Article 16

=Anthropology in the clinic: the problem of cultural competency and how to fix it.=

Kleinman A, Benson P.

PLoS Med. 2006 Oct;3(10):e294.

This was an interesting article regarding cultural competency from an anthropologic view. Anthropologists understand the need for cultural competency training, but find that cultural competency is not a proper term since it suggests culture can be reduced to a technical skill for which clinicians can bet rained to develop expertise. Anthropologists emphasize that culture is not a single variable but rather comprises multiple variables, affecting all aspects of experience. Rather than the teaching cultural competency, the authors propose training clinicians in ethnography, referring to an anthropologist’s description of what life is like in a “local world.” What sets this apart from other methods of social research is the importance placed on understanding the native’s point of view. Ethnography differs from cultural competency in that it does not use a trail list approach in understanding culture; it emphasizes engagement with others and with the practices that people undertake in their local worlds. One of the authors introduced the “explanatory models approach” as an interview technique that tries to understand how the social world affects and is affected by illness. Despite its use throughout medical education, the authors find that physicians use the model as a kind of substance or measurement and as a way to end a conversation rather than to start it. The authors propose that these models should open clinicians to human communication and set their expert knowledge alongside the patient’s own explanation and viewpoint. They propose the following “mini-ethnography” to use in the daily patient interaction: The authors assert that it is important that healthcare providers do not stigmatize or stereotype patients. Even patients of the same culture or ethnicity have their own differences in beliefs. The most important thing to understand is what is at stake for the patient.
 * 1) Ethnic identity – ask about the patient’s ethnic identity and determine if it matters for the patient. Rather than assuming knowledge of the patient, which can lead to stereotyping, simply asking the patient about ethnicity and its salience is the best way to start.
 * 2) What is at stake? – evaluate what is at stake as patients and their loved ones face an episode of illness.
 * 3) The illness narrative – this involves a series of questions aimed at acquiring an understanding of the meaning of illness.
 * 4) Psychocoial stresses – consider the ongoing stresses and social supports that characterize people’s lives.
 * 5) Influence of culture on clinical relationships – examine culture in terms of its influence on clinical relationships.
 * 6) Problems of a cultural competency approach – consider the efficacy of this type of intervention for each case.

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