Cultural divide: Physicians must recognize patients' cultural differences

Cultural differences can present one more challenge for doctors, writes Marjorie S. Rosenthal, M.D., as a guest contributor on CommonHealth.

Take the case of a mother whose child was a patient at the Yale/New Haven Primary Care Center. The 6-month-old baby weighed more than a typical 1-year-old, yet the mother just laughed when a resident asked about how she was feeding the infant, says Rosenthal, assistant director of the Yale Robert Wood Johnson Clinical Scholars Program and associate research scientist in the department of pediatrics at the Yale University School of Medicine.

The mother was apparently ignoring months of advice from resident physicians that her breast milk was sufficient and she should stop feeding the baby formula and solid foods. The physicians, however, had not taken into account the mother's cultural background. She was a refugee who had fled a Swahili-speaking country, Rosenthal says.

"Re-framing this patient's story as an American child of a refugee woman, who may have experienced trauma and food insecurity, it makes sense that this child is being fed more than he needs," she says.

Physicians need to take into account patients' cultural differences, Rosenthal says. But such cases can present many problems. For instance, in the case of this mother, she spoke Swahili and the doctors communicated with her via a phone interpreter. It made it difficult for doctors to know what the mother was thinking.

The Yale/New Haven clinic screens patients for family social factors, such as asking new mothers about depression, housing stability and safety, Rosenthal says. The center also has a designated refugee clinic. The child in this case was not enrolled in that clinic because he was not a refugee, he was born in the U.S.

"Caring for the health of children means two-generation care. It means understanding the mental health, physical health and life experiences of the whole family," says Rosenthal. But, physicians don't always ask and need to consider how the whole family's life affects that of the child.

While it's not always possible, when physicians and patients have a common cultural background, patients are more likely to understand the medical information they're given and to engage in their care, FiercePracticeManagement previously reported.

With almost 1 in 5 U.S. residents speaking a language other than English at home, it's important that physicians keep language and cultural barriers from compromising care. Physicians can help by hiring staff members fluent in languages of their patients.

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