I recently had the privilege of attending a conference on multicultural healthcare. As our society grows more and more diverse, it's increasingly important for physicians to develop at least a basic level of competence in the cultures patients come from.
It was a good conference; most of the recognized experts in the field were there. But the speaker who gave me the most insight into what physicians need to do to care for patients from different backgrounds wasn't one of "the experts" at all. He's a patient. His name is Tou Ger Xiong. He's Hmong. He told us his story.
Xiong told his story in two ways. He gave a traditional breakout session lecture, complete with slides, but he was also the after-dinner entertainment, billed as "diversity consultant, comedian, storyteller, and rap artist." The performance was wonderful, lots of fun. The breakout session the next afternoon was not fun, but it was very real. Xiong, born in Laos in 1973, told us about his family's journey from that country to this one. Fleeing the communists in 1975, four years in a refugee camp in Thailand, life as immigrants in the housing projects of St. Paul, growing up in a society very different from the one his family came from.
Aside from describing folk practiceslike coiningthat the Hmong believe in, Xiong also detailed cultural concepts that affect their relations with healthcare providersa different view on touching, a reserve that makes disrobing an uncomfortable situation, a family-oriented decision-making process, an aversion to autopsy or some surgical procedures because to enter the afterlife, you must leave life with the same parts you had when you entered it.
Xiong's listeners also gained insight into the psychological scars refugees from war-torn countries carry with them. Scars created when you have to leave grandma behind because she's too weak to continue the trek to freedom. Perspectives on child-rearing influenced by the fact that you've had to drug your children to keep them from crying lest they tip off your enemy to your position. Issues with weight control formed by the kind of poverty that equates weight with wealth.
Listening to Xiong brought an incredible understanding. I came away from the presentation thinking that all the multicultural conferences in the world will not replace, will not surpass, the "conferences" that need to take place in the individual physician's office. Becoming culturally competent is at the heart of the traditional physician/patient relationship. The physician listens to the patient and builds his or her care around the knowledge that comes from listening.
Sure, there are some basics you can learn about any given culture through books or presentations, and you must make it a point to learn those basics for at least the ethnic groups most populous in your area. But it's the physician who learns with the heart, too, who's most likely to provide culturally competent care. It comes from truly knowing your patients.
Marianne Mattera. Memo from the Editor: Knowing patients.
Nov. 7, 2003;80:9.