Wednesday, April 23, 2008

Multiculturalism & Diversity

As I mentioned in my last blog post, our learning journey to Canada as part of Futures Task Force II gave us the ability to explore the strengths and weaknesses of the Canadian health care system.

We also learned a great deal from reviewing the Canadian experience with multiculturalism and diversity. I’d like to reflect briefly on these learnings and what it means for us as providers of health care in the U.S.

Although it varies with regard to both the numbers of people and different populations in various countries, every country today has some degree of diversity within it. Over the last 20 years in the U.S., for instance, we have seen the number one minority become Hispanics. In addition, particularly in our larger cities, but now even in many of our suburban areas, we have as many as 20 different cultures represented in either distinct or integrated communities.

Although these diverse populations often experience the same diseases, their cultural traditions favor some treatment modalities over others. These include both the technical or “hard” components of health care, as well as the holistic or “soft” components of the delivery process.

In order for anyone to fully benefit from their treatments, they must be comfortable with the people who deliver them as well as the components of the treatment plan. This requires us all to be committed to becoming more culturally competent as we continue our journey as health care providers.

A clear example of this is recognizing that the family ties in Mexico and in the Hispanic populations in the U.S. are often much stronger than those in other Americans. Consequently, at the time the Hispanic patient presents, he/she is often accompanied by his/her entire immediate family, and often distant relatives. This is even more apparent when a sick child is brought for evaluation. Consequently, we as providers must be comfortable with a much larger number of people in our exam rooms often answering the same question with different voices and different thoughts. In addition, we must become comfortable with the language barrier and depend on one of these relatives to be the translator for the patient who cannot speak English. And finally, we must be fully committed to educating the bilingual family member, for they will then in turn have to be the educator and caregiver of the patient.

This obviously requires more time and effort, but in the end, if getting our patient better is our primary goal, then this is the journey we must take because of the increasingly diverse people who will enter our facilities in the future.

In addition, this also demands that we design our clinics and hospitals differently. If indeed this extended family is part of the treatment process, our waiting rooms and our exam rooms must be larger to accommodate this larger crowd. In addition, our hospital rooms must also be larger, and even provide an opportunity for at least one family member to sleep over with adult patients during their hospital stays.

Because Canada encourages immigration from all countries to enhance their population growth in order to support their employment needs and because they see the importance and added value of a culturally diverse country, they have committed to studying these various cultures, what their traditions demand in health care and to the best of their ability to meet these demands at their delivery sites.

Needless to say, the changes required to create these diverse treatment plans are often met with some resistance, but the outweighing positive is that the practitioners have learned that in fact some of the treatments carried out in these diverse cultures and some of the methodologies which they demand are really better than some of the traditional methods that have been utilized by us in the past.

They recognize that ultimately, the best practices must be based on evidence, and are working very hard to do research on these “softer” methods of health care delivery to make sure that the added value they perceive can be demonstrated to others who have not utilized them in the past. As the world becomes “flatter,” it is inevitable that the diversity of cultures who present to our health care systems for treatment will increase.

I recognize that most of us were not exposed to many of these traditions in our medical school training. But I know that in order to be successful in the future, we will need to be more open to integrating traditional and non-traditional medical modalities to a greater degree if the diverse patients we see are to be maintained in a healthy state both physically and mentally.

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