Written by Ummulwara Qasim
The ever-growing field of medicine in the twenty-first century has diversified in all aspects of its field– treatment, research, and most importantly, medical education. Our current day curriculum found in various medical schools nationwide has been creating more opportunities for student to learn about how culture affects medicine, and the various aspects that influence a patient’s health. The importance of incorporating culture with science is that it helps to serve the community better by our future doctors. Having a better understanding of our patients and their cultural background is essential to comprehending how culture affects their health. The methods taken for treatment can be varied between one patient to the next in order to provide them with more individualized care. Interestingly, this idea may seem obvious to others, but it has been a recent movement in the past 30 years to incorporate such a perspective to this field [1].
The highlight factor that was presented in early studies by medical anthropologists was that doctors were not only capable of treating and healing their patients, but that they could also help with social control [1]. Doctors interact with different communities and can reach out to those living with social inequalities, especially in our healthcare system. The concepts of global health and health disparities emerged from these social conflicts, and are still prevalent in the American society. Doctors are authoritative figures than can push for reforms to solve these social conflicts. One of the biggest results seen from the reforms was the push for an increase of female medical students [1].
The idea of “cultural competence” was advocated and pushed to be incorporated in the curriculum in order to educate our future doctors about the health disparities that are prevalent in our society. The idea that not every patient in front of you is the same regardless of similar diseases was an important perspective to incorporate to medicine. The goal was to not just train medical professionals to have an immense knowledge of innovative science and technology, but to also have a sense of cultural attachment necessary to consider the variety of backgrounds patients come from [2]. Medical anthropologists, however, have criticized the method our medical schools have attempted to introduce sociocultural contexts to their curriculum. What is the most effective way of incorporating culture and science as a whole? In many cases, the preferred teaching method becomes a “list of traits” that is handed to the doctors to teach them about different cultures and how each patient can be categorized to fit these certain “traits” [2].
Contemporary curriculums about cultural competence that are taught in the medical classroom have begun to re-examine these methods and is trying to come up with new aims to allow for a holistic approach. The new system has been shown to provide an education that promotes “open-minded” health providers that are well receptive to the various cultures, even with those they may not have studied about, rather than categorizing a patient to a certain cultural group [2]. This facilitates the idea that the treatment methods and health disparities that may arise are solved with greater efforts of a holistic approach to medicine itself.
Many medical anthropologists have been able to introduce other methods that go beyond just a class about culture, and have introduced programs that medical students can enroll in to practice these ideas in a clinical setting. Dr. Angela Jenks, a medical anthropologist at University of California, Irvine has a research interest in determining effective methods of bringing cultural competence to the medical setting. Since her undergraduate years, she has been interested in studying health disparities and how different societal factors affect different groups to become vulnerable to such inequalities. During her grad school, one of the research projects she participated in took place at a general hospital with an ethnically specialized psychiatric unit. The idea of segregated care being brought back again during the 21st century was interesting, especially when historically this method was a deep form of racism, yet that was not the case this time. In this hospital, this was more about how to get better health care for these different groups, and their argument was they could for more targeted care if they were to separate the groups out ethnically. The goal was to achieve better healthcare for these different groups of individuals. “This expanded to a bigger project on cultural competence and how it is that medicine itself was trying to respond to these health disparities,” Dr. Jenks explained, “The way cultural competence was implemented was still very problematic. There are issues in simply providing segregated care or when it’s too overly simplistic such as handing a list of a certain group of patients to a doctor and what you need to know about them.” There’s been a move away from this simple way of having a “list of traits” and moving more towards a complex way of understanding how culture can make patients differ from one another and how this can affect the way the treatment processes are individualized.
In the beginning of her research, Dr. Jenks would find that the way cultural competence was taught in medical schools was basically reduced to an hour long class talking simply about culture, and then focusing back to the sciences behind medicine. This simple class on culture slowly progressed as more efforts were done to instill the importance of culture in medicine. There is a special program called PRIME-LC (Program in Medical Education for the Latino Community) that students applying to medical school at UC Irvine can also apply to. This program traces the students’ time in medical school, and the special cohort of students take part in different types of clinical projects that teach them about cultural competence focusing primarily in the Latino community. The program shows that this can’t be done over an hour long class about Latino patients, but rather a lot of time needs to be spent in the clinical settings learning from physicians who work with these communities. Many of the concepts taught in the program are medically related, but other topics discussed are about Latin America and the history of immigration to Southern California and how such external factors can form the person a doctor sees in front of him as a patient. “Doctors can advocate for their patients. This isn’t just an issue of better treatment of when the patient is in front of you, but to also voice out the issues in our health care system that affect these groups of people. Doctors can advocate for health care reform or political changes that can change the health of their patients,” Dr. Jenks said, “It matters about what doctors say, and the authority they hold can make a difference in helping improve the health care of our society.”
References:
1. Holmes, S.M., Jenks, A., Stonington, S. 2011 “Clinical Subjectivation: Anthropologies of Contemporary Biomedical Training.” Culture, Medicine, and Psychiatry. 35:105-112
2. Jenks, A. 2011. “From ‘Lists of Traits’ to ‘Open-Mindedness’: Emerging Issues in Cultural CompetenceEducation.” Culture, Medicine, Psychiatry. 35:209