CR#2: More Than Words

Because we live in a country where several cultures are represented, it is important for us to be aware and respectful of others. Authors Melanie Tervalon and Jann Murray-Garcia argue that cultural competence needs to deepen into cultural humility in order for physicians to better understand their patients. Current training is defined and taught as cultural competence. Both cultural competence and cultural humility hold a basic foundation about possessing a better understanding of cultures. Cultural competence can be defined as a “mastery of a theoretically finite body of knowledge” (117). This “one and done” idea is not enough, however. On the other hand, cultural humility “incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and non paternalistic clinical and advocacy partnerships” (117). To break down this long definition, there are several aspects to consider. One part is the idea of lifelong self-evaluation and self-critique. Physicians and people alike must “identify and examine their own patterns of unintentional and intentional racism, classism, and homophobia” (120). By understanding where we stand in the world and our intersectionality, then we will also be able to understand the practices that are engraved in us that we need to stop ourselves from engaging in. For example, we all have unconscious and conscious biases about other people, but recognizing that we may unconsciously see someone differently because of their physical makeup is a first step in being more culturally competent. In regards to power dynamics and patterns, the authors describe situations wherein physicians are exerting too much power in a relationship that serves the patient rather than the physician. It is argued that a physician should not just be an expert to the patient, but rather a student to the patient’s needs. Therefore, cultural competence should come first. After this knowledge is learned, then humility is a way for someone to go deeper into themselves and in turn, can better interact with other people.

Adam Verghese writes an ethnographic account of his time working as a doctor during the Hurricane Katrina relief efforts. Instead of basic, “essay-like” descriptions, Verghese articulates his words to allow readers like me to visualize what the scene looks like. It makes me feel like I am there in that moment, and not just listening to a story. For example, instead of simply mentioning that the man got up from his seat, Verghese notes the man “rose, holding out his hand, his posture firm as he shouldered his garbage bag.” This description not only allows readers to know that he sat up and his current situation but shows the man’s respectfulness and strength in the midst of the natural disaster. Another example of good visualization is when Verghese wrote, “My first patient sat before me, haggard, pointing to what ailed her, as if speech no longer served her.” His choice of words effectively allows readers to paint an image in their mind of what the patient looks like and how horrible of a situation she is in. Verghese does not judge the woman, but rather writes his observations of her in a very descriptive way. Verghese says what he wants to say by showing his audience, rather than telling.

In regards to field notes, making connections to class topics has been an idea that I have practiced in my last two-service-learning experiences, so it is not new for me. As we discussed in class, I want to practice taking thick notes. This will be more of a challenge since I am used to mentioning basic surface-level things, and not really writing to show. I think it will also be a little harder to provide statistical or factual information, especially with the language barrier but I know that my supervisor will be able to assist me with any question. Furthermore, quotes may also be a little difficult since I am not fluent in the language, but I will do my best to remember and keep improving on my Spanish.