Cross-Cultural Medicine
There are many reasons why physicians need to provide culturally competent health care. Increasing numbers of patients belong to minority groups, have limited proficiency in English, or were born in foreign lands. Culturally competent physicians may be better able than other physicians to avoid misunderstandings with patients that lead to malpractice claims and may be able to communicate more effectively with all patients. Numerous health care organizations are required to comply with federal standards for culturally and linguistically appropriate services, and many medical organizations are committed to helping physicians become more culturally competent. The American Medical Association, the American College of Physicians, and the American College of Cardiology are among the many medical societies that have launched initiatives to improve cultural competency and the care of diverse populations. Moreover, to receive accreditation, medical schools are required by the Liaison Committee on Medical Education to teach medical students about the ways that cultures and belief systems can affect health and health care. For many physicians, including me, the question is not whether to be more culturally competent, but how. Cross-Cultural Medicine is an important first step toward culturally competent care. The book begins with an exploration of what it means to be culturally competent and includes useful tips for heightening one's awareness of culture, conducting clinical cultural assessments, and improving cross-cultural communication. Most of the chapters in the book focus on specific populations: blacks and African Americans, Latinos, American Indians and Alaskan Natives, Asian Americans, Arab Americans and American Muslims, and other immigrants. The chapters are well organized and provide information about the history, health beliefs and practices, barriers to health care, and high-risk conditions specific to each group. I particularly like the tables at the end of each chapter; they summarize communication issues, barriers to health care, and high-risk conditions and might easily be scanned in preparation for seeing a patient. I also like many of the clinical vignettes that illustrate specific cultural issues. The chapter on Arab Americans is noteworthy for its useful information about a group that has received little attention in the medical literature. In contrast, the chapter on immigrants covers people from around the world and is less useful because its scope is too broad. Missing from the book is any discussion about native Hawaiians and Pacific Islanders. The book ends with chapters on spirituality and religion in health care and on the role of physicians as advocates for diverse populations. Cross-Cultural Medicine will not meet everyone's needs. The book is not a panacea for cultural incompetence. It makes it clear that "cultural competence is a means, not an end" and that physicians need to remain attentive to culture to deliver optimal care to all patients. The book is not a reference that summarizes all the available information about every ethnic group that may be encountered in the office. Given the increasing diversity of the American population, such a book is probably not possible. Because Cross-Cultural Medicine is presented from the perspective of internal medicine, its many examples may not resonate as well with other physicians. However, it meets its stated purpose of providing "internists with a framework for practicing culturally competent care" in a clear and succinct fashion. It is a handy bedside resource for physicians who seek to begin the long journey toward culturally competent care.Ernest Moy, M.D.Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.