Treating the world without leaving your ED: opportunities to deliver culturally competent care

When asked about cultural sensitivity, well-meaning, highly educated, and competent physicians admit that while they desire to be culturally sensitive, it is not usually a conscious element of their professional interactions. When it is conscious, they sometimes feel at a disadvantage in their knowledge base or experience. Often physicians are familiar with certain cultural practices but do not know what those practices represent in the lives of their patients; how they produce, exacerbate, or ameliorate illness; and how to function in the patient's best interest within this milieu. In acute clinical encounters, language discordance is by far the most obvious cultural obstacle to providing care. However, increasing exposure to cultural minority populations demonstrates that beyond language, a host of other factors contribute in both obvious and subtle ways to suboptimal care. This report explores some of the challenges faced by immigrant patients and their treating physicians during clinical encounters. It examines the roots of miscommunication and dissatisfaction stemming from cultural differences and expectations and suggests ways to minimize their negative effects.