Knowledge of other cultures should mean knowledge of culturally related home remedies. We all have them in our own backgrounds; almost everyone can remember a grandmother or great aunt who had a favorite remedy for coughs or colds. It is no different in other cultures, and the well-informed physician can make a more accurate diagnosis if they are aware of what to look for. Since some of these remedies can inadvertently look like physical abuse, or interfere with medications that have been ordered, it is important that gentle, respectful questions be asked of the patient and family. It cannot be stressed enough that the physician’s demeanor must be respectful in both verbal and nonverbal communication. Without that respect, the patient will likely withhold important information that could impact the quality of the care plan.[2]

The entire reason for this push to increase physician awareness and respect for cultural differences is to improve patient care. If a patient is deeply connected to their heritage, they will likely reject a physician who disrespects it, because that shows disregard for them.[3] There can be no hope for adherence to a care plan in this situation, even if it is a good plan. Per O’Connor, “this is not a problem to solve… but a set of relationships to be negotiated.”[4]

In an article in Family Practice Management, Gottlieb, Sylvester, and Eby describe how South-central Foundation, owned by Alaskan natives, reformed their federally contracted medical services into a patient-centered system that they ran themselves. Over time, they developed four key ideas, which drove their culturally sensitive system: 1. the customer drives everything, 2. all customers deserve to have a healthcare team they know and trust, 3. customers should face no barriers when seeking care, and 4. staff members and supporting infrastructure are vital to success.

They started out with a typical situation in which the caregivers were intent upon giving good care but did not bother to take the patient and culture into consideration. At the end of ten years, they had a patient-caregiver partnership in which most care decisions were made while patients were in the low-acuity phase of their illness and the most impact could be made. Decisions were made as a team of patients with their caregivers, and the system is successful today.[5]

This is the goal of patient-centered medicine, - patient safety, and - good quality care. The patient is to be well and carefully cared for. In situations of lowered stress where good care is being given, such as this one, it is typical that the caregiver is happier too.

The JCAHO has recently released a series of resources for improving interactions between patients and caregivers, focusing on language and culture. The contents of this list are often focused on the healthcare facility, but a physician who is trying to implement this in their practice can be helped by having a back-up system in the hospitals they affiliate with. If appropriate, the readers of this article may wish to refer some of these resources to their facilities.[6]

Though this new mandate of the NJBME may seem like more work, the value that can be derived from this extra understanding between patients and physicians is evident.