Cross-cultural issues in primary care medicine

A generation ago, the experience of practicing medicine across cultural lines was far less common than it is today. In contemporary American society, the population is much more diverse in race, culture, language, religion, and ethnicity. Although health care is increasingly guided by scientific, evidence-based models, individual patients are increasingly seeking health care that addresses their personal beliefs and needs. Physicians must develop the knowledge and the skills to engage patients from different cultures and to understand the beliefs and the values of those cultures. If physicians focus only on a narrowly defined biomedical approach to the treatment of disease, they will often misunderstand their patients, miss valuable diagnostic cues, and experience higher rates of patient noncompliance with therapies. Such miscommunication will also result in greater patient dissatisfaction and more malpractice suits. This article reviews the role of culture in primary care medicine and the effect of health beliefs on decisions to seek care. Other influences, including the patient's family, language, and socioeconomic status, are examined. The possible effects of the physician's own culture are looked at as well. Methods of eliciting the patient's explanatory model are reviewed, and guidance is given on strategies to avoid miscommunication or misunderstandings. Additionally, the physician is given guidance on how to draw on the patient's beliefs and values as resources in health promotion and the treatment of disease. Specifically, the use of interpreters to overcome language barriers is reviewed. Behaviors are identified that can maximize the accuracy of communication when interpreters are needed. Physicians who actively seek to understand their patients' cultures will find their simple efforts amply rewarded by improved patient access to health care, increased patient satisfaction, and greater clinical effectiveness.