Advocates can assist healthcare professions in providing culturally- competent care to patients
Imagine lying on a hospital bed - anxious, uncomfortable, waiting for test results and fearing the worst. Now imagine being probed in all the sore places by unconcerned doctors and nurses who wear deadpan expressions as they stop by to take your vital signs, do blood tests, and listen to your chest. Also imagine that the hospital that you have landed up in is in some remote corner of Africa, and you don’t have a clue what the medical staff is saying, and you cannot explain what you are feeling. This is often how poor, uneducated, illiterate patients feel when they find themselves in a large hospital in the city, where everything is unfamiliar and threatening.
“If you speak English well, then a doctor will treat you better. If you speak only Hindi and your English is not that good, they look down on you. They think you are a fool.”
An uneducated woman from an Indian village
The reasons for healthcare disparitiesSome factors that contribute to health disparities are:
- Persistence of centuries-old racial stereotypes
- Time pressures caused by increasing case loads
- Lack of decision-making skills in the junior health care staff
- Absence of a patient-advocate in the picture
Real or perceived discrimination in hospitals can lead minorities and the poor to mistrust doctors and nurses. The onus is on the healthcare provider, who is the “more powerful actor in clinical encounters” to see to it that such disparities do not occur, and if he fails in this duty, it’s the patient-advocate’s responsibility to step in and correct matters.
In a recent survey, physicians reported that more than half of their patients do not follow medical treatment as a result of cultural or linguistic barriers. While the majority of doctors surveyed agree that language and culture are important in the delivery of care to patients, only half of the doctors reported having any form of “cultural competency training.” This lacuna is one which a caring patient advocate can fill competently, allowing him to act as a bridge between the doctor and the patient.
The need for cultural competence in patient-advocates
Cultural competence leads to cultural awareness, knowledge, understanding, sensitivity, interaction, and skill. It necessarily flows from good “communication.” Efficient health care delivery also depends upon health literacy, which varies between different cultural groups.
Although poor health literacy can be a particularly thorny problem in patients with low literacy skills, it can also affect patients who think of themselves as being literate. Even doctors sometimes find it hard to make sense of the convoluted language which health insurance companies and hospital administrators use in their forms. A patient advocate can help in decoding this medical jargon.
Lay theories of anatomy and physiology can also influence how people interpret and respond to their illness. In Indian villages, women often describe their menstrual blood as “bad” or “toxic”, and are forbidden from entering temples or even their kitchens, when they are menstruating. It is hardly surprising that they have a hard time describing their gynaecological problems to doctors. The presence of an advocate can help transcend such cultural and linguistic barriers.