Cultural Sensitivity: A Boon or Bane to the Clinical Encounter
By Aarti Sahai
The porcelain glow of the fluorescent hospital lighting refracted off my smudged glasses, my hands lethally steady, my heart inebriated on the surging adrenaline coursing through my veins. My latex gloves fluidly oscillated as my left thumb meticulously pushed the synthetic surgery thread into a loop. My right hand firmly grasped the synthetic filament as my forearms, in solidarity with my thumping heart, acutely discerned the sensation of the throw. The intensity encapsulated between the four peeling walls of the patient room began to detonate as my left hand tugged the short suture strand toward my lime green scrubs: a love deeper than yesterday yet more than tomorrow.
As an aspiring clinician, I often find myself drifting between what is and what isn’t, the living versus merely existing. Viewing myself through the reflective wall that is my inner prowess, I synthesize the passion that I exude when performing in a clinical setting. As such, my relationship with medicine is through its acute affiliation with creative brilliance. Medicine, in its purest form, is an art.
Consequently, in the context of the physician-patient relationship and its fluid-mosaic of beneficence, empathy, and the cutting-edge, I am captivated by the daunting yet vital question of how I will best provide for my patients. How will I perform a procedure in the body or formulate a diagnosis so astutely that it will disrupt nature’s palpable timeline of disease and restore that person to his or her inherent dignity and health? The immense power behind this ostensibly simple question is best exemplified in the notion that it tugs at the filaments of how we as a society set the precedent of how we view the wholeness of each being.
Thus, meticulousness, robotic precision, and accuracy immediately surge to the forefront as they are all keen to positive patient outcomes. Yet, in the pursuit of delivering healthcare to my patients, the transposition of the clinical encounter into a realm of increased security that obliterates human divisiveness and emphasizes the need for social perception becomes increasingly underscored.
Accordingly, in trying to facilitate the maximum benefit for my patients, do I allow the cultural context of each patient to inform my protocol, or do I solely view the patient’s disease external to the social factors of the situation? In the context of our increasingly pluralistic society, do I to accommodate the diversity of each patient and recognize how it might shape his or her clinical experience, or do I implement an objective protocol that fulfills the pathophysiological aspect of the patient’s health as determined by the intrinsic obligations that I have to my profession?
To unpack this lofty question, let us first immerse ourselves within the viewpoint of the healthcare professionals and bioethicists that fundamentally believe in an empirical-based approach to medicine. In “Conscience and the Way of Medicine,” Dr. Farr A. Curlin, palliative-care physician and prominent bioethicist at Duke University, and Dr. Christopher A. Tollefson, professor of philosophy at the University of South Carolina, deliberate between two models of medicine that they designate as the “Way of Medicine” and the “provider of services model.” Curlin and Tollefsen define the “Way of Medicine” as a model that calls the physician to objectively seek the patient’s health and the “provider of services model” as a framework rooted in patient variation and inclusion of this variation in formulating treatment (Curlin and Tollefson 560).
As such, Curlin and Tollefsen deftly deliver a cogent argument that the “Way of Medicine” model is birthed out of the desire to equitably seek the patient’s health and any action or lack thereof that does not ultimately concur with what the patient’s health requires, regardless of patient views on matter such as religion, culture, and what they deem necessary to their lifestyle, should be refused. Curlin and Tollefsen supplement their ideology with the notion that medicine is not founded upon the desire to implement cultural sensitivity as a medium for influencing medical technique but to aggressively treat and cure as dictated by the nature of disease and modern medicinal practices. To elaborate, when a physician celebrates cultural acknowledgment in the context of their prognosis, the factors that may undermine clinical treatment, such as dissenting religious values or personal beliefs, become increasingly exacerbated (Curlin and Tollefsen 574).
Furthermore, Curlin and Tollefsen map their philosophy in the context of specific medical specialties to assert the notion that physician acknowledgement of increasingly varied cultural aspects will only obscure the field of medicine and in fact, diminish the access and quality of healthcare that patients receive (Curlin and Tollefsen 573). For example, the authors present the field of obstetrics and gynecology and state that if an objective lens of healthcare is disregarded, matters such as abortion, sterilization, IVF, prenatal genetic diagnosis, surrogate pregnancy, artificial insemination, cosmetic genital surgery, and gender transition surgery will effectively morph into potential harmful outcomes in the name of trying to facilitate cultural acknowledgment amidst the framework of patient self-determination and diversity. They reach this conclusion on the basis that it would promote physician compliance in procedures that are inherently contradictory to the principle that medicine is meant to correct harmful disease. Also, they stipulate that an organic consequence of this methodology would be the undermining of the conscience of the physician as it would stimulate an environment of physicians performing procedures and surgeries that do not necessarily aim at correcting patient health but rather fulfill the varying social factors that led the patient to seek the procedure in the first place (Curlin and Tollefsen 573).
Thus, they establish the credibility of their notion via the cardinal principle that medicine is based upon the curing of disease. They stipulate that the internal purpose of medicine is solely derived from what it means to proactively combat pathogens in the body, and in the event that any other factor, such as cultural acknowledgement, is given weight in the context of this purpose, the integrity of patient healthcare and the medical institution at large becomes grossly undermined (Curlin and Tollefsen 572).
This is supplemented by prominent bioethicist and associate professor in medical ethics, law, and professionalism at Flinders University School of Medicine, Dr. John McMillan, and his perception of the founding theories of medicine. In “Moral Theory: Executive Summary,” McMillan emphasizes that beneficence, action that emphasizes the patient’s well-being, correlates to the internal obligation that physicians have to their patients (McMillan 3). Synonymous to the analysis of Curlin and Tollefsen, McMillan underscores the matter of beneficence in the context of patient treatment as pertaining to nothing more than the moral duty to equitably and objectively treat in regard to the nature of the medical institution (McMillan 3). Furthermore, as framed by the Hippocratic oath, he defines non-maleficence as the act of doing no harm (McMillan 3). Accordingly, one can infer that McMillan is directly synthesizing the argument presented by Curlin and Tollefsen that the scope in which our society perceives medical treatment should be limited to the lense of what medically is going to best benefit the patient, not what the cultural context deems as best.
The theories presented by Curlin, Tollefsen, and McMillan collectively constitute a growing body of professionals that believe their philosophies are highly consonant with the fundamental principles of medicine. Consequently, this has led to the influx of clinical pundits measuring the success of a medical institution through its emphasis on the cutting-edge as a marker for effective medicine. Accordingly, in conjunction with the ideology that the inherent characteristic of medicine is to heal, many medical foundations foster intense, linear environments saturated with a significance on the empirical and technical (Curlin and Tollefsen 572).
Alternatively, an increasingly growing number of healthcare professionals and bioethicists are pushing the belief that cultural sensitivity is highly essential in the clinic as empirical-based medicine has led to the result of pathogen-competent, culturally illiterate providers that hyperfocus on the science behind the disease and deem other social factors as external to the nature of their job. Proponents of cultural sensitivity argue that the principles outlined by professionals such as Curlin, Tollefsen, and McMillan while not inherently wrong as clinicians need to hone their technical capabilities to truly provide the best for their patients, are apathetic to the varying factors of the human experience that ultimately influence the clinical encounter. For example, in “In Search of a Wide-Angle Lens,” Dr. Harold Braswell of Saint Louis University presents the notion that the true nature of healing is based upon the emotional and social makeup of the human being (Braswell 21). Braswell thoroughly presents the trying situation of a pregnant, disadvantaged laborer who due to the nature of her work, was not given appropriate breaks to allow for the rest of her vulnerable body. The physical trauma and emotional stress morphed into the abortion of the woman’s baby as she felt there was simply no other choice she had (Braswell 21). This directly asserts the necessity of cultural competency in medicine as Braswell’s depictions support the claim that cultural influences directly manipulate the realm that is a person’s healthcare. Braswell further strengthens his argument through the notion that had the healthcare team acknowledged the cultural makeup of the patient, that is to give respect to the patient’s moral values, spiritual beliefs, and socio-economic status, perhaps the woman could have been connected to supplementary resources instead of undergoing an abortion, thus changing the outcome of her clinical experience (Braswell 21). Fundamentally, a greater understanding as to why a certain patient is seeking a specific treatment, that is to go beyond the solidified film of superficial interaction and really assess the cultural factors that led the person to seek professional help in the first place, is to highlight the interconnectedness of culture and illness and ultimately provide the best level of patient care (Braswell 21).
In order for this process to occur, healthcare professionals argue that we must first recognize the importance of cultural sensitivity in general as it relates to the medical profession. For example, in “Losing Culture on the Way to Competence: The Use and Misuse of Culture in Medical Education,” Drs. Gregg and Saha of Oregon Health & Science University build upon Braswell’s theory of culture and illness in their presentation of a young child of Hmong descent that lapsed into a coma (Gregg and Saha 542). The authors underscore the notion that the child’s unfortunate suffering was partly due to the invisible yet divisive barriers of cultural plurality that ultimately hindered the Hmong-American family from receiving the maximum benefits of the American healthcare system. Specifically, Gregg and Saha highlight the language barrier between the healthcare team and the patient’s parents that led to a breakdown in the family’s comprehension of their daughter’s case in addition to the preexisting spiritual values that the physicians failed to acknowledge in developing the child’s course of treatment (Gregg and Saha 542). Thus, the authors propel the notion that a physician’s ability to treat corrosive diseases would improve if he or she was deft in the ability to extrapolate the ideology behind their patient’s perception of the illness, directly influenced by his or her cultural makeup, into the context of the greater science-based principles that medicine is founded upon (Gregg and Saha 544). In other words, in order for a patient to be properly evaluated and understood on a biological level, the patient must also be evaluated on a social, emotional, and cultural level. That is, clinicians must acknowledge the dynamic arena of the external factors that are linked to the internal essence of the human being that truly makes that person himself or herself (Gregg and Saha 544).
Furthermore, with increasingly diversified patient populations sprouting in clinical contexts across the nation, an increasing number of healthcare professionals and philosophers believe that it is paramount that medical professionals and bioethicists are highly educated in addressing issues of value conflict in both the elevated and marginalized. According to “Bioethical Silence and Black Lives” by Derek Ayeh, senior associate at Medicare Rights Center, Ayeh states “The late Adrienne Asch once wrote that bioethics is at its best when people do not merely ask each other what their views are, but really take the time to find out what is behind those views” (Ayeh 2). This directly supports the claim that one must fully commit themselves to the ideology that propels certain patient behavior in order to better understand the needs and biases of the patient in relation to the corrosiveness of the illness (Ayeh 2). Ayeh states that this will then lead to a more accurate patient treatment plan that is synonymous with his or her internal values as a human being and lead to more positive outcomes in terms of disease management (Ayeh 2).
As such, we continue to find our minds waltzing on the tightrope that is the sciences and domain of cultural sensitivity and the increasingly convoluted nature of these disciplines. Perhaps, it may be our innocence or naivety in not having extensive clinical experience in healthcare as Curlin or McMillan do that to truly evaluate the patient on a mind, body, and spiritual level to best inform my treatment protocol and recognize the patient’s social and environmental background that influence their unique value base is possible. Perhaps, it may be our increasing love for the sciences that continue to morph the lens in which we view the importance of cultural sensitivity given that the sheer nature of medicine is rooted in mastery of technique. Perhaps, it is less about one or the other and more about establishing a fluid equilibrium of both in the context of the physician-patient relationship. In other words, perhaps the essential question needs to be reframed as to what extent should cultural sensitivity be given precedence in varying medical specialties. Perhaps, cultural sensitivity should be investigated as an applicable spectrum in order to best respect the specialized technicality of medicine and merits of objective healthcare.
Nonetheless, it is important to note that this exploration into the intricacies of cultural sensitivity is not fully representative of the many varying entities that compose this domain. Thus, it is highly important that the American healthcare system continue to explore the dynamics of social factors such as faith, customs, and underlying beliefs, specifically in regard to the limitedness in viewing culture as a concrete entity that can be copied and pasted into the framework of patient care and measured by arbitrary guidelines. It is then that the matter of intersectionality in medicine becomes increasingly pertinent to explore in the ongoing dialogue as culture is not an all-encompassing linear model. Thus, as we stand at the nexus of ongoing clinical advancement and social diversity. Let us continue to explore and elevate in the name of patient prosperity.
As an aspiring clinician, I often find myself drifting between what is and what isn’t, the living versus merely existing. Viewing myself through the reflective wall that is my inner prowess, I synthesize the passion that I exude when performing in a clinical setting. As such, my relationship with medicine is through its acute affiliation with creative brilliance. Medicine, in its purest form, is an art.
Consequently, in the context of the physician-patient relationship and its fluid-mosaic of beneficence, empathy, and the cutting-edge, I am captivated by the daunting yet vital question of how I will best provide for my patients. How will I perform a procedure in the body or formulate a diagnosis so astutely that it will disrupt nature’s palpable timeline of disease and restore that person to his or her inherent dignity and health? The immense power behind this ostensibly simple question is best exemplified in the notion that it tugs at the filaments of how we as a society set the precedent of how we view the wholeness of each being.
Thus, meticulousness, robotic precision, and accuracy immediately surge to the forefront as they are all keen to positive patient outcomes. Yet, in the pursuit of delivering healthcare to my patients, the transposition of the clinical encounter into a realm of increased security that obliterates human divisiveness and emphasizes the need for social perception becomes increasingly underscored.
Accordingly, in trying to facilitate the maximum benefit for my patients, do I allow the cultural context of each patient to inform my protocol, or do I solely view the patient’s disease external to the social factors of the situation? In the context of our increasingly pluralistic society, do I to accommodate the diversity of each patient and recognize how it might shape his or her clinical experience, or do I implement an objective protocol that fulfills the pathophysiological aspect of the patient’s health as determined by the intrinsic obligations that I have to my profession?
To unpack this lofty question, let us first immerse ourselves within the viewpoint of the healthcare professionals and bioethicists that fundamentally believe in an empirical-based approach to medicine. In “Conscience and the Way of Medicine,” Dr. Farr A. Curlin, palliative-care physician and prominent bioethicist at Duke University, and Dr. Christopher A. Tollefson, professor of philosophy at the University of South Carolina, deliberate between two models of medicine that they designate as the “Way of Medicine” and the “provider of services model.” Curlin and Tollefsen define the “Way of Medicine” as a model that calls the physician to objectively seek the patient’s health and the “provider of services model” as a framework rooted in patient variation and inclusion of this variation in formulating treatment (Curlin and Tollefson 560).
As such, Curlin and Tollefsen deftly deliver a cogent argument that the “Way of Medicine” model is birthed out of the desire to equitably seek the patient’s health and any action or lack thereof that does not ultimately concur with what the patient’s health requires, regardless of patient views on matter such as religion, culture, and what they deem necessary to their lifestyle, should be refused. Curlin and Tollefsen supplement their ideology with the notion that medicine is not founded upon the desire to implement cultural sensitivity as a medium for influencing medical technique but to aggressively treat and cure as dictated by the nature of disease and modern medicinal practices. To elaborate, when a physician celebrates cultural acknowledgment in the context of their prognosis, the factors that may undermine clinical treatment, such as dissenting religious values or personal beliefs, become increasingly exacerbated (Curlin and Tollefsen 574).
Furthermore, Curlin and Tollefsen map their philosophy in the context of specific medical specialties to assert the notion that physician acknowledgement of increasingly varied cultural aspects will only obscure the field of medicine and in fact, diminish the access and quality of healthcare that patients receive (Curlin and Tollefsen 573). For example, the authors present the field of obstetrics and gynecology and state that if an objective lens of healthcare is disregarded, matters such as abortion, sterilization, IVF, prenatal genetic diagnosis, surrogate pregnancy, artificial insemination, cosmetic genital surgery, and gender transition surgery will effectively morph into potential harmful outcomes in the name of trying to facilitate cultural acknowledgment amidst the framework of patient self-determination and diversity. They reach this conclusion on the basis that it would promote physician compliance in procedures that are inherently contradictory to the principle that medicine is meant to correct harmful disease. Also, they stipulate that an organic consequence of this methodology would be the undermining of the conscience of the physician as it would stimulate an environment of physicians performing procedures and surgeries that do not necessarily aim at correcting patient health but rather fulfill the varying social factors that led the patient to seek the procedure in the first place (Curlin and Tollefsen 573).
Thus, they establish the credibility of their notion via the cardinal principle that medicine is based upon the curing of disease. They stipulate that the internal purpose of medicine is solely derived from what it means to proactively combat pathogens in the body, and in the event that any other factor, such as cultural acknowledgement, is given weight in the context of this purpose, the integrity of patient healthcare and the medical institution at large becomes grossly undermined (Curlin and Tollefsen 572).
This is supplemented by prominent bioethicist and associate professor in medical ethics, law, and professionalism at Flinders University School of Medicine, Dr. John McMillan, and his perception of the founding theories of medicine. In “Moral Theory: Executive Summary,” McMillan emphasizes that beneficence, action that emphasizes the patient’s well-being, correlates to the internal obligation that physicians have to their patients (McMillan 3). Synonymous to the analysis of Curlin and Tollefsen, McMillan underscores the matter of beneficence in the context of patient treatment as pertaining to nothing more than the moral duty to equitably and objectively treat in regard to the nature of the medical institution (McMillan 3). Furthermore, as framed by the Hippocratic oath, he defines non-maleficence as the act of doing no harm (McMillan 3). Accordingly, one can infer that McMillan is directly synthesizing the argument presented by Curlin and Tollefsen that the scope in which our society perceives medical treatment should be limited to the lense of what medically is going to best benefit the patient, not what the cultural context deems as best.
The theories presented by Curlin, Tollefsen, and McMillan collectively constitute a growing body of professionals that believe their philosophies are highly consonant with the fundamental principles of medicine. Consequently, this has led to the influx of clinical pundits measuring the success of a medical institution through its emphasis on the cutting-edge as a marker for effective medicine. Accordingly, in conjunction with the ideology that the inherent characteristic of medicine is to heal, many medical foundations foster intense, linear environments saturated with a significance on the empirical and technical (Curlin and Tollefsen 572).
Alternatively, an increasingly growing number of healthcare professionals and bioethicists are pushing the belief that cultural sensitivity is highly essential in the clinic as empirical-based medicine has led to the result of pathogen-competent, culturally illiterate providers that hyperfocus on the science behind the disease and deem other social factors as external to the nature of their job. Proponents of cultural sensitivity argue that the principles outlined by professionals such as Curlin, Tollefsen, and McMillan while not inherently wrong as clinicians need to hone their technical capabilities to truly provide the best for their patients, are apathetic to the varying factors of the human experience that ultimately influence the clinical encounter. For example, in “In Search of a Wide-Angle Lens,” Dr. Harold Braswell of Saint Louis University presents the notion that the true nature of healing is based upon the emotional and social makeup of the human being (Braswell 21). Braswell thoroughly presents the trying situation of a pregnant, disadvantaged laborer who due to the nature of her work, was not given appropriate breaks to allow for the rest of her vulnerable body. The physical trauma and emotional stress morphed into the abortion of the woman’s baby as she felt there was simply no other choice she had (Braswell 21). This directly asserts the necessity of cultural competency in medicine as Braswell’s depictions support the claim that cultural influences directly manipulate the realm that is a person’s healthcare. Braswell further strengthens his argument through the notion that had the healthcare team acknowledged the cultural makeup of the patient, that is to give respect to the patient’s moral values, spiritual beliefs, and socio-economic status, perhaps the woman could have been connected to supplementary resources instead of undergoing an abortion, thus changing the outcome of her clinical experience (Braswell 21). Fundamentally, a greater understanding as to why a certain patient is seeking a specific treatment, that is to go beyond the solidified film of superficial interaction and really assess the cultural factors that led the person to seek professional help in the first place, is to highlight the interconnectedness of culture and illness and ultimately provide the best level of patient care (Braswell 21).
In order for this process to occur, healthcare professionals argue that we must first recognize the importance of cultural sensitivity in general as it relates to the medical profession. For example, in “Losing Culture on the Way to Competence: The Use and Misuse of Culture in Medical Education,” Drs. Gregg and Saha of Oregon Health & Science University build upon Braswell’s theory of culture and illness in their presentation of a young child of Hmong descent that lapsed into a coma (Gregg and Saha 542). The authors underscore the notion that the child’s unfortunate suffering was partly due to the invisible yet divisive barriers of cultural plurality that ultimately hindered the Hmong-American family from receiving the maximum benefits of the American healthcare system. Specifically, Gregg and Saha highlight the language barrier between the healthcare team and the patient’s parents that led to a breakdown in the family’s comprehension of their daughter’s case in addition to the preexisting spiritual values that the physicians failed to acknowledge in developing the child’s course of treatment (Gregg and Saha 542). Thus, the authors propel the notion that a physician’s ability to treat corrosive diseases would improve if he or she was deft in the ability to extrapolate the ideology behind their patient’s perception of the illness, directly influenced by his or her cultural makeup, into the context of the greater science-based principles that medicine is founded upon (Gregg and Saha 544). In other words, in order for a patient to be properly evaluated and understood on a biological level, the patient must also be evaluated on a social, emotional, and cultural level. That is, clinicians must acknowledge the dynamic arena of the external factors that are linked to the internal essence of the human being that truly makes that person himself or herself (Gregg and Saha 544).
Furthermore, with increasingly diversified patient populations sprouting in clinical contexts across the nation, an increasing number of healthcare professionals and philosophers believe that it is paramount that medical professionals and bioethicists are highly educated in addressing issues of value conflict in both the elevated and marginalized. According to “Bioethical Silence and Black Lives” by Derek Ayeh, senior associate at Medicare Rights Center, Ayeh states “The late Adrienne Asch once wrote that bioethics is at its best when people do not merely ask each other what their views are, but really take the time to find out what is behind those views” (Ayeh 2). This directly supports the claim that one must fully commit themselves to the ideology that propels certain patient behavior in order to better understand the needs and biases of the patient in relation to the corrosiveness of the illness (Ayeh 2). Ayeh states that this will then lead to a more accurate patient treatment plan that is synonymous with his or her internal values as a human being and lead to more positive outcomes in terms of disease management (Ayeh 2).
As such, we continue to find our minds waltzing on the tightrope that is the sciences and domain of cultural sensitivity and the increasingly convoluted nature of these disciplines. Perhaps, it may be our innocence or naivety in not having extensive clinical experience in healthcare as Curlin or McMillan do that to truly evaluate the patient on a mind, body, and spiritual level to best inform my treatment protocol and recognize the patient’s social and environmental background that influence their unique value base is possible. Perhaps, it may be our increasing love for the sciences that continue to morph the lens in which we view the importance of cultural sensitivity given that the sheer nature of medicine is rooted in mastery of technique. Perhaps, it is less about one or the other and more about establishing a fluid equilibrium of both in the context of the physician-patient relationship. In other words, perhaps the essential question needs to be reframed as to what extent should cultural sensitivity be given precedence in varying medical specialties. Perhaps, cultural sensitivity should be investigated as an applicable spectrum in order to best respect the specialized technicality of medicine and merits of objective healthcare.
Nonetheless, it is important to note that this exploration into the intricacies of cultural sensitivity is not fully representative of the many varying entities that compose this domain. Thus, it is highly important that the American healthcare system continue to explore the dynamics of social factors such as faith, customs, and underlying beliefs, specifically in regard to the limitedness in viewing culture as a concrete entity that can be copied and pasted into the framework of patient care and measured by arbitrary guidelines. It is then that the matter of intersectionality in medicine becomes increasingly pertinent to explore in the ongoing dialogue as culture is not an all-encompassing linear model. Thus, as we stand at the nexus of ongoing clinical advancement and social diversity. Let us continue to explore and elevate in the name of patient prosperity.
Works Cited
Ayeh, Derek. “Bioethical Silence and Black Lives.” Voices in Bioethics, www.voicesinbioethics.net/opeds/2015/08/03/bioethical-silence-black-lives.
Braswell, Harold. “In Search of a Wide-Angle Lens.” Hastings Center Report, vol. 41, no. 3, pp. 19–21, www.academia.edu/570820/In_Search_of_a_Wide_Angle_Lens.
Curlin, Farr A, and Christopher O Tollefsen. “Conscience and the Way of Medicine.” Perspectives in biology and medicine vol. 62,3 (2019): 560-575. doi:10.1353/pbm.2019.0033.
Gregg, Jessica, and Somnath Saha. “Losing culture on the way to competence: the use and misuse of culture in medical education.” Academic medicine: journal of the Association of American Medical Colleges vol. 81,6 (2006): 542-7. doi: 10.1097/01.ACM.0000225218.15207.30.
McMillan, John. “The Royal College of Physicians and Surgeons of Canada: Moral Theory.” Royalcollege.Ca, 2018, www.royalcollege.ca/rcsite/bioethics/primers/moral-theory-e.