Critical Reflection 2 — Wisdom Through Humility
The article “Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education” discuss the differences between cultural humility and cultural competence in the medical setting. Both aspects are important when working with diverse communities. In order to effectively work with what is unfamiliar to you in a way that fosters growth and understanding, you must first have some degree of cultural competence. But our ability to understand different cultures, ethnicity, and languages does not appear out of thin air. You must first have the cultural humility to undergo the ongoing process of self-reflection and learning from others in order to understand their beliefs, customs, and values from their point of view. It is a process in which one utilizes self-evaluation and self-critique to address power imbalances and develop advocacy partnerships within communities to offer mutual support to others. These are processes that can be applied to our everyday lives as well as within the medical setting.
The first step towards cultural competence is knowledge of current health beliefs and practices. The article mentions one occurrence between a nurse and her Latino patient. When a Latino physician noted his patient to be in a great deal of postoperative pain and commented this to the assigned nurse, she dismissed him, stating that she had taken a cross-cultural medicine course and “knew” from school that Hispanic patients overexpress “the pain they are feeling”. The nurse held on to her “cultural expertise” and rebuffed the Latino physician’s perspective. As a result of the nurse’s “expertise”, the patient’s experience was stereotyped, clear clues to their physical pain were ignored, and the resource of a medical colleague was disregarded. The nurse believed to have a sufficient degree of cultural competence because it was what she learned in class; And this is where the error occurred. The issue is that she based her next course of actions solely on what they learned in her training course. In order to achieve true cultural competence, we need to apply what we know, observe and interact with what we’re unsure of, and figure out what context it came from.
The article explains that the dynamic between physicians and their patients are “often compromised by various sociocultural mismatches… including providers’ lack of knowledge regarding patients’ health beliefs and life experiences, and providers’ unintentional and intentional processes of racism, classism, homophobia, and sexism” (Tervalon & Murray-García, 1998, p. 118). Through cultural competence, we create a comfortable and safe atmosphere for patients to describe their illnesses or wellness story without fear. While cultural competence is important, it is vital not to forget the next step towards achieving it. Increasing our knowledge means nothing if we cannot consequently alter our attitudes and behaviors. In most cases, it is not a lack of understanding of other cultures and their practices, but the need for practitioners to change their attitudes toward diverse patients.
Multicultural medical education is necessary, but how do we know when we are competent enough? The reality is that — even amongst our own cultures — we will never know everything there is to know to claim competence. The most we can do is constantly strive to learn more. As such, cultural humility should be our goal. We need to be willing to enter a lifelong commitment to active engagement amongst individuals and their communities to develop a mutually beneficial partnership on behalf of individuals and their defined populations. We become culturally competent when and only when we constantly practice cultural humility.
“Rather, it is imperative that there be a simultaneous process of self-reflection (realistic and ongoing self-appraisal) and commitment to a lifelong learning process… They are flexible and humble enough to assess anew the cultural dimensions of the experiences of each patient. And finally, they are flexible and humble enough to say that they do not know when they truly do not know and to search for and access resources that might enhance immeasurably the care of the patient as well as their future clinical practice” (Tervalon & Murray-García, 1998, p. 119).
To document your findings through your continuous journey of cultural humility, you could contribute to an ethnography. Through a combination of fieldwork and critical analysis, ethnographies and case studies offer perspective to deepen understanding of how and why people think, behave, and interact as they do in a given community, organization, or situation. “When conducting the observation or interview portion of your research, try to close read the situation by carefully parsing out details as you might do with a text. Your thick description of behaviors in their context should try to paint a clear picture of the even, situation, environment, or culture in question” (Tips for Writing Thick Descriptions for Ethnographies and Case Studies, para. 2).
A good example is Close Encounter of the Human Kind. In his New York Times article, Verghese recounts his time as a physician volunteer for hurricane Katrina refugees in 2005. To make his experience come to life for the readers, he utilized descriptive imagery to aid in storytelling, using phrases such as, “I would try to steel myself, as if putting on armor” or “he had kept his shoes on for five days, he said, removing the battered, pickled but elegant pair, a cross between bowling shoes and dancing shoes”. He uses direct quotes and descriptions of his patients to aid the reader in a visual journey, this technique showing more of his patient’s perspectives rather than simply what he was witnessing. But most importantly, he wrote about his reactions and feelings to the situation to “show” the conditions of his patients without “lecturing” of the power imbalances at play. “It reminded me of my previous work in field clinics in India and Ethiopia, where, with so few medical resources at hand, the careful listening, the thorough exam, the laying of hands was the therapy. And I felt the same helplessness, knowing that the illness here was inextricably linked to the bigger problem of homelessness, disenfranchisement and despair” (Close Encounter of the Human Kind, para. 6).
As we progress through the semester, we will create similar ethnographies to a lesser degree as we document our experiences with our community partners. The various ethnography related websites we viewed offered tips to writing engaging and unbiased pieces, such as being self-reflective, being conscious of how your presence alters the environment, being conscious of how your personal biases affect what you notice and write about, using evocative language to show what is happening, and using anecdotes, examples, descriptions, and direct quotations. For me personally, I need to work on identifying the connections between historical and local context, and how they relate to the larger social forces and structures of society. I have always been hesitant to do this, but I look forward to trying again and relating my experiences in a medical center setting.
