CF #3: Seeing the Imbalance

The readings assigned this week discussed the importance of constantly tending to both our cultural competence and cultural humility, and the dangers of only possessing the former. Cultural competence is the knowledge of different cultures and their ways of life. Cultural Humility is the ability to understand and empathize with other cultures in order to expand your perspective on life. The two terms do involve acquiring new information about cultures that one did not know of before; however, they diverge in the ways that we utilize that information. While cultural competency is merely the mental storage of culture, cultural humility urges the person to reflect and truly understand this newfound knowledge as a part of growing and gaining wisdom and kindness. Melanie Tervalon and Jann Murray-Garcia explain the power dynamic of physicians and patients, especially those from minorities in their article, “Cultural Humility vs. Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education.” Although physicians have been given cultural competence trainings, “…program developers and researchers cannot…simply stimulate a detached, intellectual practice of describing ‘the other’ in the tradition of descriptive medical anthropology” (120). The trainings given to physicians are not effective due to the fact that they are not encouraged to explore their self-awareness of their own behaviors towards their patients. This is comparative to colonial times as the British held power over the countries they reaped the benefits of, and did not consider the human beings that were laboring as slaves in their system. Due to the fact that physicians do not self-reflect on their behavior towards the people they care for, they morph into individuals of their field that only hear themselves, not those that have come to them to be heard. Studies have shown that “over 90 percent of the questions” are initiated by the physician, not the patient; even more alarming, minorities are given less information, less positivity and reinforcement, and less talking time overall (Tervalon and Murray-Garcia, 120). With proper cultural training in the workplace, physicians can eliminate these characteristics and learn to listen to their patients and plan their next steps based on their patient’s individual experience that is most likely different from theirs; only then can the power imbalance between physicians and patients be equalized.

The growth of cultural humility between a physician and a patient is demonstrated in Abraham Verghese’s first-person article in The New York Times Magazine. Verghese volunteered to assess and treat individuals in the aftermath of Hurricane Katrina, and aided a man that would alter his perspective on the physician-patient imbalance, as well as blossom his cultural humility. His patient explained his traumatic rescue story, and how he waited for three nights until he was safe, despite rescue efforts being in his area. The man admitted, “Doc, they treat refugees in other countries better than they treated us.’” After Verghese parted from the man, he “was still troubled by him when I left, even though he seemed the hardiest of all. This encounter between two Americans, between doctor and patient, had been carried to all the fullness that was permitted, and yet it was incomplete, as if he had, as a result of this experience, set in place some new barriers that neither I nor anyone else would ever cross” (Verghese, 2005). Verghese felt unfinished with mending the power balance between him and his patient. He was unable to really relate to what the man had gone through, but he knows it is beyond just one man going through a tragedy while the other did not. It is a story of wealth disparity, higher education, and resources that brought those two men to meet each other, not just the hurricane. Additionally, Verghese very much demonstrated the ability to paint a picture of the scene using thick descriptions, not just to document names and conditions like a medical chart. I can see the patients he described appear in my mind as if I was there, and weaved together descriptors with quotes very seamlessly. At my community partner, Spahr Center, I will definitely practice writing thick descriptions and observing as many stimuli as possible. Other strategies such as approaching and asking questions to those that utilize or run the service will be a lot more difficult to carry out.