We all know how important it is to feel like you "click" with your diabetes doctor or educator. Things never go well if the individual you're seeing doesn't seem to "get you." Now imagine that they didn't speak the same native language, and had absolutely no sense of your lifestyle, diet, mentality, or aesthetic preferences. In other words, you were being treated by someone utterly unfamiliar with your culture. How could you possibly discuss a workable diabetes regimen with no common ground?
A reader recently called my attention to a provocative article that appeared in the journal Insulin last April. It explains why "cultural competence" is key to helping patients thrive. Brace yourself. I'm going to quote extensively from this piece, which (IMHO) unlike many academic-medical articles, has some very down-to-Earth and important things to say.
"Cultural competence is defined by the American Medical Association as the knowledge and interpersonal skills that allow providers to understand, appreciate, and work with individuals from cultures other than their own. It involves an awareness and acceptance of cultural differences, self-awareness, knowledge of the patient's culture, and adaptation of skills."
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"Although no randomized clinical trial has been conducted to demonstrate that DM (diabetes mellitus) control and/or complications are improved by a group of health care providers with higher cultural competence compared with a group with a lower level, it appears clear that cultural competence can lead to a much more pleasant and productive health care provider—patient interaction. In the field of DM, it may be particularly relevant because disease control is greatly determined
by effective lifestyle and behavior modification."
I'd say so, yeah.
"These changes are more likely to be implemented if the patient has developed a good rapport with his or her health care provider, an aspect that can be improved through cultural competence. Some individuals have completely ignored the importance of this new area of health care practice, but it has slowly become more appealing and interesting to many."
"In fact, due to the growing number of minorities in the United States, the fact that they suffer from
higher rates of DM and its complications, and the already mentioned lower quality of DM care in these groups, the need to improve the skills of health care providers in the area of cultural competency has been more recognized than ever before."
WHO'S DOING IT:
"Currently, 2 states—New Jersey and California— require physicians to obtain some annual continuing medical education credits in programs addressing cultural aspects in health care. It is anticipated that more states will join the effort to disseminate accurate information on how to improve the lives of people with DM from various cultures."
THE BOTTOM LINE:
"Patients and health care providers have a different 'agenda' in their mind in any given clinical encounter. Both the patient and the health care provider must become more open and receptive to the other person's point of view regarding the disease process and treatment strategies. Ultimately, any therapeutic plan is an agreement or 'contract' between 2 parties. Both must recognize and acknowledge their responsibility and commitment to move forward. Unfortunately, many health care providers blame the patient for not following a treatment plan. It is disappointing to hear many professionals refer to patients as noncompliant."
"Although it is true that some patients may not adhere to their treatment plan, perhaps it is fairer and more helpful to say: 'I have not found the best way to interact with my patient so that some specific behavioral changes occur.'"
SOME PLACES TO START:
Diabetes resource web sites with a cultural bent.
http://www.ihs.gov/medicalprograms/diabetes/index.asp -- for American Indians and Alaskan natives
http://aadi.joslin.harvard.edu/intro/intro_19.asp -- for Asian-Americans
http://www.elviradarknight.com/diabetes/minorities.html -- resource list
Or you can always go have a look at David Mendosa's big list of non-English diabetes web sites, HERE. Whatever it takes, to find your point of connection.