Health Affairs, 23, no. 2 (2004): 215-219 doi: 10.1377/hlthaff.23.2.215 © 2004 by Project HOPE	New Online   House Health Reform Bill   Paying for Reform   Vetting AHIP's Report   HIV/AIDS Costs   Brief: Insurance Reform   HA Blog Top 10

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Narrative Matters

No Come Nada

PREFACE: "Cultural competence" is one of those buzz phrases that has become so commonplace in some circles as to become meaningless. It is anything but that. Within the health care delivery sector, being sensitive to patients’ cultural attitudes toward health and medicine can mean the difference between providing best care and substandard care. Growing numbers of medical training programs are attempting to teach physicians how to respond to patients of various races, ethnicities, and language groups different from their own. Empathy and compassion—staples of all good clinical care—cannot be taught overnight but are needed now more than ever. The two stories here illustrate that these qualities, even with innate cultural competence, do not guarantee an effective doctor-patient interchange, but that their absence can do great harm. California-based pediatrician Richard S. Garcia, raised like many of his patients by a Mexican mother, tells us that cultural competence is not always enough to produce healthy patient outcomes. Physician David Malebranche observes the cost to patients of cultural "incompetence," recounting what he learned as a black medical student watching a white medical team misread a "noncompliant" patient.

"No come nada," the Mexican mother of a two-year-old boy said to me at morning clinic, pointing to her toddler, who at thirty-eight pounds is far above the normal weight for his age. "He hasn’t eaten anything in three days." The father of my next patient, a chubby three-year-old girl, worries that his daughter is too thin. "She doesn’t eat enough." Another mother brings her four-month-old infant for an urgent exam because "she hasn’t been eating lately." Finally, just before lunch my nurse warns me, "Dr. Garcia, you’re not going to like going in that room." There, yet another heavy . . . [Full Text of this Article]

The Clash Between Culture And Good Sense

 

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Ingrained Behavior

 

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