Critical Reflection 2: Understanding Cultural Competence and Cultural Humility in Healthcare
Cultural competence refers to being able to understand and effectively communicate with people across different cultures. On the other hand, Tervalon and Murray-Garcia (1998), state the following about cultural humility:
Cultural humility incorporates a lifelong commitment to self-evaluation, and self-critique, to redress power imbalances in the patient-physician dynamic, and to developing mutually beneficial and not paternalistic clinic and advocacy partnerships with communities on behalf of individuals and defined populations.
In other words, cultural humility aims to address the colonial-type power dynamic found between patients and their physicians. For example, Tervalon and Murray-Garcia (1998) describes how cultural competence vs cultural humility training is best seen as physicians self-reflecting and taking the time to understand the imbalance of power that is present in the communication between physicians and patients. Both are similar in the way that they both aim to understand people from different backgrounds, but cultural competence is more about the ability to effectively interact, while cultural humility relates more to learning and self-critique. One crucial component of cultural humility in healthcare is patient-focused interviewing and care. In fact, according to Tervalom and Murray-Garcia (1198), “studies of patient-physician communication have shown a strong bias on the part of the physicians against patient-initiated questions and agendas, with physicians in one study initiating over 90 percent of the questions.” This can be very troubling for many because this way of communicating can create a relationship in which the physician is in complete control. Luckily, patient-focused interviewing, which allows the patient to use their agency to challenge the status quo, attempts to resolve this power imbalance. Also, this style of interviewing enables patients to feel more comfortable with telling “his or her own illness or wellness story” (Tervalon and Murray-Garcia, 1998).
In Verghese’s New York Time article, some aspects of his writing/expressions that make his experience come to life for the readers is the use of descriptive language. For example, Verghese (2005) states, “Within a massive structure at Kelly U.S.A. (formerly Kelly Air Force Base), a brightly lighted processing area led to office cubicles, where after registering, new arrivals with medical needs came to see us. My first patient sat before me, haggard, pointing to what ailed her as if speech no longer served her.” The descriptive language used allows the reader to actually picture the location and the distress of the patients being served. After speaking with a patient that felt as if refugees in other countries were treated better than those affected by the storm, Verghese (2005) stated the following:
I 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.
This encounter between Verghese and a patient demonstrates the power imbalance found between a physician and patient yet, focuses more on the encounter itself rather than “lecturing” about the stratification of power. Also, this encounter effectively shows the conditions of his patients by pointing out how this patient in particular seemed to be the toughest out of all the patients yet, there was still a disconnect between doctor and patient.
During my observations and documentations of my community partner this semester, I would like to try to be more specific and descriptive about physical objects in a given space as well as clues that signify people’s roles and statuses. It might help for me to bring a small notepad and jot down notes during little breaks at my community partner site. On the other hand, one that might be more challenging would be thinking about the explicit structure, rules, norms that govern the given situation. I think implementing this strategy within my community engagement will take time, and will become more comfortable to think about and dive into as I spend more time at the Ritter Center.
