CR #2: Beyond Words, Capture Actions
Cultural Competence is “best defined not by a discrete endpoint but as a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues, and with themselves” ( p.118). Cultural Humility “incorporates a lifelong commitment to self-evaluation and self-critique [as reflective practitioners], to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and non-paternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations” (Tervalon, Murray-Garcia p.117). By shifting the focus solely on the patient, and not on insurance or other personal ulterior motives that move away from patient-focused care, the power dynamic of inequity will be breached. Expanding on this, many people view doctors as all-knowing and able to treat the majority of health issues that arise. With this knowledge, most can also assume that the doctor has enough power in their minds accumulated to give orders to the patient on how to get better and the patient will follow. As a patient, sometimes we hold back on letting our doctor know what was tried and failed because previous encounters informed us of not being able to have a say in the treatment. Inherently, the doctor is a paternalistic figure. To quickly shift the doctor to be a “student”
of the patient would be to humble oneself. By having a patient be informed of what the process will be, have them hold autonomy over their own treatment (in the best judgment and advisement of medical professionals), and their own input (beliefs, culture, values, identity) considered as part of the treatment ensures a more equitable doctor-patient relationship.
As healthcare professionals, we are to be advocates for those we care for and ensure their health and well-being is a priority. Too often are communities of color afraid of going to get the service they need for lack of being understood, not taken seriously, and just kept prescribed medication they cannot afford or know isn’t helping the issue. To be humble as a healthcare practitioner is to let go of the ego we carry through school and listen intently to the patient who has put their trust in us to treat them with care, respect, and advocacy; not as a commodity.. As an institution, to be held accountable for these kinds of actions should stir up commotion about it really means to be “culturally competent” and “culturally humble”. To be culturally competent is to interact well with the people we care for based on what we have learned about in shared patterns, while I view cultural humility as a way to love to learn about the people we care of as we put “what we know” on the backburner.
Abraham Verghese’s “Close Encounter of the Human Kind” article leads with great imagery of his experience as a physician volunteer after Hurricane Katrina. Verghese begins with a metaphor of strapping on armor to protect, I assume, himself from being completely impacted by the stories and pain he will go through during his shift. As he begins to describe his anecdotal experience, I realized the patience and kindness he treated with each patient wasn’t mentioned, but he was detailed as possible describing his most notable ones. With each patient, little motions and actions told their story and humanized them beyond just a glance and quick description. His articulation went beyond words as his“ first patient sat before [him], haggard, pointing to what ailed her as if speech no longer served her” making me really visualize her disassociation.
Verghese talks about refugees by their ailments, but he also paid close attention to the context of why they were there in the first place and what will follow. As Verghese describes his encounters with the patients, he relates his emotions of “[feeling] the same helplessness, knowing that the illness here was inextricably linked to the bigger problem of homelessness, disenfranchisement, and despair”. From this, he knows the bigger problems his patients will face after they leave Kelly USA. Verghese diverts the attention of power imbalances by telling stories, making sure to humanize the patients in comparison to the lack of action on part of the government. He cared deeply about his patients and did his best “to honor their ordeal” by asking them where they were the past few days after Hurricane Katrina. As he asked “Where did you spend the last five days?” to his patients, the first woman he helped was reciting in a “courtroom voice” that would indicate that her life was used to turmoil and has had experiences with testimonies, knowing how to respond when asked these type of questions. Verghese had humbled himself to be able to interact with all his patients, making their stories come to life as they came to him. What caught my attention from his writing was not the close detail he described for each patient, but the deeper analysis of what they will continue to experience after they leave his care. He also made to not let his fear show, but focus on the therapy aspect of assessing their wounds. As he cared for each patient, recognizing their trauma was apart of their healing.
For my field notes, I will definitely try to engage my senses into the moment and make connections that will recreate a whole story from one passing experience. As a way to challenge myself I hope to be as descriptive as possible when analyzing the room and immerse myself in the work I will be helping with during the week. Instead of holding previous biases, I will try to leave them at the door and hold back any expectations for the night. As I progress through the semester, I want to make connections between concepts we learn in class and thoroughly understand my interactions with the students. Because I am bilingual, I hope to absorb verbatim quotes and factual information about their community–both in their homeland and in Marin.
