If you read this blog on a regular basis, you’ve heard of cultural competence – being able to work knowledgeably and respectfully with people across different cultures. To many healthcare professionals, it seems logical that learning about a culture will help them build closer patient relationships and make smarter care decisions. And there’s no doubt that information is a good thing. But these days, providers who care for underserved populations are emphasizing another key to great patient care – cultural humility.
Cultural humility can help us sidestep a few pitfalls when caring for patients from communities or backgrounds different from our own. One of those pitfalls: the tendency of implicit bias to masquerade as knowledge. Stereotypes can feel like an easy way to explain someone’s condition; assumptions provide a shortcut to a false sense of understanding. And while there’s a lot of great cultural competence training out there, it’s important to recognize that we can never know as much about a community or region as the people who grew up there do.
That’s where cultural humility comes into play – the recognition of the patient as the expert on their own background and experiences.
Cultural Humility vs. Cultural Competence
Maybe it sounds obvious that patients know the most about their own lives. But if you ask patients about their healthcare experiences, many tell a different story. Some patients encounter providers who, upon finding out they are gay or disabled or over sixty, jump to conclusions that just aren’t true. Other times the healthcare staff are oblivious to some critical needs or dynamics that can change patient outcomes. Some patients feel they are put in simplistic boxes, marked “marginalized” or “privileged” when most of us experience a mix of different advantages and barriers.
Cultural competence is still beneficial, helping us learn a culture’s values, beliefs, and practices. Studying the prevalence of certain illnesses and needs in specific populations is vital for good clinical research. Medical and behavioral health are influenced by many factors, such as race, gender, biological sex, religion, education level, socioeconomic status, and others.
Cultural humility functions by filling in the other part of the equation – helping providers not only realize their own knowledge limits, but also reminding them to ask questions and listen to patients without preconceptions. It’s not about showing weakness or submission but expanding our grasp of the nuances influencing the patient’s health.
Are you wondering if cultural humility is a mindset or an approach to patient care? It’s both. We stay mindful that the patient has knowledge only they can teach us. They know their cultural background and traditions, their daily habits and preferences, and their capabilities – and we take actions to learn from them. By stepping out of our own implicit bias, we grasp the real, complex person sitting before us, and become empowered to create a truly effective treatment plan.
5 Steps to Elevating Patient Care
Here a few ways to integrate cultural humility into your practice:
- Develop the habit of checking in with yourself and your team on implicit bias when it comes to specific cultures and communities. Did a nurse make casual assumptions about transgender patients? Do your front desk staff think all Native American patients live on reservations, when many live in urban areas?
- Recognize the power imbalance between you and the patient. To the patient, you are an authority figure. They may be afraid to correct something you say. Let patients know you respect their ability to educate you on their identity and background.
- Ask the patient open-ended questions and show you’re listening, rather than focusing on an EHR tool. Be open to hearing that you got something wrong and acknowledge the mistake.
- Practice motivational interviewing when asking patients to commit to change. This could be someone dealing with substance abuse or a patient making lifestyle changes to treat diabetes or heart disease. Active listening, expressing empathy, and nonconfrontational discussion styles have all been found to help foster productive conversations with underserved patients.
- Look for ways to modify your team’s approach or improve your processes. Maybe an intake form doesn’t ask the right questions. Perhaps a certain standard of conduct, like making eye contact with patients, is perceived as disrespectful by some patients.
Unlocking High-Value Care with Cultural Humility
It’s common for people to get defensive when we talk about “isms,” such as classism, ageism, racism, ableism, or sexism. But cultural humility is never about blaming people. It’s about recognizing the complexity of the human experience. Every patient intersects with a variety of communities and influences, from their job to their age to their ethnicity. No provider is omniscient, and even seasoned clinicians can be unfamiliar with some cultures and identities. Cultural humility is a way to collaborate with patients in building empathy and understanding – and in doing so, provide extraordinary patient care.