By Alex Lin, PT, DPT
Physical Therapist
Central Texas

As healthcare becomes more accessible to people around the world, clinicians are expected to not only give the highest quality of care, but also know how to tailor it to each specific person we encounter. We live in a world where not one person is alike. But as generational, ethnic, racial, and socio-economic boundaries continue to divide us, how can we bring the same caring and sincere services to those that live completely different lives from us?

What are Clinicians Typically Taught About Cultural Sensitivity?

Historically, healthcare providers were trained to be competent in various cultures and backgrounds. We are taught to be knowledgeable in how different groups of people act, think, or believe. We take online courses and modules to supplement our clinical training. We categorize people in hopes of understanding how we can interact or expect from them.

But is cultural sensitivity training the most effective approach? 

Although the intent has been lauded for its efforts, training providers in becoming competent in various cultures presents the risk of stereotyping, stigmatizing, and othering patients and can foster implicit racist attitudes and behaviors.

Sure, training in cultural competence primarily increases provider knowledge, attitudes and skills, but has still had little or no effect on patient satisfaction and/or patient health outcomes to decrease disparities.

Cultural Humility Training Provides a Better Path

Cultural humility shifts the perspective onto us as clinicians. It focuses on self-reflection of our implicit biases, an appreciation of a patient’s expertise on their own backgrounds and cultures, and an openness to continually learn from them. We take the role of the student and learn from our patients — rather than the role of the expert, defining what or who we think a patient should be.

Cultural humility training encourages providers to reflect on their own beliefs, values and biases — explicit and implicit — through introspection thus, revealing their own culture’s impact on patients.

Adopting this mindset is not an easy task! Even today, we catch ourselves with implicit biases, only to be surprised by the patients we treat. During one of our monthly regional meetings, we all shared about our implicit biases towards older adults even though they are our primary demographic! We instantly have an image of how 95-year-old Mrs. Smith who is 95 lbs and 4’ 9” should present to you during an evaluation. Does she look frail? Is she slow? She probably uses a walker. 

Self-awareness of these biases is the first step and the next best step would be to assume the role of the learner and be open to what your patients will reveal to you.

How to Practice Cultural Humility When Treating Patients

Let’s say you have a 70-year-old female patient. You read in the chart that she is morbidly obese. An empty shopping cart sits next to the front door of her apartment as you walk up to do the evaluation. You knock and are instructed to see yourself in. There is junk food lining the shelves with a kitchen sink that has seen better days and a smell that reminds you of moldy cheese. You hear the small scurry of rats along the walls. 

As you start your interview, you might be thinking things like: 

“If she only lost some weight, she wouldn’t be having such terrible hip and knee pain” 

“She should probably eat healthier.” 

“It’s not that hard to go on a walk, even down the hallway wouldn’t be so bad”

“She’s not even that old”

“Even if I tell her these things, she’s not going to listen”

After performing your assessments, you learn her main goal is to be able to get into her car and go grocery shopping. As you end your evaluation and start packing up, you leave feeling slightly relieved from the stench you’ve endured for the past hour, and come to the conclusion that it will be near impossible to change her behaviors for her to reach her goals. 

This was an actual experience of mine where my own implicit biases and assumptions were based on what I’d been taught through schooling and traditional methods of cultural competencies. Behavior change in obese older adults is a long shot.

But as I began to build my relationship with this patient, I realized I needed to change my approach to help this person. I already had a ton of biases towards how much progress this person would make, and I thought I understood her socio-economic situation. She was living off of disability payments in a housing authority and had food delivered to her regularly because she couldn’t get to the grocery store.

It was only when I began asking the right questions as the learner, not the expert, that I really began to understand her situation and how to assist her.

Through open-ended questioning with a sincere approach to learning about this person’s life, I discovered:

• Her pro-bono shopper did not always bring her the healthiest of foods, hence the shelves filled with processed foods.
• Her car needed to be taken to the shop, but there was nobody available to take it in for her. 
• She was scared that she couldn’t lift and fit her walker into her car to go grocery shopping. 
• She was ashamed of her physical ability to the point where she did not want others to see her struggling to walk.

Although some of these barriers were beyond my physical ability to assist, they helped me understand what was really preventing her from reaching her goals. I was even able to set very specific and meaningful goals for the patient to live a healthier and happier life. 

By listening to the person sitting in front of you with a blank slate and with the expectation that they will teach you something, we can slowly begin to bridge those gaps that separate us from providing the best human-centered care.