Last month in our monthly email Sandy Hoar in his "Words of Wisdom from the Feild" article began a discussion about cultural beliefs and its influence on patient care. He states " The more familiar you are with a community's belief system and using simple terms and ideas to match a patient's understanding the easier it is to form a healing partnership with the patient. "

I'd like to invite everyone to discuss this topic and present examples.

What I'd like you all to think about is:

• How does a provider go about learning about patient beliefs?
• How do you provide culturally competent care?
• Are there different cultural beliefs and medical beliefs between different ethnicities within the states? 
• how do you deal with time restraints, resource restraints and still provide education to your patients?

I have a particular interest in culturally competent healthcare as this is what my Masters Thesis topic was about. One example I like to point to is a Hispanic American patient whom I treated. He hand CML and needed to take Gleevac but the medicine was expensive and he said he did not "feel sick". He was spanish speaking and a migrant worker. When I tried to explain to him in spanish that he had too many WBCs. He did not understand. Spanish has a word for cells- globulos, but this patient did not know that his blood was made up of cells.  So I in very basic language I explained the microanatomy. And used the term globulos of which he had never heard before but I explained they were things he could not see. I used examples from his environment. I also explained that he would not feel sick until the blood "clogged" up his body and El cuerpo (the body) would lose strength from making too many globulos. He understood and took the Gleevac- once we found him assistance.  This example may be more exemplary of socio-economic and educational differences rather than culture.

Another similar example related to Hispanics is that there is a principal called "respecto" in Hispanic culture that may not be present in Anglo American culture.  Hispanic patients feel that a doctor/PA is someone in a position of authority and our judgement should not be questions. (How many of your patients question your judgement in your work in the states? - Its more acceptable to speak up in American culture!) So if a Hispanic patient is not taking the medication prescribed- they may not tell you because they don't want to disobey or disagree. So I always try to ask all patients if my treatment plan is something they can do or not.  

 Post your thoughts and experiences on this topic! Be looking for similar topics on the PAGH Yahoo!Groups site in the future.

Harmony Johnson PA-C, MMS , President Physician Assistants for Global Health, harmoniousness@...

"One person can change the world and everyone should try"  JFK