1. Cultural Competency 2 Lisa Z. Killinger, DC Palmer College: Year 3 Palmer Center for Chiropractic Research

2. Working together to develop “cultural competency”...

3. The “Evolution” of Healthcare n 2000 BC-Here, eat this root n 1000 AD-That root is heathen, say this prayer n 1850 AD-That prayer is superstition, drink this potion n 1940 AD-The potion is snake oil, swallow this pill n 1975 AD-That pill is harmful, take this antibiotic n 2000 AD-That antibiotic is no longer effective, here, eat this root.

4. When we improve cultural competency, we... n “Reach” students more effectively n Enhance the quality of the doctor/patient or student/educator interaction n Improve student/patient compliance n Achieve better educational and health outcomes!! n Enrich ourselves...

5. Our society’s growing age and diversity is not a problem (& it’s certainly not going away!) It’s an opportunity for us all to gain from each other’s cultural wealth.

6. So…. how does diversity affect us here at Palmer, and how do WE become more “culturally competent”?

7. Developing Cultural Competency in Yourself: n Turn pre-conceived notions into questions n Use or develop empathy n Tread lightly, and if you don’t know, ask n Express respect for the patient’s values/culture/faith n Become familiar with your own attitudes about cultures/faiths. Do you stress assimilation or value maintenance of patient’s/students cultural traditions?

8. Keys to Cultural Competency n Fight your fear of the unknown n Learn about someone different n Don’t let time pressures rob you of patience and tolerance n Ask questions, and LISTEN! n Recognize that ‘different’ does not equal inferior. n Let your heart lead; (Your head just wouldn’t understand!)

9. To gain information about a patient’s health beliefs, ask : n What do you think caused your problem? n Why do you think it started when it did? n How severe do you think it is? n What are the main problems this has caused for you? n What kind of care do YOU think you should receive? n What results do you hope to receive?

10. Remember to refer to “Cultural Clues” in the clinical setting... n Body language (examples, anyone?) n Eye contact n Voice tone and vocal-ness n Facial expressions n Modesty RESPECT THE HEALTH VALUES OF OTHERS!

11. Hispanic Culture- ‘Familisimo’ n Family over individual n Respect for hierarchy n Belief in spirits, and the evil eye n Includes family in health decisions n Patient may expect Dr. to wear a white coat, (and to perform miracles!) n Provider, while respecting beliefs, may need to stress the importance of adhering to care plan

12. CASE: We know that Arab, Asian, or Indo-Pakistani students (and others) may show respect by lowering their gaze (not making eye contact). Such behavior does not reflect a lack of interest or respect. So…how do we instruct our students to respectfully care for patients with such values?

13. Case: An 70 year old African American patient may make great use of facial expressions to show approval/disapproval, and you observe them becoming quite animated, raising their eyebrows and giving a look of “what ever!” during the patient education video. So…how do you instruct the student doctor to proceed with this patient?

14. Case: A 75 year old European female requests Diversified care for her thoracic spine complaint. Her x-rays show moderate osteoporosis. Q: What lifestyle recommendations are appropriate to improve patient’s bone density. What technique considerations must be made?

15. CASE: An elderly woman or practicing Muslim female patient may not wish to be cared for by a male student doctor, and may not be willing to uncover her hair, arms, legs or torso due to the value placed on modesty. So…what do you do as the clinician? How do you instruct your student to proceed with chiropractic assessment and care?

16. WARNING!!! n Since every patient (of any ethnicity or faith) is an individual, NEVER assume anything about their beliefs. (ASK!) n Remember all minority persons are BI- Cultural (at least!). They have to integrate 2+ value systems every day! n Identify strengths in your patient’s cultural orientation, age, or social status and build on them.

17. Remember that “diversity” is not all about Color….. n Patient age n Income level n Education level n Gender n Sexual orientation n Religion n Etc. (Most are factors we can’t even SEE!)

18. “The best risk management tool a chiropractor can have is good communication with the patient!” Director of Claims: National Chiropractic Mutual Insurance Company (NCMIC)

19. Thank You! Culturally Competent