Critical Reflection #2 Cultural Humility and Ethnographic Approach
Tervalon and Murray-Garcia’s approach to cultural competence and cultural humility is evaluated at a medical level. When examining the dynamic between a physician and a patient, it can often be found that the relationship can be compromised by various sociocultural mismatches. This includes providers’ lack of knowledge regarding patients’ health beliefs and life experiences, and providers’ unintentional and intentional processes of racism, classism, homophobia, and sexism. With this awareness, several national mandates have called for creative approaches to multicultural training of health care professionals aiming to incorporate cultural sensitivity in health care academia. In order to strive for this holistic approach to medicine, providers must practice optimal primary care. According to the Institute of Medicine, optimal primary care can be defined as “an understanding of the cultural, nutritional and belief systems of patients and communities that may assist or hinder effective health care delivery” (Tervalon and Murray-Garcia 118).
Multicultural medical education can be viewed as a challenge because programs must be able to produce cultural competence, without viewing the ability as an attainable skill or one that cannot be measured in a traditional medical sense: such as comparative quantitative assessments (ie., MCATs, pre- and post exams, board certification exams). Instead, cultural competence in a clinical setting is best defined as, “ A commitment and active engagement in a lifelong process that individuals enter into an ongoing basis with patients, communities, colleagues, and with themselves” (Tervalon and Murray-Garcia 118). Striving towards a culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities. Furthermore, for an individual to practice cultural competence they must also have cultural humility, which is a continued engagement of self reflection and self critique as lifelong learners and reflective health care providers. Cultural humility aims to develop mutually beneficial and advocate partnerships on behalf of individuals.This process of cultural humility reminds providers to check the power imbalances that exist in the dynamics of physician- patient communication by using patient-focused interviewing and care (Tervalon and Murray-Garcia 118). The goal of patient focused interviewing and care is to use less controlling or authoritative style that signals to the patient that the practitioner values what the patient’s agenda and perspectives are. With these communication skills, physicians create a healthy atmosphere that enables and does not obstruct the patient’s telling of their own illness or wellness story.
The similarities between cultural competence and cultural humility is that both require individuals to be lifelong learners. Cultural competence is the ability to interact effectively with people of various racial, ethnic, socioeconomic, religious and social groups. However, cultural humility aides in striving for cultural competence because it involves an ongoing process of self-exploration and self-critique combined with a willingness to learn from others.
Upon reading Verghese’s New York Times article, he effectively “shows” the conditions of his patients in the post-colonial hierarchy without “lecturing” about the power imbalances. He uses thick description to paint a clear picture of the event, situation, environment, and culture he has embedded himself in. For example, when describing his first patient he states:
My first patient sat before me, haggard, pointing to what ailed her, as if speech no longer served her. I peeled her shoes from swollen feet, trying not to remove skin in the process. Cuts from submerged objects and immersion in standing water had caused the swelling, as well as infection of both feet. (Verghese)
In this description he is able to portray the condition of the patient and the extent of her injuries that is not vague, but can give the reader a glimpse of who the patient is. He is also explaining what is happening as he takes off her shoes because he states how the feet are swollen and how he is careful when providing care as opposed to simply saying, “I took off her shoe”. In addition, Verghese offers more detailed descriptions of his patients experiences by portraying their struggles in a way that can allow the reader to imagine what the patient may be going through. For example, Verghese describes a patients struggles in seeking help by stating, “He told me that for two nights after the floods, he had perched on a ledge so narrow that his legs dangled in the water… he saw Air Force One fly over, and his hopes soared. “I waited, I waited,” he said, but no help came.” (Verghese). This quote showcases the man’s challenges as well as providing verbatim response to what he was feeling in that hardship. As a result, in order to effectively tell the story of my community partner I want to practice some strategies and tools that Verghese and the assigned readings demonstrate. This semester I want to use thick descriptions that show rather than tell by using evocative language. In my Givepulse I will consider the following questions:“What clues signify people’s statuses and roles?” and ” What are the people you are observing doing in general or attempting to accomplish?” With these questions in mind I can provide descriptive and detailed accounts of what is occuring at my community partner site. However, one strategy I believe will be challenging is when I become more involved in my community, I will feel an attachment to them, and that the storytelling nature of their ethnography can seem to bias the interpretation of the data.
