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Domains of Cultural Competency

Author(s): Carey Jackson, MD

Domains of Competency

 

Provider Training: Often left to medical schools or residency the clinicians need an orientation to the interaction between culture and medicine. Obvious examples have to do with examples of how expectations in clinical encounters vary by culture, how common illnesses are constructed linguistically and culturally, how dietary patterns impact illnesses like hyperlipidemia and diabetes that are determined by diet. How religious life impacts end of life discussions and certain illnesses.

Interpreter Services: Central to any medical service serving non-English speaking patients.

  • Interpreter training
  • Certification
  • Recruitment and retention
  • Integrating interpreter services into provider and patient education

Administrative systems:

  • Recruiting from the community to have the work force reflect the communities
  • Integrating cultural and linguistic codes into data systems such as diabetes tracking system and rehabilitation outcomes in order to assess outcomes by ethnic group
  • Developing safety systems that include cultural information about names, pronunciations, and the name order by culture.
  • Materials for appointments, procedures, and preps for procedures that are translated and culturally tailored
  • Hospital schedules that minimize no show rates and reschedules by noting important holidays of their ethnic groups served by the system

Financial systems:

  • Interpreted culturally sensitive interpretations that explain the concept of insurance, co-pay, sliding scale
  • An explanation of the billing system and special attention to explain collections and how to work with the collection agency

Medical Culture:

  • Education about the work-up, appointments, the role of specialty care, formularies
  • Advanced directives
  • Giving bad news

Patient education:

  • In medical culture as above
  • Disease specific topics (TB, cervical cancer, Hepatitis B)
  • Routine procedures
  • Dietary changes for diabetes, hypertension, ischemic heart disease
  • Pre-operative instructions and procedure explanations