For a long while, the phrase “cultural competence” seemed like just another buzzword to me. I remember sitting through our diversity class in PT school, eyes glazed and attention wavering at the mention of these touchy feely topics. I knew it was important, but I thought I had a firm grasp on understanding diversity. I grew up in California, was raised by a single immigrant mother, and went to college at UC Berkeley--known for its liberalism and activism. I figured my exposure and environment were enough, and I wanted to spend my time learning the “real” PT subject matter in the classroom.
...I was wrong.
While learning functional anatomy and differential diagnoses are important to our didactic education, so too is empathy, compassion, and reflection. After all, as physical therapists we have a duty to our patients to respect their rights and understand their needs.
Current events in our country over the past few months have exposed many harsh realities of our healthcare system. Societally, we need to recognize the impact of health disparities, as well as social and even moral determinants of health. Observing the protests for social justice and feeling the impact of COVID-19 has been difficult. I, for one, have felt at times overwhelmed and helpless, unable to aid those that are suffering.
On a positive note, many new organizations have popped up to create resources to educate the public, pushing for cultural competence and systemic change. With respect to healthcare, access to healthcare differs by race and ethnicity, racial and ethnic minorities are disproportionately burdened by chronic illness, and language and communication barriers (including low literacy) are problematic.
Cultural competence in health care is broadly defined as the ability of providers and organizations to understand and integrate these factors into the delivery and structure of the health care system. The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, English proficiency or literacy.
(Georgetown University Health Policy Institute)
I am by no means an expert, but I do care deeply and passionately about equality and health. I always have. It’s part of why I became a physical therapist--to help people. Looking back, I was a naive student who believed that I understood diversity, and underplayed the value of learning sociocultural factors, personal biases, and reflecting upon my own interactions to become better.
I now understand why we were introduced to these concepts in school: reflection in action, reflection on action, what you know, what you think you know, what you don’t know. At the time, these exercises were just more work added to my mountain. I did not give them a fair shake in my development as a clinician.
Since then, I have come full circle and have implemented these exercises into my practice. I am more aware of myself and differences inherent to the experiences of those around me. As physical therapists, we are sometimes the first line of care that a patient seeks for guidance. If our aim is to improve healthcare delivery, the onus is on us to become better and cultivate a trusting relationship with our patients. The path to becoming a better clinician is not straightforward. It takes mental effort, vulnerability, open-mindedness, and self-reflection. Here are some of the many tangible ways to start building small habits that are working for me:
On a personal level:
- Take a self-assessment to help you recognize your implicit biases, and develop strategies to check them. Here are a couple:
- Stay stoic in response to inflammatory or disagreeable remarks.
- This one is very difficult for me personally. I start by taking a slow and deep breath on a 5 count, and think of a question to ask after letting them finish their statement.
- Reflect after each patient session, even a quick 1 minute positive and negative.
- If I can’t give time after each one, I carve out a few minutes at the end of the day to celebrate my small victories and think about what I could change next time.
On a practitioner level:
- Listen. Hear them out. Let them vent.
- Sometimes I look at the time when I sit down and let them talk for as long as they need. You’d be surprised how long people can talk uninterrupted.
- You’d also be surprised at how long you can talk uninterrupted. See next point.
- Reassure.
- You don’t need to explain all the science, the way you learned in school. It can be overwhelming. You can tell them they are going to be okay and give them 2-3 things to work on.
- Reinforce the earnest efforts your patients make, however small. If you can convince them to make a small change, it is a good starting point to celebrate and build.
Being culturally competent is not an end-goal. It is an interactive process that takes a strong check on implicit biases and a dedicated effort in self reflection.
Start building the habit now.
Carve out the time for that self-assessment.
Watch a short video on antiracism and health care.
Talk to a coworker, classmate, partner, or friend about something you learned.
I am often the one to share articles, reach out, and check in with my friends and peers; it is rewarding to foster a discussion, however short, on something I found interesting. It makes me a better friend, therapist, and person.
I hope what I have shared with you can foster the same and that we can collectively take steps, however small, towards a future of healthcare that is unaffected by implicit bias and who's providers are dedicated to being better for those they serve.
Thank you for reading!
Salinda Chan PT, DPT
Resources & further reading:
https://www.apta.org/patient-care/public-health-population-care/cultural-competence
https://jamanetwork.com/journals/jama/fullarticle/2767353
https://www.census.gov/library/publications/2019/demo/p60-267.html
https://hpi.georgetown.edu/cultural/