The Ethical Self-Fashioning of Physicians and Health Care Systems in Culturally Appropriate Health Care

Abstract

Diverse advocacy groups have pushed for the recognition of cultural differences in health care as a means to redress inequalities in the U.S., elaborating a form of biocitizenship that draws on evidence of racial and ethnic health disparities to make claims on both the state and health care providers. These efforts led to federal regulations developed by the U.S. Office of Minority Health requiring health care organizations to provide Culturally and Linguistically Appropriate Services. Based on ethnographic research at workshops and conferences, in-depth interviews with cultural competence trainers, and an analysis of postings to a moderated listserv with 2,000 members, we explore cultural competence trainings as a new type of social technology in which health care providers and institutions are urged to engage in ethical self-fashioning to eliminate prejudice and embody the values of cultural relativism. Health care providers are called on to re-orient their practice (such as habits of gaze, touch, and decision-making) and to act on their own subjectivities to develop an orientation toward Others that is "culturally competent." We explore the diverse methods that cultural competence trainings use to foster a health care provider's ability to be self-reflexive, including face-to-face workshops and classes and self-guided on-line modules. We argue that the hybrid formation of culturally appropriate health care is becoming detached from its social justice origins as it becomes rationalized by and more firmly embedded in the operations of the health care marketplace.

EPA guidance on cultural competence training

“…Cultural competence is necessary in clinical practice whereby the psychiatrist sees each patient in the context of the patient's culture as well as their own cultural values and prejudices [7,8,9,10,77,80,100,111,112]. Psychiatrists are experts in biomedicine; patients are experts in their own experience of distress.…”

“…Clinically competent mental health professionals are interested in the patient's cultural biases and world view, knowing that these are strongly colored by cultural values, and are also aware of their own personal cultural strengths, weaknesses and prejudices which may affect their response to patients [58,65,84,91,100,111,112,129]. Cultural competency constitutes cultural sensitivity, cultural empathy and cultural insight.…”

“…Competent treatment of minority patients requires that mental health professionals are open to understanding the similarities and differences between more traditional and modern Western approaches [7,8,18,57,77,100,101,129]. It is important to understand and emphasize that cultural competence is not a static phenomenon but a developmental process, which represents a continuum [29,57].…”

“…With increasing globalization and movement of people across national boundaries it has become important that service providers are aware of the different needs of the patients they look after [100]. It is significantly likely that the stress of migration may contribute to the development of psychiatric disorders in vulnerable individuals.…”

Background paper on the needs of migrant, refugee and asylum seeker patients around the globe

“…Cultural psychiatry and psychotherapy must therefore be regarded as a matter of primary relevance. It is recommended that service providers cultivate an awareness of the different needs of the patients they look after (Shaw & Armin, 2011). It is highly likely that stress factors before, during and after migration will contribute to the development of psychiatric disorders in vulnerable individuals.…”